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Objective: To evaluate the effect of age on functional outcomes at discharge from prosthetic rehabilitation. Design: Retrospective chart audit. Setting: Rehabilitation hospital. Participants: Individuals ≥50 years with a transtibial level lower limb amputation (LLA) and above admitted to the inpatient prosthetic rehabilitation program from 2012 to 2019 (n=504). A secondary analysis included a subset of matched participants (n=156). Interventions: Not applicable. Main Outcome Measures: The L-Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence scale. Results: A total of 504 participants (66.7±10.1 years) met the inclusion criteria, 63 participants (84.9±3.7 years) were part of the oldest old group. The sample was stratified into 4 age groups (50-59, 60-69, 70-79, and 80+) for data analysis. The analysis of variances were statistically significant for all outcome measures (P <.001). Post-hoc testing for the L-Test, 2MWT, and 6MWT demonstrated that the oldest old had significantly reduced performance compared with people 50-59 years old (P <.05), but there were no significant differences between the oldest old and the 60-69 [(L-Test, P =.802), (2MWT, P =.570), (6MWT, P =.772)] and 70-79 [(L-Test, P =.148), (2MWT, P =.338), (6MWT, P =.300)] age groups. The oldest old reported significantly lower balance confidence compared with all 3 age groups (P <.05). Conclusion: The oldest old achieved similar functional mobility outcomes as people 60-79 years, the most common age group of people with an LLA. Advanced age alone should not disqualify individuals from prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

• Gait aid use improves stability but may cause falls in people with dementia. • Staff education should include safe mobility for hospital patients with dementia. • Education for therapists could include gait aid use and prescription for dementia. • Inter-professional practice may improve consistency in mobility management. • Strategies for safe mobility with and without gait aids should be considered. This study described mobility care practice of nurses, physiotherapists and occupational therapists and gait aid use for hospital patients with dementia. Two surveys, tailored to staff mobility care roles were distributed in Australian hospitals. Physiotherapists and occupational therapists were asked additional questions regarding assessments and factors for prescribing gait aids to patients with dementia. Descriptive statistics for closed-ended and summative content analyses for open-ended questions were undertaken. Nurses (n=56), physiotherapists (n=11) and occupational therapists (n=23) used various practices to ensure ambulation safety for patients with dementia. Nurses and occupational therapists commonly referred patients with dementia to physiotherapists for mobility and gait aid assessments. Therapists predominantly considered the severity of dementia, the person's learning ability and mobility history in deciding about gait aid use. Exploring ways to strengthen nursing and health professional education, and inter-professional practice for safe mobility in patients with dementia, with and without gait aids, could be helpful. [ABSTRACT FROM AUTHOR]

• Walking with a 4-wheeled walker is a complex motor task. • People with Alzheimer's dementia experienced using a 4-wheeled walker were tested. • Complex walking paths and cognitive challenge resulted in increased instability. • People self-prioritized gait over the cognitive task in the most complex tests. Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations. What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker? Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question. A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω2 = 0.36), cadence (p = 0.04, ω2 = 0.15) and STV (p < 0.001, ω2 = 0.53). Velocity and cadence decreased and STV increased with increasing walking configuration complexity and upon dual-tasking. Dual-task gait and cognitive task cost deteriorated in all walking configurations, but gait was prioritized in the GMWT and F8 configurations. Despite familiarity, experienced walker users with AD exhibit impaired gait when walking in complex situations which increases falls risk. Upon dual-task, individuals with AD self-prioritized a posture-first strategy in complex configurations. Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments. [ABSTRACT FROM AUTHOR]

To assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months' follow-up. Prospective cohort study. Rehabilitation hospital. People with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program. Not applicable. Gait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment and Trail Making Test quantified cognition as secondary outcomes. Repeated measures analysis of variance evaluated the effects of task (single task and dual task) and time (at discharge and 4 months' follow-up) and their interaction on each outcome. A performance-resource operating characteristic graph evaluated gait and cognitive task prioritization. Multivariable linear regression evaluated the association between cognition and change in mobility over time. No significant interactions between task and time were found (all P >.121) for L Test and gait velocity. The L Test single task (P =.001) and dual task (P =.004) improved over time. Gait velocity improved over time for both single task and dual task (P <.001). Dual-task performance was slower than single-task performances at each time point. The Trail Making Test B was independently associated with the change in dual-task L Test (P =.012), and single-task (P =.003) and dual-task (P =.006) gait velocity at follow-up. Gait velocity and L Test single and dual task improved over time. No significant interactions indicated that cognitive task did not differentially affect performance over time. Lower executive function scores at discharge were independently associated with lower gains in all gait velocity and dual-task L Test outcomes at follow-up. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) and depression independently affect balance control in older adults. However, it is uncertain whether depressive symptoms would amplify balance problems in older adults with MCI. Aim: To evaluate if the presence of significant depressive symptoms affects postural sway under somatosensory challenges in a MCI population. Methods: Eighty two participants (mean of 75.3 ± 6.4 years of age; 46% women) with MCI completed cognitive and balance assessments. Participants were grouped by severity of depressive symptoms using the Geriatric Depression Scale-15, as MCI with depressive symptoms (MCI-D = 14, score ≥ 5) and MCI without depressive symptoms (MCI = 68, score < 5). Postural sway area was evaluated during eyes open (EO) and eyes closed (EC) while standing on a rigid flat force plate platform, and compared across groups. Analyses were controlled for age, sex, comorbidities, anti-depressant medication use, executive function, and baseline sway. Results: MCI-D showed larger postural sway area when compared with MCI irrespective of visual feedback conditions ( p  = 0.03). This difference remained significant after adjusting for anti-depressant use and executive function performance. The lack of interaction between groups and visual condition was associated with group differences in postural sway during EO condition (Beta = 0.08, CI −257.5–621.9; p  = 0.41) and by comparable sway increase from EO to EC in both groups. Conclusion: Depressive symptoms in individuals with MCI worsened postural stability during both eyes open and eyes closed conditions independently of cognitive function. Significant depressive symptoms may affect balance in MCI populations, potentially increasing the risk of falls. [ABSTRACT FROM AUTHOR]

Background: Walking is a cognition intensive activity and impaired walking is associated with an increased fall risk in people with Alzheimer's dementia (AD). Walking in a curved path configuration increases complexity of the task, reflects real-life environments and situations when falls occur. The effect of walking path task complexity has not been evaluated in people with AD.Research Question: The purpose was 1) to assess the utility of a curved path walking task to detect differences in gait performance between people with AD and healthy controls and 2) to assess the relationship of cognitive function to gait performance on straight path and curved path walking.Methods: Participants with AD (n = 14, mean age ± SD = 73.08 ± 9.22) and age and sex matched controls (n = 14, mean age = 72.86 ± 9.53) were recruited. Time to complete a 6-meter straight path and a curved path (Figure of 8 Test) walking task was recorded. Steps taken, accuracy and qualitative measures of smoothness were rated for curved-path walking. Measures of global cognition (MMSE, MoCA) and executive function (Trail making A and B, Digit Span forwards and backwards) were assessed.Results: Gait was significantly slower in people with AD for both the straight-path (AD = 6.05 ± 1.26 s, Control = 5.09 ± 0.76 s, p = 0.02) and curved-path walking (AD = 11.25 ± 4.87 s, Control = 8.28 ± 2.44 s, p =  0.05). In addition, smoothness scores were significantly lower for people with AD (AD = 1.93±1.26; Control = 3.00±0.00, p = 0.004).Significance: Walking in a curved path resulted in a significant deterioration in gait quality in the people with AD. Executive function was related only to curved path walking, in which lower executive function scores were associated with longer time to walk. [ABSTRACT FROM AUTHOR]

