Somporn Sungkarat

Efficacy of an insole shoe wedge and augmented pressure sensor for gait training in individuals with stroke: a randomized controlled trial:

Objective: To determine whether external feedback to promote symmetrical weight distribution during standing and walking would improve gait performance and balance in people with stroke. Design: Randomized, controlled, assessor-blinded trial. Setting: Rehabilitation unit and physical therapy department. Subjects: Thirty-five individuals with stroke (mean (SD) age = 53.0 (9.3) years) were randomly assigned to an experimental (n = 17) or control group (n = 18). Time post stroke was less than six months for most subjects (n = 27, 77%). Interventions: Subjects participated in 15 rehabilitation sessions including 30 minutes of gait retraining per session. During gait retraining, the experimental group used an insole shoe wedge and sensors set-up (I-ShoWS) while the control group received a conventional programme. The I-ShoWS set-up consisted of a wedge insole and a footswitch for the non-paretic leg and a pressure sensor on the paretic leg. Outcome measures: Gait speed, step length and single support time asymmetry ratio, balance and amount of load on paretic leg during stance were evaluated twice: one day before and after training. Results: The experimental group demonstrated significant increase in standing and gait symmetry compared with the control group (P < 0.05). They demonstrated 3 times greater improvement in gait speed than the control group (P = 0.02). Balance improvement was significantly greater for the experimental than for the control group (P < 0.05). Conclusion: Gait retraining using the I-ShoWS set-up was more effective in restoration of gait speed, standing and walking symmetry and balance than a conventional treatment programme. These results indicate the benefit of implementing feedback during gait retraining.

The influence of neck pain on sensorimotor function in the elderly

Greater disturbances in sensorimotor control have been demonstrated in younger to middle aged groups. However, it is unknown whether or not the impairments documented in these populations can be extrapolated to elders with neck pain. The aim of this study was to investigate the influence of neck pain on sensorimotor function in elders. Twenty elders with neck pain (12 women and 8 men) and 20 healthy elder controls (14 women and 6 men) aged 65 years and over were recruited from the general community. Tests for sensorimotor function included; cervical joint position sense (JPS); computerised rod-and-frame test (RFT); smooth pursuit neck torsion test (SPNT); standing balance (under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable stance); step test and ten-meter walk test with and without head movement. Elders with neck pain had greater deficits in the majority of sensorimotor function tests after controlling for effects of age and comorbidities. Significant differences were found in the SPNT (p<0.01), error in the RFT (frame angled at 10° and 15° anticlockwise) (p<0.05), standing balance (amplitude of sway) - eyes open on a firm surface in the medio-lateral (ML) direction (p=0.03), and total number of steps on the step test, both left and right sides (p<0.01). Elders with neck pain have greater sensorimotor disturbances than elders without neck pain, supporting a contribution of altered afferent information originating from the cervical spine to such disturbances. The findings may inform falls prevention and management programs.

Effects of Tai Chi on Cognition and Fall Risk in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial.

To examine whether combined center‐ and home‐based Tai Chi training can improve cognitive ability and reduce physiological fall risk in older adults with amnestic mild cognitive impairment (a‐MCI).

Spatial variability during gait initiation while dual tasking is increased in individuals with mild cognitive impairment

BackgroundGait initiation (GI) is a complex transition phase of gait that can induce postural instability. Gait impairment has been well documented in people with Alzheimer’s disease, but it is still inconclusive in individuals with Mild Cognitive Impairment (MCI). Previous studies have usually investigated gait performance of cognitive impaired persons under steady state walking.ObjectiveThis study aimed to examine spatiotemporal variability during GI under single- and dual-task conditions in people with and without MCI.MethodsSpatiotemporal stepping characteristics and variability under single- and dual-task conditions (counting backwards by 3s) were assessed in 30 older adults with MCI and 30 cognitively intact controls. Mean and coefficients of variation (COV) of swing time, step time, step length and step width were compared between the two groups.ResultsMixed-model repeated measures ANOVA revealed a significant Group x Walking condition interaction for COV of step length and step width (P<0.05). Post-hoc analysis revealed that variability for these measures were significantly larger in the MCI group compared with the control group under the dual-task condition (P<0.05).ConclusionsStep length and step width variability is increased in people with MCI during GI, particularly in a condition involving a secondary cognitive task. These findings suggest that individuals with MCI have reduced balance control when undertaking a challenging walking task such as gait initiation, and this is exacerbated with an added cognitive task. Future studies should prospectively investigate the relationship between GI variability and fall risk in this population.

