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Introduction The literature still lacks evidence about patient-reported outcome measures to fast screen the reduced physical performance of the lower body in older adults to be applied in any clinical setting as primary health care or without specific instruments in prevention campaigns, or even easy to be applied by phone. Objective: To develop a brief questionnaire to screen the lower body functional performance in community-dwelling older adults and to validate this new questionnaire with objective clinical tests. Methods A convenience sampling of 221 community-dwelling older adults was included in this cross-sectional study. The validity between Brief-LBFPQ and objective tests such as gait speed, Timed-Up and Go test (TUG), 5-Time Stand-to-Sit test (5TSST), and step test were assessed by multinominal logistic regression. Internal consistency was determined using Cronbach’s alpha and Test-retest reliability was determined using intraclass correlation coefficient (ICC) for numeral scale and Cohen’s Kappa for ordinal scale. Results Brief-LBFPQ was significantly associated with objective tests. All eight items from Brief-LBFPQ presented an absolute agreement with ICCs values above 0.7. Kappa values of Brief-LBFPQ items ranged from 0.6 to 0.83, showing substantial agreement and perfect agreement. Conclusion Brief-LBFPQ could be very useful in general clinic settings as it provides earlier screening of functional impairment in independent older adults, and consequently may allow an earlier intervention approach. Resumo Introdução A literatura ainda carece de evidências acerca de instrumentos de autorrelato para o rastreio rápido do prejuízo no desempenho físico dos membros inferiores em idosos, que possam ser aplicados em qualquer ambiente clínico, como na Atenção Básica à Saúde, e que não requeiram nenhum ins-trumento específico para campanhas de prevenção, ou mesmo de fácil aplicação por contato telefônico. Objetivo Desenvolver um breve questionário para triagem do desempenho funcional dos membros inferiores em idosos da comunidade e validar este novo questionário com testes clínicos objetivos. Métodos Uma amostra de conveniência de 221 idosos da comunidade foi incluída neste estudo transversal. A validade entre o Brief-LBFPQ e os testes objetivos como velocidade da marcha, Timed-Up and Go (TUG), teste de levantar e sentar 5 vezes (TLS5x) e teste do degrau foi avaliada pela regressão logística multinominal. A consistência interna foi determinada pelo alfa de Cronbach e a confiabilidade teste-reteste foi determinada pelo coeficiente de correlação intraclasse (CCI) para a escala numérica e o Kappa de Cohen para a escala ordinal. Resultados O Brief-LBFPQ foi significativamente associado aos testes objetivos. Todos os oito itens do Brief-LBFPQ apresentaram concordância absoluta com valores de CCI acima de 0,7. Os valores de Kappa dos itens do Brief-LBFPQ variaram de 0,6 a 0,83, mostrando concordância substancial e concordância perfeita. Conclusão O Brief-LBFPQ pode ser muito útil em diferentes ambientes clínicos, pois permite uma triagem precoce do comprometimento funcional em idosos independentes e, consequentemente, pode permitir uma abordagem de intervenção mais precoce.

OBJECTIVES To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n=465) and men (n=94). METHODS 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed

The objective was to investigate the association between rate of torque development (RTD) and torque steadiness (TS) of the lower limb and the occurrence of prospective falls in community-dwelling older adults without falls in the previous year. One hundred older adults performed the tests to obtain the RTD and TS of the hip, knee, and ankle. New episodes of falls were monitored through telephone contact for a prospective period of 12 months. The association of RTD and TS with the occurrence of prospective falls was verified by multiple logistic regression adjusted for confounding variables. There was no association between RTD of hip, knee, and ankle and prospective falls. Only the TS at 50% of the peak torque of the hip flexors was associated with the occurrence of future falls (p = .023). Identifying modifiable risk factors for the first fall in older adults is essential for the development of adequate prevention programs.

Despite the well-established role of muscle in maintaining bone mass and physical performance, there are still few studies that assess the relationship between muscle groups and specific bone sites and its contribution to physical function in older people. The aim of the study is to verify the association between hip and knee's muscle strength and bone mineral density of the femoral neck (BMD-FN) and investigated which muscle strength that are related with BMD-FN is associated with physical function in older women.This is a cross-sectional study of 94 women over the age of 60 years, physically independent. Muscle strength of the hip and knee was evaluated using an isokinetic dynamometer (Biodex, USA) to obtain peak torque (PT). The BMD-FN was obtained using dual-energy x-ray absorption densitometry (DXA). Physical function was evaluated by the Timed Up and Go (TUG), gait speed (GS), five times stand to sit (5TSS) and single-leg stance (SS). To verify the association between muscle strength (independent variable) and the BMD-FN (dependent variable) and the relationship between muscle strength (independent variable) and clinical tests (dependent variable), the multiple linear regression was carried out, adjusted for age, time of menopause, height and level of physical activity. All of the analyses were carried out by the SPSS 17.0 software, with a level of p 0.05 significance.We found an association between the hip abductors PT and the BMD-FN and between hip abductors PT and all clinical tests.We observe that hip abductor muscle strength contributes to BMD-FN and to performance in several clinical tests in older women. These findings reinforce the importance of this musculature not only for improving balance and gait, but also it can be a strategy to maintain/improve bone mass in the femoral neck in this population.

