Gerhild Ullmann

Effects of Feldenkrais Exercises on Balance, Mobility, Balance Confidence, and Gait Performance in Community-Dwelling Adults Age 65 and Older

BACKGROUND Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls. OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults. METHODS Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted. RESULTS After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067). CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.

The relationships among gait and mobility under single and dual task conditions in community-dwelling older adults

Aims: The purpose of this study was to examine relationships among gait and mobility under single and dual task conditions in older adults. Methods: Community-dwelling older adults (n=41, mean age=75) completed mobility and gait tasks. Mobility was assessed with the Timed-Up-and-Go (TUG). Select gait parameters were examined while individuals walked at their preferred speed across the GAITRite electronic walkway. Two age groups were studied (younger age group=65–75; older age group=76+). Multiple linear regression analyses were used to examine the relationship between gait and mobility under single vs dual conditions. Results: Older adults required more time to complete the TUG when concurrently performing a second cognitive task (10.84 sec vs 15.77 sec). In addition, one or more gait characteristic such as stride length, cadence and stance explained (a) a high percentage of variance in mobility performance under single task conditions (TUG 74%) and (b) a smaller portion of variance in mobility performance under dual task conditions (TUGc 25%). No salient age group differences were observed in TUG performance, but gait characteristics accounted for a larger portion of variance in TUGc performance (46%) for the older age group (mean age=81) than for the younger age group (mean age=69; TUGc 18%).

Memphis FitKids: implementing a mobile-friendly web-based application to enhance parents’ participation in improving child health

BackgroundChild obesity is a major public health challenge, increasing the risk of chronic medical conditions such as type 2 diabetes, metabolic syndrome, and hypertension. Among U.S. states, Tennessee has one of the highest rates of child obesity. Emerging communication technologies can help to deliver highly disseminable population-level interventions to improve health behavior. The aim of this paper is to report the implementation and the evaluation of the reach of Memphis FitKids, a web-based application, intended to promote healthy behaviors for families and children.MethodsA community-level demonstration project, Memphis FitKids, was developed and implemented in Tennessee’s Greater Memphis Area. This application (www.memphisfitkids.org) was designed for parents to assess their children’s obesity risk through determinants such as weight, diet, physical activity, screen time, and sleep adequacy. A built-in “FitCheck” tool used this collected information to create a report with tailored recommendations on how to make healthy changes. A Geographic Information Systems component was implemented to suggest low-cost neighborhood resources that support a healthy lifestyle. A social marketing framework was used to develop and implement FitKids, and a Community Advisory Board with representatives from community partners (e.g., the YMCA of Memphis, the Pink Palace Family of Museums, and the Memphis Public Library) supported the implementation of the project. Five kiosks distributed in the community served as public access points to provide a broad reach across socioeconomic strata. Presentations at community events and the use of Facebook facilitated the promotion of FitKids. Website traffic and Facebook usage were evaluated with Google Analytics and Facebook Insights, respectively.ResultsIn Tennessee, 33,505 users completed 38,429 FitCheck sessions between July 2014 and December 2016. Among these, 6763 sessions were completed at the five kiosks in the community. FitKids was presented at 112 community events and the social media posts reached 23,767 unique Facebook users.ConclusionsThe Memphis FitKids demonstration project showed that web-based health tools may be a viable strategy to increase access to information about healthy weight and lifestyle options for families. Mobile-friendly web-based applications like Memphis FitKids may also serve health professionals in their efforts to support their clients in adopting healthy behaviors.

Functional Status Assessment for Community Long-Term Care: Preliminary Observations

The Community Long-Term Care (CLTC) program in South Carolina offers services to nursing home eligible persons that allow them to remain at home and receive help with activities of daily living. Variation in the ways potential clients are evaluated often produces inconsistent eligibility determinations. We developed a simple, objective assessment tool to complement CLTC evaluations. A conceptual framework, based on Nagis model of disablement, was tested on community-dwelling healthy older adults and CLTC clients. Three simple physiologic tasks assessing mobility, functional leg strength, and manual dexterity discriminated between community-dwelling older adults and CLTC clients, classifying them with 80% to 90% accuracy.

The Feldenkrais Method® can enhance cognitive function in independent living older adults: A case-series

Poor cognitive health a major concern of aging individuals, can compromise independent living. More than 16 million people in the United States are affected by cognitive impairment. We have studied the effects of the Feldenkrais Method(®) on cognitive function. In this case series with three participants cognitive function was assessed with the Trail Making Test A and B at baseline and after the Feldenkrais intervention. All participants improved performance on Trail Making Test A and B after completing the Feldenkrais intervention indicating that Feldenkrais lessons may offset age-related decline in cognitive function. The results of this case series warrant larger scale studies on cognitive outcomes of Feldenkrais interventions in clinical and non-clinical populations.

Effect of Feldenkrais exercises on dual task postural control in older adults

Dear editor Agmon et al1 recently published an interesting systematic review of interventions to improve dual-task postural control in older adults. Given that many everyday activities (eg, walking and carrying groceries) require dual-task postural control, this is an important topic. This type of research is integral to expanding scientific knowledge in the field of interventions. The authors describe the methods of the review process clearly. However, in our opinion, adherence to the stated methods is not always evident. First, in the abstract, the authors claim to select randomized and nonrandomized controlled studies. In contrast with the stated study selection, Table 1 shows that not all of the 22 studies included are in compliance with these design requirements; several uncontrolled studies were examined, including an earlier uncontrolled study by the authors. Second, at least one randomized controlled trial that fulfills the selection and inclusion criteria has not been considered in the review. Our randomized controlled trial examined the effects of a Feldenkrais intervention on balance, gait, and single-task and dual-task mobility.2 This study can be found in electronic databases with several of the mentioned search terms. Our research met all inclusion and selection criteria: participants were healthy, community-dwelling older adults aged 65 years and older; the intervention was conducted in a clinical setting; the one-hour Feldenkrais sessions were held three times per week for 5 weeks; one of the outcome measures was mobility under dual-task conditions (in our Feldenkrais study we used the Timed Up and Go with an added cognitive [TUGc]3 task, and several studies included in Agmon’s review used the same TUGc measure for examining dual-task performance, see Table 4 of the systematic review1); the article was published in English; and the randomized controlled trial excluded participants with neurologic disorders. After completion of the Feldenkrais intervention, participants improved significantly on balance (P=0.030), mobility under single-task conditions (P=0.042), and showed positive changes in mobility under dual-task conditions (P=0.067).2 The authors of the review underline in their discussion the prominence of dual-task training for improving dual-task performance. However, an important outcome of our publication is that a broad spectrum of activities that are part of the Feldenkrais method can result in improvements in both single-task performances and dual-task performance. From our perspective, this is an important piece of the puzzle and should be noted if we want to design evidence-based interventions based on current scientific knowledge.