[How to take care of exercise needs of nursing home residents?].
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Activities of Daily Living↗
Biomedical subjects
Jorunn L Helbostad
Publications and source records attributed to Jorunn L Helbostad.
Modulation of gait during visual adaptation to dark.
The authors investigated the modulation of gait during dark adaptation. Twenty-five women (mean age = 72 years, SD = 5 years) walked back and forth on an arbitrarily uneven walkway during normal lighting at speeds ranging from slow to fast. Participants then performed 20 trials at preferred speed after sudden reduction of lighting; the authors compared those trials with point estimates at equivalent speeds representing normal lighting. The authors estimated speed, cadence, mediolateral trunk acceleration, and mediolateral interstep trunk-acceleration variability for each trial. Participants compensated for sudden reduction of lighting by reducing their walking speed. Compared with performance at equivalent speeds during normal lighting, cadence, trunk acceleration, and interstep trunk-acceleration variability initially increased. All variables showed an asymptotic approximation toward normal values during 60-90 s of walking in subdued lighting. The authors suggest that the sudden transition from normal to marginal lighting, rather than marginal lighting itself, may challenge locomotor control.
Adaptation, Ocular↗
[Physical training for nursing home residents--has it any effect?].
BACKGROUND: The paper presents documentation of the effect of physical training for nursing home residents. MATERIAL AND METHODS: Literature study based on review articles and exercise trials in nursing home populations. RESULTS AND INTERPRETATION: The relatively few studies available indicate that physical training in a nursing home setting could be carried out. One study, reporting the effect of a fourfold increase in physiotherapy and occupational therapy, found positive effects on physical functioning and nursing costs. Furthermore, training is reported to improve aspects of physical functioning, like muscle strength and mobility. Several studies report effect on incontinence of low-dose physical exercises combined with scheduled toilet training. No study reports effect of physical training alone on the incidence of falls among nursing home residents. Nevertheless, physical training seems to improve physical fitness and functioning, cognition and behaviour. It is suggested that physical training for nursing home residents is carried out routinely in order to maintain physical functioning. Important aspects of such training are muscle strength, balance, coordination, endurance and flexibility. However, the most crucial type of training is active participation in the activities of daily life in order to prevent loss of independence.
Accidental Falls↗
Interstride trunk acceleration variability but not step width variability can differentiate between fit and frail older adults.
Variability of gait may be regarded as a sign of adaptability and thus a requirement for successful locomotion, or as a sign of impaired balance control. In this study we examined the role of step width variability (SWV) and interstride trunk acceleration variability in two groups of fit and frail old people. We investigated the association of these measures and how they differentiated the two groups. We examined 33 fit older adults (mean age 73 years, S.D. 3.3 years) and 32 frail old people (mean age 80 years, S.D. 4.0 years). Subjects performed timed walking at different speeds ranging from very slow to very fast. SWV was measured from footprints. Trunk accelerations were registered by a triaxial accelerometer and interstride trunk acceleration variability assessed by an unbiased autocorrelation procedure. All measures were normalized to a walking speed of 0.9 m/s to avoid the confounding effect of gait speed on speed dependent gait parameters. SWV demonstrated low association with the trunk variability measures, and did not differ between groups. The frail group had lower mediolateral (P=0.015), but higher vertical (P=0.015) and anteroposterior (P<0.02) trunk variability than the fit group. Trunk variability classified 80% of the subjects correctly into their respective group (sensitivity=0.75, specificity=0.85). The findings are compatible with a notion that mediolateral interstride trunk variability represents a different aspect of motor control than variability in the direction of propulsion.
Acceleration↗
Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study.
