https://escholarship.org/content/qt3254d7bt/qt3254d7bt.pdf?t=pzvrnh

Sarcopenia With Limited Mobility: An International Consensus

Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the "sixth vital sign". By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual's WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding predicted outcomes, as well as minimal detectable change values for specific populations and settings are provided.

https://digitalcommons.sacredheart.edu/cgi/viewcontent.cgi?article=1172&context=pthms_fac

Walking Speed: The Functional Vital Sign

Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60

Lack of neural innervation due to neurological damage renders muscle unable to produce force. Use of electrical stimulation is a medium in which investigators have tried to find a way to restore movement and the ability to perform activities of daily living. Different methods of applying electrical current to modify neuromuscular activity are electrical stimulation (ES), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and functional electrical stimulation (FES). This review covers the aspects of electrical stimulation used for rehabilitation and functional purposes. Discussed are the various parameters of electrical stimulation, including frequency, pulse width/duration, duty cycle, intensity/amplitude, ramp time, pulse pattern, program duration, program frequency, and muscle group activated, and how they affect fatigue in the stimulated muscle.

Neuromuscular electrical stimulation for skeletal muscle function.

Background—Cardiac surgery risk scores perform poorly in elderly patients, in part because they do not take into account frailty and disability which are critical determinants of health status with advanced age. There is an unmet need to combine established cardiac surgery risk scores with measures of frailty and disability to provide a more complete model for risk prediction in elderly patients undergoing cardiac surgery. Methods and Results—This was a prospective, multicenter cohort study of elderly patients (≥70 years) undergoing coronary artery bypass and/or valve surgery in the United States and Canada. Four different frailty scales, 3 disability scales, and 5 cardiac surgery risk scores were measured in all patients. The primary outcome was the STS composite end point of in-hospital postoperative mortality or major morbidity. A total of 152 patients were enrolled, with a mean age of 75.9±4.4 years and 34% women. Depending on the scale used, 20–46% of patients were found to be frail, and 5–76% were f...

Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity

Background: With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability of outcome measures for people with this disease is necessary.

Objective: The goals of this study were to assess test-retest reliability of data for the Timed “Up & Go” Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups with mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were studied.

Design: This was a prospective, nonexperimental, descriptive methodological study.

Methods: Background data collected for 51 people with AD included: use of an assistive device, Mini-Mental Status Examination scores, and FAST scale scores. Each participant engaged in 2 test sessions, separated by a 30- to 60-minute rest period, which included 2 TUG trials, 1 6MWT trial, and 2 gait speed trials using a computerized gait assessment system. A specific cuing protocol was followed to achieve optimal performance during test sessions.

Results: Test-retest reliability values for the TUG, the 6MWT, and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately (intraclass correlation coefficients ≥.973); however, individual variability of performance also was high. Calculated MDC scores at the 90% confidence interval were: TUG=4.09 seconds, 6MWT=33.5 m (110 ft), and gait speed=9.4 cm/s. The 2 groups were significantly different in performance of clinical tests, with the participants who were more cognitively impaired being more physically and functionally impaired.

Limitations: A single researcher for data collection limited sample numbers and prohibited blinding to dementia level.

Conclusions: The TUG, the 6MWT, and gait speed are reliable outcome measures for use with people with AD, recognizing that individual variability of performance is high. Minimal detectable change scores at the 90% confidence interval can be used to assess change in performance over time and the impact of treatment.

/pdf/test-retest-reliability-and-minimal-detectable-change-scores-7ak6eslq31.pdf

Test-Retest Reliability and Minimal Detectable Change Scores for the Timed “Up & Go” Test, the Six-Minute Walk Test, and Gait Speed in People With Alzheimer Disease

