M.F. Reelick

The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinson's Disease and Healthy Older Adults: An fNIRS Study

Background. Gait is influenced by higher order cognitive and cortical control mechanisms. Functional near infrared spectroscopy (fNIRS) has been used to examine frontal activation during walking in healthy older adults, reporting increased oxygenated hemoglobin (HbO2) levels during dual task walking (DT), compared with usual walking. Objective. To investigate the role of the frontal lobe during DT and obstacle negotiation, in healthy older adults and patients with Parkinson’s disease (PD). Methods. Thirty-eight healthy older adults (mean age 70.4 ± 0.9 years) and 68 patients with PD (mean age 71.7 ± 1.1 years,) performed 3 walking tasks: (a) usual walking, (b) DT walking, and (c) obstacles negotiation, with fNIRS and accelerometers. Linear-mix models were used to detect changes between groups and within tasks. Results. Patients with PD had higher activation during usual walking (P < .030). During DT, HbO2 increased only in healthy older adults (P < .001). During obstacle negotiation, HbO2 increased in patients with PD (P = .001) and tended to increase in healthy older adults (P = .053). Higher DT and obstacle cost (P < .003) and worse cognitive performance were observed in patients with PD (P = .001). Conclusions. A different pattern of frontal activation during walking was observed between groups. The higher activation during usual walking in patients with PD suggests that the prefrontal cortex plays an important role already during simple walking. However, higher activation relative to baseline during obstacle negotiation and not during DT in the patients with PD demonstrates that prefrontal activation depends on the nature of the task. These findings may have important implications for rehabilitation of gait in patients with PD.

Fall-prone older people's attitudes towards the use of virtual reality technology for fall prevention

Background: Virtual reality (VR) technology is a relatively new rehabilitation tool that can deliver a combination of cognitive and motor training for fall prevention. The attitudes of older people to such training are currently unclear. Objective: This study aimed to investigate: (1) the attitudes of fall-prone older people towards fall prevention exercise with and without VR; (2) attitudinal changes after intervention with and without VR; and (3) user satisfaction following fall prevention exercise with and without VR. Methods: A total of 281 fall-prone older people were randomly assigned to an experimental group receiving treadmill training augmented by VR (TT+VR, n = 144) or a control group receiving treadmill training alone (TT, n = 137). Two questionnaires were used to measure (1) attitudes towards fall prevention exercise with and without VR (AQ); and (2) user satisfaction (USQ). AQ was evaluated at baseline and after intervention. USQ was measured after intervention only. Results: The AQ revealed that most participants had positive attitudes towards fall prevention exercise at baseline (82.2%) and after intervention (80.6%; p = 0.144). In contrast, only 53.6% were enthusiastic about fall prevention exercise with VR at baseline. These attitudes positively changed after intervention (83.1%; p < 0.001), and 99.2% indicated that they enjoyed TT+VR. Correlation analyses showed that postintervention attitudes were strongly related to user satisfaction (USQ: r = 0.503; p < 0.001). Conclusions: Older peoples attitudes towards fall prevention exercise with VR were positively influenced by their experience. From the perspective of the user, VR is an attractive training mode, and thus improving service provision for older people is important.

Activity in older people with and without a major depressive disorder.

Psychomotor disturbances are an essential feature of major depressive disorders. Clinicians and researchers found a reduction in physical activity, less participation in activity and also gait disorders per se (Sobin and Sackeim, 1997; Iersel et al., 2005). There can also be an increased activity with agitation (Sobin and Sackeim, 1997). Many studies have been carried out to investigate these psychomotor disturbances, except in the geriatric population. This may be caused by their frailty and intrinsic problems in including depressive geriatric subjects in studies that ask compliance to protocols that require physical activity, for which depressive subjects are often not motivated. However, physical activity may be an important feature in diagnosing and in treating depressive disorders: it can probably be a diagnostic marker and an outcome measure to monitor therapy. Activity can be measured in different ways: with observational scales, self‐report questionnaires or accelerometers, which are available in many forms. In essence, an accelerometer measures activity in two or three dimensions. The data are converted into electrical pulses per epoch (counts per 5min), which is a measure for activity. Accelerometers have been validated in older people and have been proven to be valid and reliable (Heinen et al., 2007). In the present pilot study, we compared the physical activity in patients with a major depressive disorder (DSM‐IV), before and after treatment with a Selective Serotonine Reuptake Inhibitor, with older subjects without an affective disorder as controls. The study was carried out in a small number of consecutive outpatients of the geriatric department, of the Radboud University Medical Centre Nijmegen and Rijnstate Hospital, Arnhem, from 2006 until 2008. We instructed patients to use an activity registration diary and administeredmini mental state examination, Montgomery‐Åsberg Depression Rating Scale and Cumulative Illness Rating Scale for Geriatrics. Physical activity was measured by wearing an accelerometer for five consecutive days. Because of small sample size, values are expressed as means with range. Results were analysed by using the t‐test. The mean age of the population with depressive disorder (n= 4) was 78 years (75–80), versus 78 years (72–82) for controls (n= 8). There were no significant