BACKGROUND AND AIMS: Exercise in older people may reduce falls and improve functional abilities. Less is known about the optimal amount of training. The aim of this study was to determine the effectiveness of home training, and whether group training in addition to home training enhances the effect. METHODS: This randomized trial included 77 persons aged 75 years and older (mean 81, SD 4.5), living at home. Home training (HT) comprised twice-daily functional balance and strength exercises and 3 group meetings. Combined training (CT) included group training twice weekly and the same home exercises. The trial lasted 12 weeks. Physical therapists ran both programs. Exercises and falls were recorded daily. We assessed function at baseline, 3 and 9 months, and falls at one year. RESULTS: Mean participation for group meetings was 2.5 out of 3 (HT group) and, for group training sessions, 21 out of 24 (CT group). The mean numbers of daily home sessions were 1.29 and 1.35 in the HT and CT groups. Overall improvement, but no group differences, were found at 3 months for walking speed, Figure of Eight, Timed Up & Go, Maximum Step Length, Timed Pick-up and Sit-to-stand (p<0.02). Posturography (p=0.85) and isometric quadriceps strength (p=0.26) showed no improvement. Function at 9 months was equivalent to baseline level. There were no group differences in fall rate (p=0.78) or time to first fall (p=0.84). CONCLUSIONS: Daily home training supervised by physical therapists improved functional abilities. Supplementary individualized group training gave no additional effect. The effect on function was not present 6 months after the end of the intervention.
Accidental Falls↗
Short-term repeatability of body sway during quiet standing in people with hemiparesis and in frail older adults.
OBJECTIVE: To investigate short-term repeatability of a posturographic quiet standing test protocol in people with hemiparesis and in frail older adults. DESIGN: Test-retest design, using 5 different quiet standing task conditions in which size and compliance of the support surface, visual influence, and cognitive demands were manipulated. Retest was performed after 15 minutes. SETTING: Rehabilitation units and day care center. PARTICIPANTS: Twenty-three people with stroke (mean age, 74.4y) and 16 frail older adults (mean age, 82.1y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Repeatability of trunk acceleration root mean square by within-subject standard deviation, coefficient of variation, and intraclass correlation coefficients (ICCs). RESULTS: The ICC(1,2) ranged from.13 to.75 for people with hemiparesis and from.73 to.92 for frail older adults when tested with their eyes open. The least demanding task condition gave the best repeatability. Standing with eyes closed resulted in very low ICC(1,2) in people with hemiparesis (.16) and in frail older adults (-.18). Interpretation of the results was similar for the other 2 reliability measures. CONCLUSIONS: A mean of 2 repeated measures gave adequate repeatability for frail older adults but not for people with stroke when they were tested with their eyes open. This study showed the importance of establishing short-term repeatability relative to each clinical population in which such tests are used.
Aged↗
Estimation of gait cycle characteristics by trunk accelerometry.
This study reports on the novel use of a portable system to measure gait cycle parameters. Measurements were made by a triaxial accelerometer over the lower trunk during timed walking over a range of self-administered speeds. Signals from each trial were transformed to a horizontal-vertical coordinate system and analyzed by an unbiased autocorrelation procedure to obtain cadence, step length, and measures of gait regularity and symmetry. By curvilinear interpolation, speed-dependent gait parameters could be compared at a normalized speed. It was demonstrated that analysis of gait cycle parameters which previously required fixed laboratory equipment and paced walking procedures, now can be made from data obtained by a timing device and a portable sensor at free walking speeds.
Abdomen↗
Home training with and without additional group training in physically frail old people living at home: effect on health-related quality of life and ambulation.