A autopercepção da dor lombar crônica inespecífica na população idosa está aumentando paralelamente às transições epidemiológicas e demográficas do envelhecimento. Pesquisa e iniciativas globais, buscam investigar a dor lombar não específica, por ser uma condição clínica que culmina com a redução da funcionalidade e representa um desafio para a saúde pública. Objetivo: Avaliar se a dor lombar crônica não específica está associada a redução do desempenho funcional em idosas da região centro-oeste do Brasil. Método: Trata-se de um estudo observacional transversal em idosas (68,9±6,99 anos) do sexo feminino, independentes e autônomas da região centro-oeste do Brasil. Características sociodemográficas, autopercepção de dor, sintomas depressivos pelo GDS, cognição, funcionalidade (Timed Up and Go e teste de sentar e levantar cinco vezes), prática de atividade física e percepção do estado de saúde foram avaliados. Resultados: foi observada relação entre a presença de dor lombar e o baixo desempenho no TUG (p=0,000) e no TSL-5x (p=0,006) mesmo depois do modelo estatístico ter sido ajustado pelas variáveis confundidoras idade, peso, altura, status cognitivo, escolaridade e GDS. Conclusão: Os resultados sugerem que a dor lombar crônica não específica prejudica a funcionalidade de idosas residentes na região centro-oeste do Brasil independentemente de fatores de risco determinantes como idade, peso, altura, MEEM, sintomas depressivos e escolaridade. Desta forma, buscar estratégias para melhorar o manejo da dor lombar crônica inespecífica na população idosa é clinicamente relevante, uma vez que pode minimizar o declínio funcional e contribuir para o envelhecimento bem-sucedido. Palavras-chave: Autopercepção; Dor lombar; Funcionalidade; Idosos.

Objective: To verify the accuracy of functional tests in identifying frail older adults in two different regions. Methods: Observational, descriptive and cross-sectional study with the participation of 120 community older adults. Fried Phenotype and Edmonton Frail Scale were used to classify the frailty and the Timed Up and Go (TUG) and gait speed tests to identify the frail older adults. Results: In Ribeirão Preto and Lagarto, frail older adults performed TUG test in a longer time than pre-frail (p = 0.001) and non-frail (p < 0.001). As for gait speed, frail older adults had lower speed than non-frail (p = 0.01). The TUG test had moderate accuracy for the identification of frail older adults in Ribeirão Preto (AUC = 0.86, 95% CI 0.78 to 0.95, p < 0.001) and in Lagarto (AUC = 0.76, 95% CI 0.64 to 0.88, p = 0.001). Gait speed, on the other hand, is not accurate to discriminate frail older adults. The cut-off points for TUG with the highest sensitivity and specificity were 11.5 seconds for both older adults living in Ribeirão Preto and Lagarto. Conclusion: The TUG was capable of identifying frail older adults of two different regions, even when two different diagnostic methods of frailty were applied, standing out as a simple screening to be used in clinical practice. Objetivo: Verificar la precisión de las pruebas funcionales en la identificación de ancianos frágiles en dos regiones diferentes. Métodos: Estudio observacional, descriptivo y transversal con la participación de 120 ancianos de la comunidad. Se utilizaron el fenotipo Fried y la Edmonton Frail Scale para clasificar la fragilidad y las pruebas Timed Up and Go (TUG) y de velocidad de la marcha para identificar a los adultos mayores frágiles. Resultados: En Ribeirão Preto y Lagarto, los ancianos frágiles realizaron la prueba TUG en mayor tiempo que los pre frágiles (p = 0,001) y los no frágiles (p < 0,001). En cuanto a la velocidad de la marcha, los ancianos frágiles presentaron menor velocidad que los no frágiles (p = 0,01). La prueba TUG tuvo precisión moderada para la identificación de ancianos frágiles en Ribeirão Preto (AUC = 0,86, IC 95% 0,78 a 0,95, p < 0,001) y en Lagarto (AUC = 0,76, IC 95% 0,64 a 0,88, p = 0,001). La velocidad de la marcha, por otro lado, no fue precisa para discriminar ancianos frágiles. Los puntos de corte del TUG con mayor sensibilidad y especificidad fueron 11,5 segundos para los ancianos residentes de Ribeirão Preto y Lagarto. Conclusión: TUG pudo identificar ancianos frágiles de dos regiones diferentes, incluso cuando se aplicaron dos métodos de diagnóstico de fragilidad diferentes, destacándose como una simple clasificación para usar en la práctica clínica. Objetivo: Verificar a acurácia de testes funcionais na identificação de idosos frágeis em duas regiões diferentes. Métodos: Estudo observacional, descritivo e transversal com a participação de 120 idosos da comunidade. Fenótipo Fried e Edmonton Frail Scale foram utilizados para classificar a fragilidade e os testes Timed Up and Go (TUG) e velocidade de marcha para identificar os idosos frágeis. Resultados: Em Ribeirão Preto e Lagarto, idosos frágeis realizaram o teste TUG em um tempo maior que pré-frágeis (p = 0,001) e não frágeis (p < 0,001). Quanto à velocidade da marcha, os idosos frágeis apresentaram menor velocidade do que os não frágeis (p = 0,01). O teste TUG apresentou acurácia moderada para a identificação de idosos frágeis em Ribeirão Preto (AUC = 0,86, IC 95% 0,78 a 0,95, p < 0,001) e em Lagarto (AUC = 0,76, IC 95% 0,64 a 0,88, p = 0,001). A velocidade da marcha, por outro lado, não foi precisa para discriminar idosos frágeis. Os pontos de corte do TUG com maior sensibilidade e especificidade foram 11,5 segundos tanto para idosos residentes em Ribeirão Preto quanto para Lagarto. Conclusão: O TUG foi capaz de identificar idosos frágeis de duas regiões diferentes, mesmo quando foram aplicados dois métodos diagnósticos diferentes de fragilidade, destacando-se como uma triagem simples para ser utilizada na prática clínica.

