Devinder Kaur Ajit Singh

Participating in a virtual reality balance exercise program can reduce risk and fear of falls

OBJECTIVE The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women. METHODS Thirty six community dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA. RESULTS Both VRBG and conventional balance exercise groups had significant decrease in PPA (p<0.001) and ABC-6 (p<0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA (p=0.18) and ABC-6 (p=0.25) post intervention. Time and group interaction effect were not significant for PPA (p=0.18) and ABC-6 (p=0.45). CONCLUSIONS Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women.

Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions

Purpose The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions. Methods Forty-seven older adults (26 males, 21 females) aged ≥60 (69.23±8.63) years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test), biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels), and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered. Results The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL), and 21.7% were at risk of protein energy malnutrition with prealbumin level (100–170 mg/L). A significant correlation (P<0.05) was demonstrated between hand grip strength and ferritin, between self-reported mobility dependence and prealbumin levels, and between self-reported mobility tiredness and body mass index. Conclusion These results confirm that older adults with undernutrition have poor physical function, higher falls risk, and depression. Clinically, overall health that includes nutritional status, physical function, and depression level should be taken into consideration in the assessment and treatment of older adults residing at residential institutions.

Effects of balance-focused interactive games compared to therapeutic balance classes for older women

ABSTRACT Objective The prospective pre–post control study was designed to evaluate the effect of introducing balance-focused interactive virtual-reality games to community-dwelling older women to improve their agility, balance and functional mobility. Method The study was set in a senior citizens’ club in Cheras, Kuala Lumpur, Malaysia. The participants were 36 community-dwelling older women. Participants were randomly divided into either a group undertaking balance-focused virtual-reality games or a group doing therapeutic balance exercises. The program lasted 6 weeks and was conducted twice a week for 40 min during each session. As the main outcome measures, the results of the Ten Step Test (TST), postural sway (overall performance index, OPI) and the Timed Up and Go test (TUG) were measured pre- and post-intervention to evaluate agility, balance and functional mobility, respectively. Results Although both groups improved in OPI (F = 4.63, p < 0.001), TST (F = 46.15, p < 0.001) and TUG (F = 52.57, p = 0.03), combined time and group interaction only improved in the TUG (F = 4.54, p < 0.05). No significant differences between the two groups were found in terms of TST (F = 0.02, p = 0.86), OPI (F = 0.66, p = 0.42), and TUG (F = 0.11, p = 0.74). Conclusion Older people could improve their agility, balance and functional mobility by complementing therapeutic balance exercises with active participation in interactive virtual-reality games at home or in the community.

Ageing modifies the fibre angle and biomechanical function of the lumbar extensor muscles.

BACKGROUND Ageing is associated with geometrical changes in muscle fascicles that may lead to deteriorations in physical functions. The purpose of this study was to study the effects of ageing on fibre orientation and strength of the lumbar extensor muscles. METHODS Fifty two healthy, 26 younger (10 males and 16 females, aged from 20 to 35) and 26 older (10 males and 16 females, aged from 65 to 90) volunteers participated in this study. Ultrasound images of the lumbar extensor muscles were obtained with the participants in relaxed standing and half flexion (50% of the range of trunk flexion). The fibre angles at the mid-substance of the muscle were recorded. Lumbar extensor muscle strength was measured in the upright posture with a load cell. FINDINGS The mean lumbar extensor fibre angles were found to significantly decrease in the half flexion posture when compared to upright stance (P<0.01). Both the fibre angle and the moment generation capability of the muscles decreased with ageing (P<0.01). There was a moderate correlation between the fibre angles in the upright posture and the muscle strength measured in this posture (r=0.40, P<0.01). INTERPRETATION Age-related changes in muscle geometry and posture may partly account for the deterioration in muscle function in the elderly.