Objective To determine the relative and absolute reliability of a dual-task functional mobility assessment. Design Cross-sectional study. Setting Academic rehabilitation hospital. Participants Individuals (N=60) with lower extremity amputation attending an outpatient amputee clinic (mean age, 58.21±12.59y; 18, 80% male) who were stratified into 3 groups: (1) transtibial amputation of vascular etiology (n=20); (2) transtibial amputation of nonvascular etiology (n=20); and (3) transfemoral or bilateral amputation of any etiology (n=20). Interventions Not applicable. Main Outcome Measures Time to complete the L Test measured functional mobility under single- and dual-task conditions. The addition of a cognitive task (serial subtractions by 3's) created dual-task conditions. Single-task performance on the cognitive task was also reported. Intraclass correlation coefficients (ICCs) measured relative reliability; SEM and minimal detectable change with a 95% confidence interval (MDC 95 ) measured absolute reliability. Bland-Altman plots measured agreement between assessments. Results Relative reliability results were excellent for all 3 groups. Values for the dual-task L Test for those with transtibial amputation of vascular etiology (n=20; mean age, 60.36±7.84y; 19, 90% men) were ICC=.98 (95% confidence interval [CI], .94–.99), SEM=1.36 seconds, and MDC 95 =3.76 seconds; for those with transtibial amputation of nonvascular etiology (n=20; mean age, 55.85±14.08y; 17, 85% men), values were ICC=.93 (95% CI, .80–.98), SEM=1.34 seconds, and MDC 95 =3.71 seconds; and for those with transfemoral or bilateral amputation (n=20; mean age, 58.21±14.88y; 13, 65% men), values were ICC=.998 (95% CI, .996–.999), SEM=1.03 seconds, and MDC 95 =2.85 seconds. Bland-Altman plots indicated that assessments did not vary systematically for each group. Conclusions This dual-task assessment protocol achieved approved levels of relative reliability values for the 3 groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the population with lower extremity amputation. [ABSTRACT FROM AUTHOR]

Background: The improvement of gait and mobility are major rehabilitation goals following lower extremity amputations. However, when living in the community many daily activities require the multitasking of motor and cognitive tasks. The dual-task paradigm can be used to evaluate the concurrent performance of mobility and cognitive tasks.Research Question: The purpose of this study was to evaluate the effects of dual-task gait testing in older adults with trans-tibial amputations.Methods: Twenty-four people (15 men, mean age ± SD, 62.72 ± 8.59) with trans-tibial amputation walked on an electronic walkway at i) self-selected comfortable pace and ii) self-selected comfortable pace while counting backwards by threes from a number randomly selected between 100 and 150. Cognitive performance, in the form of corrected response rate, was also evaluated as a single-task.Results: The dual-task testing produced poorer performance in velocity (single-task = 58.15 ± 23.16 cm/s, dual-task = 50.92 ± 21.16 cm/s, p = 0.008), cadence (single-task = 76.65 ± 15.84 steps/min, dual-task = 67.85 ± 15.76 steps/min, p = 0.002) and stride time (single-task = 1094 ± 458.28 ms, dual-task = 1241.44 ± 513.73 ms, p = 0.005). Step length, stance time and single limb support time symmetry were also affected, such that less time was spent on the amputated limb during the dual-task testing.Significance: Dual-task testing demonstrated interference resulting in a poor performance in both gait and cognitive performance in trans-tibial amputees. Further research is suggested to evaluate the change in cognition-mobility effects over time and the relationship of this value to future adverse events such as falls and successful outcomes such as community ambulation and reintegration. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation. Design Retrospective chart audit. Setting Rehabilitation hospital. Participants Consecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology. Interventions Not applicable. Main Outcome Measures Cognitive status was assessed using the MoCA. The L Test of Functional Mobility (L Test) and the 2-minute walk test were used to estimate functional mobility and walking endurance. Results In multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest. Conclusions Individuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test. [ABSTRACT FROM AUTHOR]

