Yasushi Uchiyama

Specific effects of balance and gait exercises on physical function among the frail elderly

Objective: To evaluate the specific effects of balance and gait exercises among frail elderly individuals. Design: A randomized three-group parallel controlled study. Setting: Geriatric health services facility in Japan. Subjects: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education. Interventions: The two exercise groups received balance or gait exercise for 40 minutes, 2–3 times weekly, for 12 weeks. Main outcome measures: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed ‘Up and Go’ Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention. Results: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed ‘Up and Go’ Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group. Conclusions: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.

How often and how far do frail elderly people need to go outdoors to maintain functional capacity

The purpose of this study was to investigate the relationship between the frequency of going outdoors into the life-space and functional impairment in community-living frail elderly people. Participants were 1872 community-dwelling elderly people (65-100 years). The participants were asked activities of daily living (ADL) status and how far they traveled and how often they traveled to that area in the 4 weeks before the assessment. We selected two demographic variables, five physiological variables, 11 primary diseases or geriatric syndromes, and four psychosocial variables as possible confounding factors of ADL limitations and correlates of going outdoors. After adjusting for the confounders, multiple logistic regression showed that limitations in basic ADL and instrumental ADL were most strongly associated with going outside the home less than once a week and with going into the neighborhood less than once a week, respectively. Low self-efficacy for going outdoors related most strongly to restrictions in these outdoor activities. These results suggest that going outdoors into the neighborhood at least once a week is beneficial for maintaining physical function in frail elderly people.

Effects of visual interference on initial motor program errors and execution times in the choice step reaction

The purpose of this study was to examine whether visual interference has any effect on error in the initial direction of anticipatory postural adjustment (APA) prior to a step (indicating a motor program error) and response time during the choice step execution. Twenty healthy young participants were instructed to execute forward stepping as quickly and accurately as possible on the side indicated by a central arrow (←, left vs. →, right) of a visual cue in the neutral condition. In the flanker condition, they were additionally required to ignore the 2 flanking arrows on each side (→→→→→, congruent or →→←→→, incongruent). Errors in the direction of the initial weight transfer (APA errors) and the step execution times were measured from the vertical force data. In the incongruent condition, the percentage of APA errors and the step execution times were significantly greater than those in the neutral and congruent conditions. A linear mixed model revealed that the step execution time in trials with APA errors was longer than those in trials without APA errors. The visual interference effect of a flanker task may load selective attention and judgment processing during movement initiation, leading to increased initial motor program errors and prolonged step execution times even in healthy young adults.

Effects of speed and accuracy strategy on choice step execution in response to the flanker interference task.

The purpose of this study is to examine the effects of a speed or accuracy strategy on response interference control during choice step execution. Eighteen healthy young participants were instructed to execute forward stepping on the side indicated by a central arrow (←, left vs. →, right) under task instructions that either emphasized speed or accuracy of response in the neutral condition. In the flanker condition, they were additionally required to ignore the 2 flanking arrows on each side (→→→→→, congruent or →→←→→, incongruent). Errors in the direction of the initial weight transfer (APA errors) and the step execution times were measured from the vertical force data. APA error was increased in response to the flanker task and step execution time was shortened with a speed strategy compared to an accuracy strategy. Furthermore, in response to the visual interference of the flanker task, speed instructions in particular increased APA errors more than other instructions. It may be important to manipulate the level of the speed-accuracy trade-off to improve efficiency and safety. Further research is needed to explore the effects of advancing age and disability on choice step reaction in a speed or accuracy strategy.

Analysis of Choice Stepping with Visual Interference Can Detect Prolonged Postural Preparation in Older Adults with Mild Cognitive Impairment at High Risk of Falling.

Background/Aims: We aimed to clarify postural control deficits in older adults with mild cognitive impairment (MCI) at high risk of falling by addressing the inhibitory process. Methods: This study involved 376 community-dwelling older adults with MCI. Participants were instructed to execute forward stepping on the side indicated by the central arrow while ignoring the 2 flanking arrows on each side (→→→→→, congruent, or →→←→→, incongruent). Initial weight transfer direction errors [anticipatory postural adjustment (APA) errors], step execution times, and divided phases (reaction, APA, and swing phases) were measured from vertical force data. Participants were categorized as fallers (n = 37) and non-fallers (n = 339) based on fall experiences in the last 12 months. Results: There were no differences in the step execution times, swing phases, step error rates, and APA error rates between groups, but fallers had a significantly longer APA phase relative to non-fallers in trials of the incongruent condition with APA errors (p = 0.005). Fallers also had a longer reaction phase in trials with the correct APA, regardless of the condition (p = 0.01). Conclusion: Analyses of choice stepping with visual interference can detect prolonged postural preparation as a specific falling-associated deficit in older adults with MCI.

Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury.

Study design:Cross-sectional study.Objective:To identify the physical impairments and walking function required for community ambulation in patients with cervical incomplete spinal cord injury (ISCI).Setting:Chubu Rosai Hospital, Nagoya, Japan.Methods:Forty patients with cervical ISCI (mean age: 49.9 years, American Spinal Injury Association Impairment Scale D) were included. The primary outcome measure was community ambulation based on Spinal Cord Independence Measure outdoor scores for a distance of >480 m. We measured the upper- and lower-extremity motor scores (UEMS and LEMS), sensory and spasticity. The walking tests included 10 m of walking at a comfortable- and maximum-walking speed (CWS and MWS; m s−1), 6 min walking test (6MWT; m) and the walking index for spinal cord injury II (WISCI II). Multivariate logistic regression models were used to assess the physical impairments associated with community ambulation. Receiver operating characteristic curves were analyzed to determine the cutoff points for physical impairment and walking function.Result:The LEMS (beta coefficient (β)=0.71) and UEMS (β=0.41) were independently associated with community ambulation in patients with cervical ISCI. The cutoff points of the LEMS, UEMS, CWS, MWS, 6MWT and WISCI II were 41.5, 36.5, 1.00 m s−1, 1.32 m s−1, 472.5 m and 17.5, respectively, which suggests moderate to high accuracy.Conclusion:The LEMS and UEMS were the most important factors affecting community ambulation in patients with cervical ISCI. The cutoff points of the walking function tests were highly accurate; therefore, these points can serve as targets for walking training in the future.

Analysis of the Function for Coordinated Mechanism with Ataxia

運動失調症状に対して動作・障害学的観点から運動生理的な解析を試みた。その際とくに、制御機構の破綻状態と運動療法概念との有機的な関係を考慮し、協調・平衡障害を論議の中心に据えた。その結果、運動失調症の障害特性が明確となり、特に躯幹協調能の意義と重症度を客観的に示し得た。ここで得られた知見は、広義の平衡機能の検討に対しても応用の可能性が示唆された。