Background and Purpose. Neuromuscular electrical stimulation is used by physical therapists to improve muscle performance. Optimal forms of stimulation settings are yet to be determined, as are possible sex-related differences in responsiveness to electrical stimulation. The objectives of the study were: (1) to compare the ability of 3 different waveforms to generate isometric contractions of the quadriceps femoris muscles of individuals without known impairments, (2) to compare muscle fatigue caused by repeated contractions induced by these same waveforms, and (3) to examine the effect of sex on muscle force production and fatigue induced by electrical stimulation. Subjects. Fifteen women and 15 men (mean age=29.5 years, SD=5.4, range=22–38) participated in the study. Methods. A portable battery-operated stimulator was used to generate either a monophasic or biphasic rectangular waveform. A stimulator that was plugged into an electrical outlet was used to generate a 2,500-Hz alternating current. Phase duration, frequency, and on-off ratios were kept identical for both stimulators. Participants did not know the type of waveform being used. Torque was measured using a computerized dynamometer: a maximal voluntary isometric contraction (MVIC) of the right quadriceps femoris muscle set at 60 degrees of knee flexion was determined during the first session. In each of the 3 testing sessions, torque of contraction and fatigue elicited by one waveform were measured. Order of testing was randomized. Torque elicited by electrical stimulation was expressed as a percentage of average MVIC. A mixed-model analysis of variance was used to determine the effect of stimulation and sex on strength of contraction and fatigue. Bonferroni-corrected post hoc tests were used to further distinguish between the effects of the 3 stimulus waveforms. Results. The results indicated that the monophasic and biphasic waveforms generated contractions with greater torque than the polyphasic waveform. These 2 waveforms also were less fatiguing. The torques from the maximally tolerated electrically elicited contractions were greater for the male subjects than for the female subjects. Discussion and Conclusion. Muscle torque and fatigue of electrically induced contractions depend on the waveform used to stimulate the contraction, with monophasic and biphasic waveforms having an advantage over the polyphasic waveform. All tested waveforms elicited, on average, stronger contractions in male subjects than in female subjects when measured as a percentage of MVIC.

/pdf/quadriceps-femoris-muscle-torques-and-fatigue-generated-by-50u1pxtt96.pdf

Quadriceps Femoris Muscle Torques and Fatigue Generated by Neuromuscular Electrical Stimulation With Three Different Waveforms

Background and purpose Individuals with Alzheimer disease (AD) have a higher risk of falls than their cognitively intact peers. This pilot study was designed to assess the feasibility and effectiveness of a small-group balance exercise program for individuals with AD in a day center environment. Methods Seven participants met the inclusion criteria: diagnosis of AD or probable AD, medical stability, and ability to walk (with or without assistive device). We used an exploratory pre- and post-test study design. Participants engaged in a functional balance exercise program in two 45-minute sessions each week for eight weeks. Balance activities were functional and concrete, and the intervention was organized into constant, blocked, massed practice. Outcome measures included Berg Balance Scale (BBS), Timed Up and Go (TUG), and gait speed (GS; self-selected and fast assessed by an instrumented walkway). Data were analyzed by comparing individual change scores with previously identified minimal detectable change scores at the 90% confidence level (MDC90). Results Pre- and post-test data were acquired for five participants (two participants withdrew). The BBS improved in all five participants, and improved > or = 6.4 points (the MDC90 for the BBS in three participants. Four participants improved their performance on the TUG, and three participants improved > or = 4.09 seconds (the MDC90 for the TUG). Self-selected GS increased > or = 9.44 cm/sec (the MDC90 for gait speed) in three participants. Two participants demonstrated post-test self-selected GS comparable with their pretest fast GS. Discussion and conclusions This pilot study suggests that a small-group functional balance intervention for individuals with AD is feasible and effective. Although participants had no explicit memory of the program, four of five improved in at least two outcome measures. Larger scale functional balance intervention studies with individuals with AD are warranted.

A small-group functional balance intervention for individuals with Alzheimer disease: a pilot study.

