Hiroshi Ando

Comparing the effects of different individualized music interventions for elderly individuals with severe dementia

Background: Individuals with dementia often experience poor quality of life (QOL) due to behavioral and psychological symptoms of dementia (BPSD). Music therapy can reduce BPSD, but most studies have focused on patients with mild to moderate dementia. We hypothesized that music intervention would have beneficial effects compared with a no-music control condition, and that interactive music intervention would have stronger effects than passive music intervention. Methods: Thirty-nine individuals with severe Alzheimers disease were randomly and blindly assigned to two music intervention groups (passive or interactive) and a no-music Control group. Music intervention involved individualized music. Short-term effects were evaluated via emotional response and stress levels measured with the autonomic nerve index and the Faces Scale. Long-term effects were evaluated by BPSD changes using the Behavioral Pathology in Alzheimers Disease (BEHAVE-AD) Rating Scale. Results: Passive and interactive music interventions caused short-term parasympathetic dominance. Interactive intervention caused the greatest improvement in emotional state. Greater long-term reduction in BPSD was observed following interactive intervention, compared with passive music intervention and a no-music control condition. Conclusion: Music intervention can reduce stress in individuals with severe dementia, with interactive interventions exhibiting the strongest beneficial effects. Since interactive music intervention can restore residual cognitive and emotional function, this approach may be useful for aiding severe dementia patients’ relationships with others and improving QOL. The registration number of the trial and the name of the trial registry are UMIN000008801 and “Examination of Effective Nursing Intervention for Music Therapy for Severe Dementia Elderly Person” respectively.

The harmonic ratio of trunk acceleration predicts falling among older people: results of a 1-year prospective study

BackgroundGait variables derived from trunk accelerometry may predict the risk of falls; however, their associations with falls are not fully understood. The purpose of the study was to determine which gait variables derived from upper and lower trunk accelerometry are associated with the incidence of falls, and to compare the discriminative ability of gait variables and physical performance.MethodsThis study was a 1-year prospective study. Older people (n = 73) walked normally while wearing accelerometers attached to the upper and lower trunk. Participants were classified as fallers (n = 16) or non-fallers (n = 57) based on the incidence of falls over 1 year. The harmonic ratio (HR) of the upper and lower trunk was measured. Physical performance was measured in five chair stands and in the timed up and go test.ResultsThe HR of the upper and lower trunk were consistently lower in fallers than non-fallers (P < 0.05). Upper trunk HR, was independently associated with the incidence of falls (P < 0.05) after adjusting for confounding factors including physical performances. Consequently, upper trunk HR showed high discrimination for the risk of falls (AUC = 0.81).ConclusionsHR derived from upper trunk accelerometry may predict the risk of falls, independently of physical performance. The discriminative ability of HR for the risk of falls may have some validity, and further studies are needed to confirm the clinical relevance of trunk HR.

Brain Atrophy and Trunk Stability During Dual-Task Walking Among Older Adults

BACKGROUNDnDual-task walking is believed to be more cognitively demanding than normal walking and alters trunk movement among older adults. However, the possible association between brain atrophy and spatiotemporal gait parameters, particularly during dual-task walking, is poorly understood. In this study, we examined the relationship between dual-task walking and brain atrophy.nnnMETHODSnOne hundred ten elderly adults (aged 65-94 years, women n = 55) underwent magnetic resonance imaging scanning and gait experiments under normal and dual-task walking conditions. Linear accelerations of the trunk were measured in vertical, anteroposterior, and mediolateral directions using a triaxial accelerometer attached to the lower trunk. Gait speed, stride length, and cadence were recorded. The harmonic ratio, a measure of trunk stability, was computed separately in each direction to evaluate the smoothness of trunk movement during walking. Brain atrophy was quantitatively assessed using magnetic resonance image data.nnnRESULTSnGait speed, stride length, cadence, and harmonic ratio in all directions were lower in dual-task walking than in normal walking (p < .05). The dual-task-related changes in harmonic ratio were independently correlated with brain atrophy adjusted for subject characteristics only in the vertical direction (p < .05).nnnCONCLUSIONSnOur findings support the hypothesis that dual-task walking is more cognitively demanding than normal walking. Decreased trunk stability during dual-task walking is associated with brain atrophy. Additional studies are necessary to elucidate the effects of regional brain atrophy on the control of walking.