Made available in DSpace on 2022-04-29T08:30:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-02-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: During the walk along the streets, older adults are exposed to various visual stimuli that can affect their gait in a harmful or beneficial way. Aims: To evaluate gait strategies during different situations with and without visual stimulation in older adults to identify the influence of the visual stimulus on these gait parameters. Methods: A total of 200 older adults were divided into 4 groups according to age range between 60 and 102 years. Gait was evaluated in the following situations: (1) habitual gait (HG); (2) gait with the visual stimulation (GVS) provided by a pedestrian traffic light, and (3) GVS associated with a cognitive task (GVS-C). The GAITRite Platinum equipment was used to assess gait variables. Results: Comparison of GVS and HG revealed that the visual stimulus influences the gait parameters and promotes a gait speed increase. However, to increase their gait speed, older adults aged 60–89 years used strategies of increased step length and cadence, whereas subjects older than 90 years used only strategies of increased cadence. In addition, comparison of GVS and GVS-C revealed a decrease in gait speed in all age ranges when the cognitive task was added, although this reduction was more pronounced in subjects older than 70 years. Conclusion: Visual stimulus influences the gait parameters in older adults and the strategy used is different depending on their age, a fact that shows that traffic light may be an interesting strategy to improve the gait performance during physical therapy. Postgraduate Program in Rehabilitation and Functional Performance Department of Health Sciences Ribeirão Preto School of Medicine University of São Paulo (USP), SP Physiotherapy Course Department of Health Sciences School of Medicine University of São Paulo (USP), SP Department of Physical Therapy and Occupational Therapy School of Philosophy and Science São Paulo State University (UNESP), SP Department of Health Sciences Rehabilitation and Functional Performance Program Ribeirão Preto Medical School University of São Paulo (USP), Avenida Bandeirantes, 3900, SP Department of Physical Therapy and Occupational Therapy School of Philosophy and Science São Paulo State University (UNESP), SP FAPESP: 2012/01770-1

To establish a protocol of dance choreographies in order to determine how the regular practice of dance interferes with gait (habitual and dual-task) of community-dwelling older adults. This single-blinded parallel group randomised controlled trial will include 114 older adults divided into a dance group (DG) that will receive dancing intervention twice a week for 12 weeks, and a control group (CG) that will receive no intervention during the same period of time. The gait parameters of all participants will be evaluated in 3 moments: an initial evaluation, a re-evaluation after 12 weeks and a follow-up re-evaluation after 24 weeks. General linear model adjusted for confounding variables will be performed to compare the gait variables between groups. The intent to treat method will be applied. The study was registered in the Brazilian Registry of Clinical Trials (ReBEC) through the number RBR-4zqcyr. It is expected that the DG presents better gait parameters than does CG after the dance, and that these benefits are retained for three months after the intervention. Once the benefits of dance therapy for gait are identified, the dance protocol could be useful for strategies of health promotion and rehabilitation of older adults.

Objective To assess the effectiveness of the anchors in the balance rehabilitation of participants with chronic peripheral vestibulopathy who failed to respond positively to conventional rehabilitation for dynamic balance and gait. Design Assessor-blind, randomized controlled trial. Setting Department of Otoneurology and Laboratory of Assessment and Rehabilitation of Equilibrium. Participants Women with chronic dizziness of peripheral vestibular origin (N=42), who continued to show otoneurologic symptoms for more than 6 months after starting classic vestibular rehabilitation, with no clinical improvement observed. Interventions Participants were randomly assigned to receive a clinical intervention with the anchor system, a clinical intervention without the anchor system, or no intervention or anchor system. The intervention was based on multi-sensory exercises for 6 weeks, twice a week, totaling 12 sessions, in groups of up to 4 participants, with an average time of 40 minutes per session. Main Outcome Measures The primary outcome was functional balance as assessed by the short version of the Balance Evaluation Systems Test. The secondary outcomes were gait parameters of step width in meters, step length in meters, and gait speed in meters per second. The measures were assessed preintervention and postintervention, and after a 3-month follow-up period. Results The proposed intervention was beneficial for dizziness, balance, and gait for both groups studied. At the 3-month follow-up, only the group that used anchors retained the benefits related to the physical aspects of dizziness, balance, and gait. Conclusions The present study found that the proposed intervention protocol, with or without the use of anchors, was beneficial for improving the dizziness, balance, and gait. However, retention of the benefits achieved through the exercise protocol was observed only for those using the anchor system, which promotes the use of haptic information. The use of anchors was effective, in short protocols (12wk), with maintenance of results after 3 months.

Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass.To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture.Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer.We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgmVFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance.

BACKGROUND: In a short time, COVID-19 adopted the proportions of a pandemic. Consequently, measures as social distancing were adopted to try to slow down the spread of the disease. The objective of this study was to understand the behavior of the Brazilian older adults during a period of social restriction by Covid-19.METHODS: 61 healthy older adults participated in this study. A questionnaire was applied over 12 months from the beginning of the social restriction recommendations using only telephone contact. The questionnaire included the profile of falls during the evaluation period and 4 questions based on fear and risk of infection by Covid-19, the practice of physical activity and compliance with measures of social restriction. The chi-square test (X2) was used to observe the possible associations between the independent and dependent variables.RESULTS: Most participants were female (90.2%), with mean age of 67 years and secondary education level. 78.7% adopted social restriction measures in the first month while in the last six months 54.1% of the participants complied with restrictive measures. The analysis of the chi-square test showed significant association between the evaluation period and social restriction [X2 (2) = 22.072; p = 0.000] and the risk of being infected [X2 (2) = 17.561; p = 0.000].CONCLUSION: There was a reduction in the number of older adults who complied with social restriction over time and a decrease in the practice of physical exercises in the sample evaluated.

Low socioeconomic status has been associated with individual health-related problems; however, no study has specifically investigated the impact of socioeconomic disparities on gait performance using an index that considers the population aggregation, as the Human Development Index (HDI). Thus, the aim of the present study was to assess gait parameters of older people living in cities with differences in socioeconomic conditions, identified by HDI.Cross-sectional design study conducted with a sample of 233 older people from two Brazilians regions: Coari, state of Amazonas, Brazil (n= 124, low-HDI-Bra) and Ribeirão Preto, state of São Paulo, Brazil (n= 109, very high-HDI-Bra). The gait performance was assessed by an electronic walkway, and the interest variables were gait speed, cadence, stride time, step length and stride width.Low-HDI-Bra group presented worse gait performance as identified by slower gait speed (p = .001), slower cadence (p = .001), higher stride time (p = .001), shorter step length (p = .001), compared with the very high-HDI-Bra group. There was a positive association between HDI, and gait spend, cadence and step length, and there was a negative association between HDI and stride time and stride width.Long-term exposure to socioeconomic inequalities found in low HDI cities may impair gait performance in late life. Such information may be relevant to create public politics that use the gait parameter based on the region where the people live.

RESUMO O medo de quedas pode fazer com que o idoso desenvolva estratégias que alteram o equilíbrio semiestático e dinâmico, predispondo-o a um risco aumentado de cair. A função muscular dos abdutores e adutores de quadril tem importante papel na manutenção da estabilidade postural. Entretanto, não se sabe se idosos com medo de cair apresentam maior comprometimento na função muscular do quadril. Assim, o objetivo foi comparar o pico de torque (PT) isométrico dos músculos abdutores e adutores de quadril entre idosos com e sem medo de quedas. Os participantes foram divididos em dois grupos: com (n=81) e sem (n=81) medo de quedas. O PT dos abdutores e adutores de quadril foi obtido com dinamômetro isocinético (System 4 Pro, Biodex, Nova York, EUA). A comparação do PT dos grupos foi realizada por meio de modelo linear geral univariado, ajustado pelas covariáveis idade, sexo, índice de massa corporal, nível de atividade física e histórico de quedas, utilizando o software SPSS 17.0, com nível de significância de 5%. Não houve diferença do PT abdutor e adutor do quadril entre os grupos após análise univariada com ajustamento. Observou-se que idosos com medo de quedas não apresentam prejuízos na função muscular dos estabilizadores de quadril quando comparados a idosos sem medo de quedas. RESUMEN El miedo a caerse puede hacer que los ancianos desarrollen estrategias de alteración del equilibrio semiestático y dinámico, predisponiéndolos a un mayor riesgo de caídas. La función muscular de los abductores y de los aductores de cadera juega un papel importante en el mantenimiento de la estabilidad postural. Sin embargo, no se sabe si los ancianos con miedo a caerse tienen un mayor deterioro en la función muscular de la cadera. Por lo tanto, el objetivo fue comparar el torque máximo (TM) isométrico de los músculos abductores y aductores de cadera entre los ancianos con miedo y sin miedo a caerse. Los participantes se dividieron en dos grupos: con miedo a caerse (n=81) y sin (n=81) miedo a caerse. El TM de los abductores y aductores de cadera se obtuvo mediante la utilización del dinamómetro isocinético (System 4 Pro, Biodex, Nueva York, EE.UU.). La comparación del TM de los grupos se realizó mediante un modelo lineal general univariado, ajustado por covariables edad, género, índice de masa corporal, nivel de actividad física e historial de caídas, utilizando el software SPSS 17.0, con nivel de significancia del 5%. No hubo diferencias entre el TM del abductor y del aductor de cadera entre los grupos tras el análisis univariado con ajuste. Se observó que los ancianos con miedo a caerse no presentaron daños en la función muscular de los estabilizadores de la cadera en comparación con los ancianos sin miedo a caerse. ABSTRACT The fear of falling can cause older adults to develop strategies that alter the semi-static and dynamic balance, predisposing them to increased risk of falling. The muscular function of abductors and adductors plays an important role in maintaining postural stability. However, it is unknown whether older people with fear of falling have greater impairment in hip muscular function. Thus, the objective was to compare the isometric peak torque (PT) of hip abductor and adductor muscles among older adults with and without fear of falling. Participants were divided into two groups: with (n=81) and without (n=81) fear of falling. The PT of hip abductors and adductors was obtained with isokinetic dynamometer (System 4 Pro, Biodex, New York, USA). The PT groups were compared using general linear model univariate, adjusted for covariates age, sex, body mass index, physical activity level and history of falls, using the SPSS 17.0 software, with a significance level of 5%. No difference was found between the PT of hip abductor and adductor and the groups after univariate analysis with adjustment. We observed that older people with fear of falling have no muscle function loss of the hip stabilizers when compared with subjects without fear of falling.