Biplanar Measurement of Thoracolumbar Curvature in Older Adults Using an Electromagnetic Tracking Device

UNLABELLED Singh DK, Bailey M, Lee R. Biplanar measurement of thoracolumbar curvature in older adults using an electromagnetic tracking device. OBJECTIVES To develop a new biplanar method of thoracolumbar curvature measurement by using an electromagnetic tracking device and to study the effects of aging on the thoracolumbar curvature. DESIGN Cross-sectional study. SETTING Human movement laboratory. PARTICIPANTS Healthy (N=52, 26 younger and 26 older) volunteers. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An electromagnetic tracking device was used to trace the thoracolumbar curvature by recording the positions of the spinous processes of the spine. The coordinates of the curvature were fitted with polynomial equations, and the magnitudes of thoracic kyphosis, lumbar lordosis, and lateral thoracic and lumbar curves were determined. RESULTS The present technique was shown to be highly reliable in measuring thoracolumbar curvature with an intraclass correlation coefficient of more than .90. The mean thoracic kyphosis (-46.95 degrees +/-11.41 degrees ) in the older adults was significantly larger than that in the younger adults (-38.82 degrees +/-9.86 degrees ) (P<.01). However, there were no significant differences in lumbar lordosis and lateral curvatures between the 2 subject groups. CONCLUSIONS The present study provided evidence of an increase in thoracic kyphosis in older adults. The method of measurement presented in this study was found to provide reliable biplanar data that will be useful in a clinical setting.

Exploring views on long term rehabilitation for people with stroke in a developing country: findings from focus group discussions

BackgroundThe importance of long term rehabilitation for people with stroke is increasingly evident, yet it is not known whether such services can be materialised in countries with limited community resources. In this study, we explored the perception of rehabilitation professionals and people with stroke towards long term stroke rehabilitation services and potential approaches to enable provision of these services. Views from providers and users are important in ensuring whatever strategies developed for long term stroke rehabilitations are feasible and acceptable.MethodsFocus group discussions were conducted involving 15 rehabilitation professionals and eight long term stroke survivors. All recorded conversations were transcribed verbatim and analysed using the principles of qualitative research.ResultsBoth groups agreed that people with stroke may benefit from more rehabilitation compared to the amount of rehabilitation services presently provided. Views regarding the unavailability of long term rehabilitation services due to multi-factorial barriers were recognised. The groups also highlighted the urgent need for the establishment of community-based stroke rehabilitation centres. Family-assisted home therapy was viewed as a potential approach to continued rehabilitation for long term stroke survivors, given careful planning to overcome several family-related issues.ConclusionsBarriers to the provision of long term stroke rehabilitation services are multi-factorial. Establishment of community-based stroke rehabilitation centres and training family members to conduct home-based therapy are two potential strategies to enable the continuation of rehabilitation for long term stroke survivors.

Association between physiological falls risk and physical performance tests among community-dwelling older adults

Background Physical performance and balance declines with aging and may lead to increased risk of falls. Physical performance tests may be useful for initial fall-risk screening test among community-dwelling older adults. Physiological profile assessment (PPA), a composite falls risk assessment tool is reported to have 75% accuracy to screen for physiological falls risk. PPA correlates with Timed Up and Go (TUG) test. However, the association between many other commonly used physical performance tests and PPA is not known. The aim of the present study was to examine the association between physiological falls risk measured using PPA and a battery of physical performance tests. Methods One hundred and forty older adults from a senior citizens club in Kuala Lumpur, Malaysia (94 females, 46 males), aged 60 years and above (65.77±4.61), participated in this cross-sectional study. Participants were screened for falls risk using PPA. A battery of physical performance tests that include ten-step test (TST), short physical performance battery (SPPB), functional reach test (FRT), static balance test (SBT), TUG, dominant hand-grip strength (DHGS), and gait speed test (GST) were also performed. Spearman’s rank correlation and binomial logistic regression were performed to examine the significantly associated independent variables (physical performance tests) with falls risk (dependent variable). Results Approximately 13% older adults were at high risk of falls categorized using PPA. Significant differences (P<0.05) were demonstrated for age, TST, SPPB, FRT, SBT, TUG between high and low falls risk group. A significant (P<0.01) weak correlation was found between PPA and TST (r=0.25), TUG (r=0.27), SBT (r=0.23), SPPB (r=−0.33), and FRT (r=−0.23). Binary logistic regression results demonstrated that SBT measuring postural sways objectively using a balance board was the only significant predictor of physiological falls risk (P<0.05, odds ratio of 2.12). Conclusion The reference values of physical performance tests in our study may be used as a guide for initial falls screening to categorize high and low physiological falls risk among community-dwelling older adults. A more comprehensive assessment of falls risk can be performed thereafter for more specific intervention of underlying impairments.