Cultural adaptation and validating a Japanese version of the readiness for interprofessional learning scale (RIPLS)

Readiness for interprofessional education (IPE) can be an important factor to evaluate because of the influences of attitudes toward the outcomes of interprofessional learning activities. However, a dearth of Japanese evaluation tools hinders its evaluation. The readiness for interprofessional learning scale (RIPLS) was selected, because it has been validated in different countries and its items reflected our local situation best. This research aimed to develop and validate a Japanese version of the original 19-item RIPLS. We developed a Japanese RIPLS employing forward/backward translation. Reliability of the Japanese version was studied using classical test theory and structural equation modeling to construct a model to inform curriculum development. We obtained a 0.74 Cronbachs α, which indicates adequacy. Subscales of “interprofessional education opportunities” (α = 0.90) and “uniqueness of profession” (α = 0.60) have relatively little weight compared to “teamwork and collaboration” (α = 0.92). A one-way structure suggests that readiness for interprofessional learning starts with “teamwork & collaboration” followed by changes in “learning opportunities” and subsequently “uniqueness of profession” (root mean square error of approximation = 0.06, comparative fit index = 0.93). This Japanese RIPLS can be used in undergraduate health sciences students with appropriate caution. Further development of the subscales and a client-centered subscale would be beneficial to fully achieve its potential. The need for further research into its reliability and validity is identified. Recommendations are provided for cross-cultural adaptation and for establishing validity across different contexts.

Dual tasking affects lateral trunk control in healthy younger and older adults.

Assessing the effects of attention-demanding tasks on trunk movement provides useful insights into postural control while walking in an attention-split situation, such as occurs in daily life. The coefficient of attenuation of acceleration (CoA) at the trunk is a useful gait index to assess whole trunk movements. We investigated the effect of attention-demanding tasks on CoA to assess the role of attention on trunk control during walking. Thirty healthy, community-dwelling older adults (70.1±5.6 years) and 38 younger adults (22.1±3.4 years) participated in this study. Participants walked 20 m at a self-selected speed (slow, normal, fast) and while performing an attention-demanding cognitive task. Trunk acceleration was measured using triaxial accelerometers attached to the lower (L3 spinous process) and upper (C7 spinous process) trunk and used to compute CoA (the reduction in acceleration from the lower to upper trunk). Results showed that an attention-demanding task significantly decreased CoA in the medio-lateral (ML) direction in both age groups (p<0.001), whereas it did not affect CoA in the vertical (VT) and anterior-posterior (AP) directions. Our findings suggest that the priority of whole trunk control in the ML direction may be higher than in other directions and be strongly associated with attention, whereas whole trunk control in the VT and AP directions may be passively regulated and require minimal attentional control.

Dual-task costs for whole trunk movement during gait

The control of trunk movement plays an important role in stabilizing the head during gait. However, the effects of performing dual tasks on trunk movements during gait are unclear. We compared the effects of an arithmetic task and the colored Stroop test on trunk movement during gait in 34 healthy older adults. The participants walked 20 m normally, or while performing serial seven subtractions or the colored Stroop test. Trunk accelerations were measured using triaxial accelerometers attached to the lower and upper trunk and used to calculate trunk attenuation rate (TAR) as the reduction in acceleration from the lower to upper trunk. Both dual task conditions affected the TAR in the mediolateral and vertical directions (p<0.01), but not in the anteroposterior direction. In the mediolateral direction, the decrease in TAR was greater during the serial seven subtractions than during the Stroop test (p<0.01). In conclusion, dual task-related changes of whole trunk movement during gait, particularly in the mediolateral direction, are dependent on the type of additional task.

Effects of aerobic exercise on the circadian rhythm of heart rate and blood pressure.

Although the effects of aerobic exercise on resting heart rate, heart rate variability, and blood pressure have been investigated, there are scant data on the effects of aerobic exercise on the circadian rhythm of such cardiovascular parameters. In this study, we investigated the effects of aerobic exercise on the 24u2009h rhythm of heart rate and ambulatory blood pressure in the morning, when cardiovascular events are more common. Thirty-five healthy young subjects were randomized to control and aerobic exercise groups. Subjects in the latter group participated in their respective exercise program for two months, while those in the former group did not exercise. Twenty-four-hour electrocardiogram and ambulatory blood pressure monitoring data were obtained at baseline and at the end of the exercise intervention. The control group showed no changes, while the aerobic exercise group showed a significant decrease in heart rate (73.7u2009±u20096.6u2009bpm to 69.5u2009±u20095.1u2009bpm, pu2009<u20090.005) and sympathetic activity such as LF/HF ratio (2.0u2009±u20090.7 to 1.8u2009±u20090.6, pu2009<u20090.05) throughout the 24u2009h period, particularly in the daytime. The decrease in the heart rate was most prominent in the morning. However, heart rate and LF/HF ratio showed no statistical changes during the night. No significant changes were observed in blood pressure. These findings suggest aerobic exercise exerts beneficial effects on the circadian rhythm of heart rate, especially in the morning. (Author correspondence: hshio@kobe-u.ac.jp)