Background: Frailty is an age-associated syndrome that increases the risk for loss of functional independence. The strategies to treat frailty include the improvement of weakness, physical activity...

Objective: Explore the association of cognitive decline with handgrip strength and performance in clinical functional tests of Brazilian older adults living in the community. Methodology: Cross-sectional study community-dwelling, 101 community-dwelling older adults (45 men and 56 woman) aged 60 years or older with no mobility limitation. Cross-sectional study involving 101 individuals (45 men and 56 woman) aged 60 years or older with no mobility limitation. Cognition was assessed by the 10-point Cognitive Screener (10-CS). Grip strength was assessed using a manual dynamometer. Functional performance was assessed using gait speed (single and double task) and the Timed Up and Go (TUG) test (single and double task). Results: A significant positive association was found between cognition and handgrip strength, gait speed (single and double task), TUG (single and double task), maintaining the association even after adjustments for confounding variables. Conclusion: Decline in cognitive function is associated with low handgrip strength and worse performance in clinical tests of gait speed and TUG with a single and dual task. Prevention of cognitive decline is an important modifiable condition that must be addressed in clinical practice through cognitive-motor training to prevent functional loss and promote healthy aging. Objetivo: Explorar la asociación del deterioro cognitivo con la fuerza de prensión manual y el rendimiento en pruebas clínicas funcionales de ancianos brasileños residentes en la comunidad. Metodología: Estudio transversal con residentes de la comunidad, 101 adultos mayores (45 hombres y 56 mujeres) de 60 años o más, sin limitación de movilidad, residentes en la comunidad. Estudio transversal en el que participaron 101 individuos (45 hombres y 56 mujeres) de 60 años o más y sin limitaciones de movilidad. La cognición se evaluó mediante el Cognitive Screener de 10 puntos (10-CS). La fuerza de agarre se evaluó utilizando un dinamómetro de mano. El rendimiento funcional se evaluó mediante la velocidad de la marcha (tarea simple y doble) y la prueba Timed Up and Go (TUG) (tarea simple y doble). Resultados: Se encontró una asociación positiva significativa entre la cognición y la fuerza de prensión manual, la velocidad de la marcha (tarea simple y doble), TUG (tarea simple y doble), manteniendo la asociación incluso después de los ajustes por variables de confusión. Conclusión: La disminución de la función cognitiva se asocia con una baja fuerza de prensión manual y un peor rendimiento en las pruebas clínicas de velocidad de la marcha y TUG en una y dos tareas. La prevención del deterioro cognitivo es una importante condición modificable que debe ser abordada en la práctica clínica a través del entrenamiento cognitivo-motor para prevenir la pérdida funcional y promover un envejecimiento saludable. Objetivo: Explorar a associação do declínio cognitivo com a força de preensão palmar e o desempenho em testes clínicos funcionais de idosos brasileiros residentes na comunidade. Metodologia: Estudo transversal de moradores da comunidade, 101 idosos da comunidade (45 homens e 56 mulheres) com 60 anos ou mais sem limitação de mobilidade. Estudo transversal envolvendo 101 indivíduos (45 homens e 56 mulheres) com 60 anos ou mais e sem limitação de mobilidade. A cognição foi avaliada pelo Cognitive Screener de 10 pontos (10-CS). A força de preensão foi avaliada usando um dinamômetro manual. O desempenho funcional foi avaliado por meio da velocidade da marcha (tarefa simples e dupla) e do teste Timed Up and Go (TUG) (tarefa simples e dupla). Resultados: Foi encontrada associação positiva significativa entre cognição e força de preensão manual, velocidade de marcha (tarefa simples e dupla), TUG (tarefa simples e dupla), mantendo a associação mesmo após ajustes para variáveis ​​de confusão. Conclusão: O declínio da função cognitiva está associado à baixa força de preensão manual e pior desempenho nos testes clínicos de velocidade da marcha e TUG com uma e dupla tarefa. A prevenção do declínio cognitivo é uma importante condição modificável que deve ser abordada na prática clínica por meio do treinamento cognitivo-motor para prevenir a perda funcional e promover o envelhecimento saudável.