Strength and fatigue of lumbar extensor muscles in older adults

Introduction: Loss of lumbar extensor muscle strength and fatigue resistance may contribute to functional disability. Methods: Two groups of subjects were recruited: young (n = 26, 20–35 years of age) and old (n = 26, ≥65 years of age) adults. Lumbar extensor muscle strength was measured with a load cell, and electromyographic activities were recorded to study muscle fatigue at 60% of maximum voluntary contraction. Results: We found that the muscle moments generated by the extensor muscles decreased with age (P < 0.05). Aging was associated with a significant increase in the power of the lower frequency band (101–200 Hz) of the electromyographic signals (P < 0.05), but the spectral characteristics did not appear to change with sustained contraction (P > 0.05). Conclusions: The changes in strength and spectral properties of the electromyographic signals of lumbar extensor muscles may be related to age‐related alterations in muscle fiber composition and recruitment. These changes should be considered in clinical functional task evaluation. Muscle Nerve 44: 74–79, 2011

Efficacy of L-carnitine supplementation on frailty status and its biomarkers, nutritional status, and physical and cognitive function among prefrail older adults: a double-blind, randomized, placebo-controlled clinical trial

Background Frailty is a biological syndrome of decreased reserve and resistance to stressors due to decline in multiple physiological systems. Amino acid deficiency, including L-carnitine, has been proposed to be associated with its pathophysiology. Nevertheless, the efficacy of L-carnitine supplementation on frailty status has not been documented. Thus, this study aimed to determine the effect of 10-week L-carnitine supplement (1.5 g/day) on frailty status and its biomarkers and also physical function, cognition, and nutritional status among prefrail older adults in Klang Valley, Malaysia. Methodology This study is a randomized, double-blind, placebo-controlled clinical trial conducted among 50 prefrail subjects randomized into two groups (26 in L-carnitine group and 24 in placebo group). Outcome measures include frailty status using Fried criteria and Frailty Index accumulation of deficit, selected frailty biomarkers (interleukin-6, tumor necrosis factor-alpha, and insulin-like growth factor-1), physical function, cognitive function, nutritional status and biochemical profile. Results The results indicated that the mean scores of Frailty Index score and hand grip test were significantly improved in subjects supplemented with L-carnitine (P<0.05 for both parameters) as compared to no change in the placebo group. Based on Fried criteria, four subjects (three from the L-carnitine group and one from the control group) transited from prefrail status to robust after the intervention. Conclusion L-carnitine supplementation has a favorable effect on the functional status and fatigue in prefrail older adults.

Relationship between physical performance and cognitive performance measures among community-dwelling older adults

Purpose Cognitive impairment is correlated with physical function. However, the results in the literature are inconsistent with cognitive and physical performance measures. Thus, the aim of this study was to determine the association between cognitive performance and physical function among older adults. Methods A total of 164 older adults aged ≥60 years and residing in low-cost housing areas in Kuala Lumpur, Malaysia participated in this study. Cognitive performance was measured using the Mini Mental State Examination, clock drawing test, Rey auditory verbal learning test, digit symbol test, digit span test, matrix reasoning test, and block design test. Physical performance measures were assessed using the ten step test for agility, short physical performance battery test for an overall physical function, static balance test using a Pro.Balance board, and dynamic balance using the functional reach test. Results There was a negative and significant correlation between agility and the digit symbol test (r=−0.355), clock drawing test (r=−0.441), matrix reasoning test (r=−0.315), and block design test (r=−0.045). A significant positive correlation was found between dynamic balance, digit symbol test (r=0.301), and matrix reasoning test (r=0.251). The agility test appeared as a significant (R2=0.183, R2=0.407, R2=0.299, P<0.05) predictor of some cognitive performance measures, including the digit span test, clock drawing test, and Mini Mental State Examination. Conclusion These results suggest that a decline in most cognitive performance measures can be predicted by poor execution of a more demanding physical performance measure such as the ten step test for agility. It is imperative to use a more complex and cognitively demanding physical performance measure to identify the presence of an overall cognitive impairment among community-dwelling older adults. It may also be beneficial to promote more complex and cognitively challenging exercises and activities among older adults for optimal physical and cognitive function.