Home-based interventions improve trained, but not novel, dual-task balance performance in older adults: A randomized controlled trial

The purpose of this study was to compare the efficacy of four different home-based interventions on dual-task balance performance and to determine the generalizability of the four trainings to untrained tasks. Sixty older adults, aged 65 and older, were randomly assigned to one of four home-based interventions: single-task motor training, single-task cognitive training, dual-task motor-cognitive training, and dual-task cognitive-cognitive training. Participants received 60-min individualized training sessions, 3 times a week for 4 weeks. Prior to and following the training program, participants were asked to walk under two single-task conditions (i.e. narrow walking and obstacle crossing) and two dual-task conditions (i.e. a trained narrow walking while performing verbal fluency task and an untrained obstacle crossing while counting backward by 3s task). A nine-camera motion capture system was used to collect the trajectories of 32 reflective markers placed on bony landmarks of participants. Three-dimensional kinematics of the whole body center of mass and base of support were computed. Results from the extrapolated center of mass displacement indicated that motor-cognitive training was more effective than the single-task motor training to improve dual-task balance performance (p=0.04, ES=0.11). Interestingly, balance performance under both single-task and dual-task conditions can also be improved through a non-motor, single-task cognitive training program (p=0.01, ES=0.13, and p=0.01, ES=0.11, respectively). However, improved dual-task processing skills during training were not transferred to the novel dual task (p=0.15, ES=0.09). This is the first study demonstrating that home-based dual-task training can be effectively implemented to improve balance performance during gait in older adults.

Specific but not global cognitive functions are associated with gait initiation in older adults

The objective of this study was to examine the association between cognitive ability and gait initiation performance in older adults. Global and specific cognitive functions and spatiotemporal gait parameters during gait initiation were assessed in 60 older adults. Multivariate linear regression was conducted to determine the association between cognitive functions and gait initiation parameters. Results showed that global cognitive function was not associated with any of the spatiotemporal parameters. Poorer performance on measures of executive function and language ability were associated with shorter step length, narrower step width, and longer step time. In addition, poorer performance on test of visuospatial ability was associated with longer step time. In conclusion, specific but not global cognitive functions were associated with gait initiation performance. Clinical gait examination should incorporate gait initiation and cognitive assessments. Rehabilitation strategies aimed at improving cognition and gait initiation performance may be beneficial for preventing falls.

Short-Term Effects of Cognitive Training Program for Individuals with Amnestic Mild Cognitive Impairment: A Pilot Study

ABSTRACT This study examined the effects of a cognitive training program on cognitive function and neurochemistry changes in individuals with amnestic mild cognitive impairment (aMCI). Ten individuals with aMCI were randomly assigned to the experimental (n = 5) and control (n = 5) groups. The experimental group took part in an 18-session cognitive training program over a 6-week period. After completing the cognitive training course, the experimental group demonstrated significant improvement in memory, attention, and executive functions. With respect to the neurochemistry biomarkers, the myoinositol/creatine (mI/Cr) ratio was significantly decreased in the hippocampus, prefrontal cortex, and anterior cingulate cortex of the experimental group after training. Findings demonstrate that the cognitive training program showed promising evidence in improving cognitive functions in individuals with aMCI. The observed cognitive function improvement was accompanied by a decrease of mI levels.