Objective To determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation. Design Retrospective cohort study. Setting Rehabilitation hospital. Participants Consecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program. Interventions Not applicable. Main Outcome Measures Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance. Results The mean ± SD MoCA score was 24.05±4.09 (range, 6–30), and 56.3% of patients had scores <26. MoCA scores had a small positive correlation with the 2MWT ( r =.29, P <.01), and a small negative correlation to the L Test ( r =−.24, P <.01). In multivariable linear regression, compared with people with the highest MoCA score quartile, there was no difference on the 2MWT, but people in the lowest 2 quartiles took longer to complete the L Test. Conclusions Cognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone. [ABSTRACT FROM AUTHOR]

There is considerable diversity in the types of exercise programs investigated to reduce falls in older people. The purpose of this paper was to review the effectiveness of individualized (tailored) home-based exercise programs in reducing falls and improving physical performance among older people living in the community. A systematic review and meta-analysis was conducted of randomized or quasi-randomized trials that utilized an individualized home-based exercise program with at least one falls outcome measure reported. Single intervention exercise studies, and multifactorial interventions where results for an exercise intervention were reported independently were included. Two researchers independently rated the quality of each included study. Of 16,871 papers identified from six databases, 12 met all inclusion criteria (11 randomized trials and a pragmatic trial). Study quality overall was high. Sample sizes ranged from 40 to 981, participants had an average age 80.1 years, and although the majority of studies targeted the general older population, several studies included clinical groups as their target (Parkinson's disease, Alzheimer's disease, and hip fracture). The meta-analysis results for the five studies reporting number of fallers found no significant effect of the intervention (RR [95% CI] = 0.93 [0.72–1.21]), although when a sensitivity analysis was performed with one study of participants recently discharged from hospital removed, this result was significant (RR [95% CI] = 0.84 [0.72–0.99]). The meta-analysis also found that intervention led to significant improvements in physical activity, balance, mobility and muscle strength. There were no significant differences for measures of injurious falls or fractures. [ABSTRACT FROM AUTHOR]

Highlights • Effects of exercise on executive function in Alzheimer's-type dementia was examined. • A systematic search yielded six studies published between 2009 and 2016. • Improvement in executive function was found for all studies and interventions. • Significant improvement was seen in four of the eligible studies. • Research applying executive function measures in interventions is required. Abstract Executive function deficit is an indicator of Alzheimer's-type dementia and manifests as disruptions of attentional control, memory, cognitive flexibility, planning, and reasoning, among other cognitive problems. Physical exercise is suggested to have a protective effect on global cognition with aging. However, whether it influences executive function in people living with Alzheimer's-type dementia specifically is unknown. The current systematic review examined the efficacy of physical exercise on executive function performance in community-dwelling older adults living with Alzheimer's-type dementia. An electronic search of databases retrieved randomized and non-randomized controlled trials of community-dwelling older adults diagnosed with Alzheimer's-type dementia who completed a physical exercise intervention and who were assessed using an executive function outcome measure. Methodological quality of six studies meeting the inclusion criteria published between 2009 and 2016 was scored independently by two raters using the Physiotherapy Evidence Database and a Cochrane informed domain-based assessment of risk of bias. Trends toward improvement in executive function scores were seen across all six studies, and significant improvement was seen in four of the eligible studies. Future studies should explore the benefits of the American College of Sports Medicine recommended 150 min of physical exercise per week with select measures of executive function. [ABSTRACT FROM AUTHOR]

Although much of the literature on neuromuscular changes with aging has focused on loss of muscle mass and isometric strength, deficits in muscle power are more pronounced with aging and may be a more sensitive measure of neuromuscular degeneration. This review aims to identify the adaptations to the neuromuscular system with aging, with specific emphasis on changes that result in decreased muscle power. We discuss how these changes in neuromuscular performance can affect mobility, and ultimately contribute to an increased risk for falls in older adults. Finally, we evaluate the literature regarding high-velocity muscle power training (PT), and its potential advantages over conventional strength training for improving functional performance and mitigating fall risk in older adults. [ABSTRACT FROM AUTHOR]