The effects of shoe fit on gait in community-dwelling older adults

Shoes have a beneficial function in physical performance, particularly for gait. The purpose of this study was to investigate the association of shoe fit with gait parameters in community-dwelling older people. The fit of habitual shoes (HS) was evaluated in healthy older subjects and subjects were classified into well-fit (n=48) and poorly-fit (n=37) groups. The sizes of their feet were measured using an optical laser scanning system to provide newly-fitted shoes (NFS). Gait experiments were performed while wearing HS and NFS, separately. Trunk linear accelerations were measured along the vertical, anteroposterior and mediolateral axes using a tri-axial accelerometer attached to the L3 spinous process. Measurements were sampled at 200-Hz during a 20-m gait task at a self-selected speed. After signal processing, the gait velocity, stride duration, stride length and gait regularity (Reg) were obtained. Among the poorly-fit group, 86% wore shoes that were too loose. Subjects wearing ill-fitting shoes had a tendency to walk slower, had shorter stride lengths and lower Reg in the vertical direction than those wearing well-fitting shoes. Whereas NFS increased the gait velocity, the stride length and the Reg in the vertical direction, the increases in subjects that previously wore ill-fitting HS was significantly greater than in subjects that originally wore well-fitting HS. In conclusion, our study indicates that a significant proportion of older adults wear ill-fitting shoes and that well-fitting shoes are important to improve gait performance.

Self-reported Exhaustion is Associated with Small Life Space in Older Adults with Mild Cognitive Impairment

[Purpose] Older adults experience exhaustion-induced health problems, such as poor physical function and low physical activity levels. The associations between self-reported exhaustion and physical function and activity are not clear in older adults with mild cognitive impairment (MCI). The aim of this study was to investigate the relationships between self-reported exhaustion and physical function and activity in older adults with mild cognitive impairment. [Subjects] A total of 356 older adults with mild cognitive impairment (mean age = 71.6 ± 0.3u2005years, 50.8% women) were included in this study. [Methods] Self-reported exhaustion was identified by one item from the Study of Osteoporotic Fractures index. Gait speed, gait endurance, and life space were also assessed. [Results] Sixty-two participants reported having exhaustion, giving a 17.4% prevalence of self-reported exhaustion among these individuals. Logistic regression analysis showed that the Life-Space Assessment score was the only parameter significantly independently associated with exhaustion status (adjusted odds ratio 0.97, 95% confidence interval 0.95–0.99). [Conclusion] These results suggest that self-reported exhaustion is associated with life space. Future research is needed to identify ways for older people with MCI to improve their exhaustion status.

Influence of Pacing by Periodic Auditory Stimuli on Movement Continuation: Comparison with Self-regulated Periodic Movement.

[Purpose] The purpose of this study was to investigate the influence of external pacing with periodic auditory stimuli on the control of periodic movement. [Subjects and Methods] Eighteen healthy subjects performed self-paced, synchronization-continuation, and syncopation-continuation tapping. Inter-onset intervals were 1,000, 2,000 and 5,000u2005ms. The variability of inter-tap intervals was compared between the different pacing conditions and between self-paced tapping and each continuation phase. [Results] There were no significant differences in the mean and standard deviation of the inter-tap interval between pacing conditions. For the 1,000 and 5,000u2005ms tasks, there were significant differences in the mean inter-tap interval following auditory pacing compared with self-pacing. For the 2,000u2005ms syncopation condition and 5,000u2005ms task, there were significant differences from self-pacing in the standard deviation of the inter-tap interval following auditory pacing. [Conclusion] These results suggest that the accuracy of periodic movement with intervals of 1,000 and 5,000u2005ms can be improved by the use of auditory pacing. However, the consistency of periodic movement is mainly dependent on the inherent skill of the individual; thus, improvement of consistency based on pacing is unlikely.