Tai Chi Improves Cognition and Plasma BDNF in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial:

Background. Effects of Tai Chi (TC) on specific cognitive function and mechanisms by which TC may improve cognition in older adults with amnestic mild cognitive impairment (a-MCI) remain unknown. Objective. To examine the effects of TC on cognitive functions and plasma biomarkers (brain-derived neurotrophic factor [BDNF], tumor necrosis factor-α [TNF-α], and interleukin-10 [IL-10]) in a-MCI. Methods. A total of 66 older adults with a-MCI (mean age = 67.9 years) were randomized to either a TC (n = 33) or a control group (n = 33). Participants in the TC group learned TC with a certified instructor and then practiced at home for 50 min/session, 3 times/wk for 6 months. The control group received educational material that covered information related to cognition. The primary outcome was cognitive performance, including Logical Memory (LM) delayed recall, Block Design, Digit Span, and Trail Making Test B minus A (TMT B-A). The secondary outcomes were plasma biomarkers, including BDNF, TNF-α, and IL-10. Results. At the end of the trial, performance on the LM and TMT B-A was significantly better in the TC group compared with the control group after adjusting for age, gender, and education (P < .05). Plasma BDNF level was significantly increased for the TC group, whereas the other outcome measures were similar between the 2 groups after adjusting for age and gender (P < .05). Conclusions. TC training significantly improved memory and the mental switching component of executive function in older adults with a-MCI, possibly via an upregulation of BDNF.

Impaired Standing Balance in Individuals with Cervicogenic Headache and Migraine

AIMS To determine whether a difference in standing balance exists among individuals with cervicogenic headache, those with migraine, and asymptomatic controls. METHODS A total of 24 participants with cervicogenic headache, 24 with migraine, and 24 asymptomatic controls of similar age, gender, and body mass index were included. Standing balance was assessed with a swaymeter under the conditions of eyes open and closed; on firm and soft surfaces; and in comfortable and narrow stances (for a total of eight testing conditions). Each condition was tested for 30 seconds. The outcome measures were sway area and displacement. Multivariate analysis of variance with Bonferroni post hoc test were used to analyze between-group differences in the postural sway variables. RESULTS Both headache groups had significantly larger sway areas than the control group during comfortable stance with eyes open and with eyes closed on a soft surface (P < .05) and during narrow stance with eyes closed on firm and soft surfaces (P < .05). The overall results demonstrated significantly greater sway in the anterior-posterior direction and less sway in the medial-lateral direction in selected tests in the cervicogenic headache group compared to the migraine group. CONCLUSION Individuals with cervicogenic headache and those with migraine have impaired balance during standing, but possibly to a different extent and pattern. Assessment of balance in patients with cervicogenic headache and migraine should be considered in clinical practice.

Clusterin as a Blood Biomarker for Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease

With increasing global life expectancy, Alzheimers disease will become an increasingly prevalent health problem. The development of biomarkers that predict risk for both Alzheimers disease and mild cognitive impairment will be useful for early diagnosis of dementia. To date, no surrogate blood biomarker exists to classify between Alzheimers disease/mild cognitive impairment and normal controls or Alzheimers disease and mild cognitive impairment/normal control as a diagnostic parameter. In this study, we analyzed serum levels of amyloid-β 40 (Aβ 40 ), amyloid-β 42 (Aβ 42 ), clusterin (CLU) and p97 using ELISA kits from 157 subjects with normal cognition, mild cognitive impairment and Alzheimers disease. We found a significant increase in serum levels of Aβ 42 (P<0.05) and serum clusterin (P<0.001) between normal and Alzheimers disease subjects and between normal and mild cognitively impaired subjects. In contrast, serum Aβ 40 and p97 levels did not differ significantly between all groups. We also used receiver operating characteristic curves to determine the cut-off point of Aβ 42 and clusterin to differentiate either cognitively normal from cognitively impaired subjects (both Alzheimers disease and mild cognitive impairment) or cognitively normal and mild cognitively impaired subjects from those with Alz- heimers disease. Only clusterin with 84% sensitivity, 75% specificity and good accuracy of diagnosis showed promise for diagnosing patients with cognitive impairment (Alzheimers disease and mild cognitive impairment).