The objective of this study was to compare the functional performance of community-dwelling older adults of both sexes and investigate the possible mediation aspects that may influence the sex differences regarding socioeconomic and anthropometric characteristics, health status, and quadriceps muscle strength. 233 Brazilian older adults were assessed, and men's and women's sociodemographic data, physical activity level, quadriceps muscle strength, functional performance (gait speed and the SPPB), and history of falls were compared. Sex differences in functional performance were observed even after statistically adjusting the model (age, body mass, income, physical activity level, and occurrence of falls). When quadriceps muscle strength was included in the adjusted model, the sex difference remained only for gait speed. When stature was included in the adjusted model, the sex difference in gait speed disappeared. Our results suggest that the sex difference in functional performance assessed by the SPPB can be explained due to the fact that men are stronger than women. In addition, the sex difference regarding gait speed was explained by the sex difference in stature. Public actions that encourage older women to practice physical activities that promote increased muscle strength can positively interfere with their best functional performance for as long as possible.

Background Understanding of the influence of trunk muscles on the older adult's limit of stability (LOS) is important for clinical practice. Objective To compare the anterior and posterior LOS and the flexor and extensor trunk muscle function; verify the association of trunk muscles and LOS, and the association of LOS and the previous falls of community-dwelling older adults. Methods Sample characterization data, trunk muscle function (peak torque - PT and torque steadiness - TS), LOS and previous falls (6 months) were collected from 79 older people. Comparisons were made between the variables of the anterior/posterior LOS (Reaction time, Movement velocity, Maximum excursion, Directional control), between trunk extensors/flexors muscle function and between TS at 10% and at 50%. Associations were made between the anterior/posterior LOS and the number of previous falls and between LOS and trunk muscle function. Results The posterior LOS was worse than the anterior LOS, except for the reaction time. The flexor muscles obtained a lower PT, but better performance in TS. The TS at 10% of the trunk extensor was associated with the posterior directional control (p = 0.032). There was no association between trunk muscle function and the anterior LOS, or between previous falls and LOS. Conclusions The older adults presented worse performance in the posterior LOS and worse TS in the trunk extensor muscles, although the trunk extensor muscles presented a higher PT. Although no association between LOS and previous falls, the better the TS at 10% of the trunk extensors, better posterior directional control.

Made available in DSpace on 2021-06-25T10:47:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To compare the parameters of gait kinematics of older adults with cognitive impairment who live in community dwellings or those living or spending most of the time in non-family environment settings. Methods: The sample was composed of 33 older adults of both sexes with cognitive impairment. Participants were separated into three groups: a community-dwelling older adult group comprised of 11 subjects; a semi-institutionalized older adult group comprised of 10 older adults attended in a geriatric daycare institution; and an institutionalized older adult group comprised of 12 older adults living in long-term institutions. Gait kinematics were recorded by pressure sensors (footswitches). Fifty gait cycles at self-selected pace were analyzed to obtain: gait speed, stride length, stance, swing, and stride time. The variability of these parameters was also analyzed. Results: MANCOVA identified the main effect of groups (p < 0.001). Gait speed of older adults living in long-term institutions and older adults attended in geriatric daycare institutions was slower than community-living older adults (p < 0.001 and p = 0.04, respectively). Swing and stride time variability was higher in older adults living in long-term institutions (p = 0.003 and p = 0.001) and in older adults attended in geriatric daycare institutions (p = 0.02 and p = 0.001) than in community-dwelling older adults. Conclusion: The most important finding was that older adults with cognitive impairment who need non-family residential setting care had higher gait kinematics abnormalities, which may increase the risk of falls, compared to those who live in the community. Health Science Center Sacred Heart University USC Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP Marilia Medical School FAMEMA Department of Health Science Ribeirão Preto Medical School University of São Paulo USP Department of Physical Therapy and Occupational Therapy São Paulo State University UNESP FAPESP: 2014/07722-3 FAPESP: 2016/02727-3 FAPESP: 2016/02728-0

The objective of the present study was to evaluate the association of hip muscle strength, dynamic balance and functional capacity in the older adults aged 60 to 79 years and older adults aged 80 years and older. A total of 191 community-dwelling older adults participated in this study. Isometric muscle strength was quantified as the peak torque (PT), measured using an isokinetic dynamometer. Functional capacity was determined by the forward step test (ST) and the dynamic balance by the tandem gait (TG) test. The hip flexor, extensor, abductor and adductor PT in the older adults aged 60 to 79 years had a positive influence on the execution of the step test (p 0.05). The peak adductor torque did not show a significant association with tandem gait (p = 0.649). In older adults aged 80 years and older, the peak adductor torque was the only one that showed an association with the performance of the ST (p = 0.001) and TG (p = 0.024) tests. The hip adductors may have a higher contribution in adults aged 80 years and older during the execution of clinical tests. These findings are relevant to clinical practice as they can help in the development of appropriate physical exercise programs targeting older adults of different age groups.