OBJECTIVE: To test the effect of two exercise regimes on health-related quality of life (HRQoL) and ambulatory capacity. DESIGN: Randomized controlled trial. SUBJECTS: Seventy-seven community-dwelling physically frail people over 75 years of age (mean = 81, SD = 4.5). INTERVENTIONS: Home training (HT, N= 38) comprised twice daily functional balance and strength exercises and three group meetings. Combined training (CT, N= 39) included group training twice weekly and the same home exercises. Interventions lasted 12 weeks. Physiotherapists ran both programmes. Home exercises were recorded daily. MAIN MEASURES: HRQoL was assessed by SF-36, and ambulatory capacity by walking speed and frequency and duration of outdoor walks. RESULTS: Following intervention, CT improved the SF-36 mental health index significantly more than HT (p = 0.01). The SF-36 physical health index (p = 0.002) and walking speed (p = 0.02) demonstrated improvements, but no group differences. Six months after cessation of intervention there was still overall improvements on the mental health index (p = 0.032), borderline overall improvements on the physical health index (p = 0.057), higher weekly number of outdoor walks for the CT group than for the HT group (p = 0.027) and an improved habitual walking speed in the CT group only (p = 0.022). CONCLUSIONS: HT improved HRQoL and walking speed, but additional group training gave larger benefits on mental health. Group training away from home may be beneficial for mental health and ambulatory capacity.
Activities of Daily Living↗
Balance and gait in children with dyslexia.
Tests of postural stability have provided some evidence of a link between deficits in gross motor skills and developmental dyslexia. The ordinal-level scales used previously, however, have limited measurement sensitivity, and no studies have investigated motor performance during walking in participants with dyslexia. The purpose of this study was to investigate if continuous-scaled measures of standing balance and gait could discriminate between groups of impaired and normal readers when investigators were blind to group membership during testing. Children with dyslexia ( n=22) and controls ( n=18), aged 10-12 years, performed walking tests at four different speeds (slow-preferred-fast-very fast) on an even and an uneven surface, and tests of unperturbed and perturbed body sway during standing. Body movements were registered by a triaxial accelerometer over the lower trunk, and measures of reaction time, body sway, walking speed, step length and cadence were calculated. Results were controlled for gender differences. Tests of standing balance with eyes closed did not discriminate between groups. All unperturbed standing tests with eyes open showed significant group differences ( P<0.05) and classified correctly 70-77.5% of the subjects into their respective groups. Mean walking speed during very fast walking on both flat and uneven surface was > or =0.2 m/s ( P< or =0.01) faster for controls than for the group with dyslexia. This test classified 77.5% and 85% of the subjects correctly on flat and uneven surface, respectively. Cadence at preferred or very fast speed did not differ statistically between groups, but revealed significant group differences when all subjects were compared at a normalised walking speed ( P< or =0.04). Very fast walking speed as well as cadence at a normalised speed discriminated better between groups when subjects were walking on an uneven surface compared to a flat floor. Continuous-scaled walking tests performed in field settings may be suitable for motor skill assessment as a component of a screening tool for developmental dyslexia.
Child↗
Treadmill training and/or body weight support may not improve walking ability following stroke.
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Journal Article↗
The effect of gait speed on lateral balance control during walking in healthy elderly.
The aim of this paper was to investigate the effect of speed dependency on lateral gait parameters. In 36 healthy elderly (mean age=72.5 years, S.D.=3.2 years), walking at four different self-administered speeds, mediolateral trunk acceleration and step width (SW), but not step-width variability (SWV), were found to have quadratic relations to gait speed. Normalizing for speed by curvilinear interpolation, and controlling for subject characteristics, disclosed smaller SW (adjusted R2=0.41, P<0.001), but larger SWV (adjusted R2=0.26, P=0.01) with increasing age in multiple regression models. These relations were camouflaged at preferred speed.
Acceleration↗
Trunk accelerometry as a measure of balance control during quiet standing.
The goal was to investigate whether body sway measured by trunk accelerometry during quiet standing could differentiate between young and elderly healthy subjects, and between conditions with eyes open and closed on firm and compliant surfaces. Raw data demonstrated poor discrimination, but horizontal transformation to eliminate a constant gravity component disclosed consistent mean differences across groups (P < or = 0.0025), and also between conditions (P < or = 0.0005), except for the most marginal difference. When drift associated with very low frequency body sway was adjusted for, a significant difference appeared also here (P = 0.001). This study indicates that trunk accelerometry can discriminate between populations and conditions during quiet standing.
Acceleration↗