BACKGROUND AND PURPOSE:: Individuals with Alzheimer disease (IwAD) experience more frequent and more injurious falls than their cognitively intact peers. Evidence of balance and gait dysfunction is observed earlier in the course of Alzheimer disease (AD) than once believed. Balance training has been demonstrated to be effective in improving balance and decreasing falls in cognitively intact older adults but is not well studied in IwAD. This study was designed to analyze the effects of a group balance training program on balance and falls in IwAD. The program was developed specifically for IwAD, with explicit guidelines for communication/interaction and deliberate structure of training sessions catered to the motor learning needs of IwAD. DESIGN:: This prospective, quasi-experimental, pretest-posttest design study describes the effects of a balance training program for a cohort of IwAD. METHODS:: Thirty IwAD were recruited from 3 adult day health centers; 22 completed at least 1 posttest session. Participants were tested with Berg Balance Scale (BBS), Timed Up and Go (TUG), Self-Selected Gait Speed (SSGS), Fast Gait Speed (FGS), and Mini-Mental Status Examination (MMSE) immediately before and after the 3-month intervention and again 3 months later. Group training was held at the adult day health centers for 45 minutes, twice per week. Sessions were characterized by massed, constant, and blocked practice of functional, relevant activities with considerable repetition. Ratio of participant to staff member never exceeded 3:1. Physical therapist staff members assured that participants were up on their feet the majority of each session and were individually challenged as much as possible. RESULTS:: Repeated-measures analysis of variance (ANOVA) for BBS was significant (F = 15.04; df = 1.67/28.40; P =.000) with post hoc tests, revealing improvement between pretest and immediate posttest (P =.000) and decline in performance between immediate and 3-month posttest (P =.012). Repeated-measures ANOVA posttest for MMSE was significant (F = 5.12; df = 1.73/22.53; P =.018) with post hoc tests, showing no change in MMSE between pretest and immediate posttest but decline in MMSE when comparing immediate posttest with 3-month posttest (P =.038) and pretest with 3-month posttest (P =.019). Repeated-measures ANOVA for TUG, FGS, and SSGS were not significant. Immediate effects of the intervention as assessed by the a priori paired t tests (comparing pre- and immediate posttest data) revealed significant improvement in BBS (t = -7.010; df = 20; P =.000), TUG (t = 3.103; df = 20; P =.006), and FGS (t = -2.115; df = 19; P =.048), but not in SSGS (t = -1.456; df = 20; P =.161). DISCUSSION AND CONCLUSION:: The 3-month group balance training intervention designed specifically for IwAD was effective in improving balance and mobility, as evidenced by improved BBS and TUG performances. Cognition did not decline during the course of the intervention but did decline following the intervention, suggesting a possible protective effect. Given the promising findings, a larger-scale controlled study is warranted. Language: en

Group Balance Training Specifically Designed for Individuals With Alzheimer Disease: Impact on Berg Balance Scale, Timed Up and Go, Gait Speed, and Mini-Mental Status Examination.

Individuals with dementia (IwD) have unique characteristics related to movement quality, motor learning strategies, and interpersonal needs. Without an understanding of these issues, physical therapists (PTs) treat these patients as they would cognitively intact older adults and become frustrated or disheartened when patients do not respond to therapy as expected. The purpose of this article is to facilitate the success of therapeutic interventions with IwD by suggesting therapeutic strategies that play to the strengths of this population. Classic and recent literature related to motor control and motor learning in IwD is reviewed, and relevant clinical applications are highlighted. Key components related to successful interventions in existing evidence are presented. Armed with an understanding of the unique qualities related to movement disorders and motor learning, PTs will be better equipped to exploit the strengths of IwD for optimal rehab outcomes.

Julie D. Ries

Papers

Test-Retest Reliability and Minimal Detectable Change Scores for the Timed “Up & Go” Test, the Six-Minute Walk Test, and Gait Speed in People With Alzheimer Disease

Quadriceps Femoris Muscle Torques and Fatigue Generated by Neuromuscular Electrical Stimulation With Three Different Waveforms

A small-group functional balance intervention for individuals with Alzheimer disease: a pilot study.

Group Balance Training Specifically Designed for Individuals With Alzheimer Disease: Impact on Berg Balance Scale, Timed Up and Go, Gait Speed, and Mini-Mental Status Examination.

Rehabilitation for Individuals with Dementia: Facilitating Success