Objectives To assess the Balance Evaluation Systems Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) test and gait speed to determine which is the most appropriate test for identification of adults aged ≥80 years at higher risk of falls, and to investigate the clinical usefulness of the combination of such tests by cumulative post-test probability (PoTP) for predicting the risk of falls. Design Longitudinal prospective study. Participants Ninety-eight older adults (aged 80–102 years). Interventions Older adults were submitted to the clinical tests and followed-up in order to record the occurrence of falls. The capacity of the clinical tests to detect which older adults are at higher risk of falls was measured using the receiver operating characteristic curve, followed by calculation of PoTP for predicting the risk of falls. Results The BESTest and the Mini-BESTest demonstrated the best PoTP for predicting the risk of falls for a positive test (70%), followed by the TUG test (66%) and gait speed (63%). When performed in combination, a positive result on the TUG test, gait speed and Mini-BESTest increased the probability of older adults falling within the next 6 months from 50% to 89%; a negative result on these three tests decreased the probability of older adults falling within the next 6 months from 50% to 3%. Conclusion The combination of TUG test, gait speed and Mini-BESTest provided the best approach. If all three tests are positive, there is an 89% chance of identifying an older person at risk of falling. If all three tests are negative, there would only be a 3% chance of obtaining a false-negative result.

Objective The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. Methods In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. Results Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. Conclusion The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. Impact Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

Made available in DSpace on 2020-12-12T01:58:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-04-01 ASCRS Research Foundation Safe street crossing is important for older adults' social inclusion. We assessed gait kinematic adaptation under different simulated street crossing conditions in older adults with Parkinson's disease (PD) and made comparisons with older adults without PD to understand how PD interferes in outdoor task performance, helping in the development of strategies to reduce road traffic accident risk. In 20 older adults without PD (control group – CG) and 20 with PD (GPD), we assessed usual gait (C1), gait during street crossing simulation (C2), and gait during reduced-time street crossing simulation (C3). Velocity, step length, and step, swing, stance, and double support time were analyzed. Spatiotemporal differences in gait between groups and conditions were analyzed. The GPD walked 16% slower in C1 and 12% slower in C2 and C3 than the CG. GPD also took 11% shorter steps in C1 and 9.5% shorter steps in C2. The double support time was 8.5% greater in C1. In intragroup comparisons, there were significant differences in all gait conditions. The CG showed increased velocity (C2 15% > C1; C3 13% > C2; C3 26% > C1), step length (C2 8% > C1; C3 5% > C2; C3 13% > C1), and swing time (C2 2% > C1; C3 3.7% > C2; C3 6% > C1), and decreased step time (C2 7.5% < C1; C3 8% < C2; C3 15% < C1), stance time (C2 1.3% < C1; C3 2.5% < C2; C3 3.6% < C1), and double support time (C2 6.3% < C1; C3 10.5% < C2; C3 16% < C1). GPD showed increased velocity (C2 19% > C1; C3 13.5% > C2; C3 29.7% > C1), step length, (C2 6% > C1; C3 7% > C2; C3 16% > C1), and swing time (C2 3% > C1; C3 3% > C2; C3 5.5% > C1) and decreased step time (C2 10.3% < C1; C3 7.7% < C2; C3 17% < C1), stance time (C2 1.7% < C1; C3 1.7% < C2; C3 3.4% < C1), and double support time (C2 7% < C1; C3 9.5% < C2; C3 16% < C1). Kinematic changes observed in the intergroup comparison show that participants with PD had lower velocity in all conditions. However, per the intragroup results, both participants with and without PD managed to significantly modify gait variables to attempt to cross the street in the given time. It is necessary to assess whether this increases fall risk by exposing them to road traffic accidents. Institute of Biosciences São Paulo State University (UNESP), Avenida vinte e quatro A, 1515 Faculty Anhanguera of Jundiaí Rua do Retiro 3000 Faculty of Higher Education of Interior São Paulo (FAIP), Avenida Antonieta Altenfelder, 65 Laboratory of Assessment and Rehabilitation of Equilibrium Department of Biomechanics Medicine and Rehabilitation of the Locomotor System School of Medicine of Ribeirão Preto University of São Paulo, Avenida Bandeirantes, 3900 Faculty of Physical Education and Physiotherapy Federal University of Amazonas, Avenida General Rodrigo Octavio Jordão Ramos, 1200 Department of Physical Therapy and Occupational Therapy School of Philosophy and Science São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737 Institute of Biosciences São Paulo State University (UNESP), Avenida vinte e quatro A, 1515 Department of Physical Therapy and Occupational Therapy School of Philosophy and Science São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737 ASCRS Research Foundation: 2012/01770-1

Objective to investigate the accuracy of the step test (ST) to evaluate total lower limb muscle strength (LLMS) in older women. Design observational cross-sectional study. Methods 119 community-dwelling older women were submitted to the ST and LLMS evaluation (isometric peak torque of eight muscle groups of the dominant lower limb). The capacity of the ST to discriminate older women with reduced LLMS was measured using ROC curve, followed by the posttest probability (PoTP) calculation. Results a ST score of 0.24 cm per cm of participant's height presents a sensitivity of 63.3%, specificity of 77%; enhances the PoTP from 48% to 72% for positive test and decreases the PoTP from 48% to 31% for negative test. Conclusion the ST may complement the clinical screening of reduced LLMS in older women, given that it is a simple and quick low-cost test and allows the evaluation of each lower limb separately.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls ( p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.

Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD

Introduction One of the main risk factor for falls is a history of falls itself. Henceforth, preventing a fall is an important strategy for the prevention of new ones. The objective of the present study was to determine whether personal self-perception questions and functional tests might represent risk factors for a fall during the year following a year without any falls among independent community-dwelling older adults, considering a period of 12 prospective months. Methods A total of 101 community-dwelling older adults without a fall in the previous year underwent an initial evaluation (sample characterization, self-perception questionnaire and functional tests) and monthly monitoring of prospective fall episodes by telephone contact. We determined the association between the occurrence of prospective falls (dependent variable) and personal questions and functional tests (independent variables) with multiple binary logistic regression adjusted for confounding variables. Results Only age (p = 0.005) and self-perception of general health (p = 0.019) showed association with the occurrence of prospective falls. Conclusion Our results showed that the only factors bearing an association with the occurrence of prospective falls were age and general health self-perception, which demonstrates the importance of administrating self-perception measures in clinical practice or in epidemiological studies for the prevention of a fall during the year following a year without any falls in older adults.

Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

Background Hip abductor muscles are important for the maintenance of postural stability, mainly on the mediolateral direction and unipodal support conditions. The objective of the present study was to evaluate the effect of unilateral induced fatigue of hip abductor muscles on balance and functional capacity of older women. Methods The study included physically independent women aged 60–75 years. We assessed static balance with the single limb stance test (SLS) and evaluated functional capacity with the maximum gait speed (MGS) and step test (ST). We ran the protocol of hip abductor muscle fatigue with a Biodex isokinetic dynamometer. Assessment of balance and functional capacity happened before and after the muscle fatigue protocol. We applied the t-test for repeated measures to determine whether unilateral hip abductor muscle fatigue influences the performance in the tests (SLS, MGS and ST). Results The protocol of hip abductor muscle fatigue negatively affected all three evaluated tasks: SLS (p = 0.000), ST (p = 0.000) and MGS (p = 0.000). However, the single limb stance test was the most task affected (effect size = 0.51, pre- and post-fatigue difference = 28.1 %). Conclusion After the unilateral muscle fatigue of hip abductors, we observed the worst performance on clinical tests, mainly regarding the SLS test, which shows the involvement of hip abductors during usual motor tasks. However, the small magnitude of the limitation of functional tests (MGS and ST) suggests the presence of postural compensations.

Objective: To evaluate the effects of individual and combination therapies (low-level laser therapy and physical exercises) on pain, stiffness, function, and spatiotemporal gait variables in subjec...

The aim of the present study was to investigate levels of physical activity and risk factors for inactivity in older adults living in an urban area in the interior of the Amazonas state, Brazil. Data were collected between 2013 and 2015 from 274 individuals 60 years of age or older who resided in the interior of the Brazilian Amazon. Sociodemographic, general health, functional capacity and physical performance were associated with self-referred physical activity level. A multivariate analysis, after adjustment, showed that being a man, having a body mass index above 27kg/m2, never having lived in riverside communities and having less than three associated chronic diseases were independent risk factors for low levels of physical activity among elderly residing in the interior of the Brazilian Amazon. Few studies have been conducted about the characteristics that are singular to this population. Our results suggest that the physical activity level and, consequently, the aging process of the elderly is influenced by where they have resided throughout their lives. Additionally, the results showed particular risk factors associated with low physical activity level among older adults residing in the interior of the state of Amazonas.

Typically, falls in older adults occur when 2 tasks are performed simultaneously, due to the increased motor demand required to maintain stability and attention to perform the other task. The authors' purpose was to investigate walking while grasping, transporting, and placing a dowel on a predetermined target while manipulating difficulty levels of the manual task. Faller and nonfaller older adults performed a walking block (manual tasks combined with gait) and a stationary block (upright stance combined with manual tasks). The manual task involved grasping, transporting, and placing the dowel over a target. The results showed that fallers underperformed when compared with nonfallers in the task of placing the dowel over the target. The main difference observed between the groups was found in the condition that required allocation of attention between tasks and greater accuracy in the final placement of the object. Fallers showed gait stability similar to the nonfallers, but fallers were less accurate than nonfallers in the object placement task, especially for the highest level of difficulty. Thus, fallers seem to use a stability-first strategy. Fallers had problems in executing the manual tasks, which suggests a more global change in motor behavior rather than specific changes to balance control.

Objective: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Methods: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p

Human gait has been widely investigated under dual-task conditions because it has been demonstrated to be an important way to uncover differences in gait biomechanics between older fallers and non-fallers. However, exactly how simultaneous tasks affect the kinematics of walking remains unclear. In the present study, gait kinematic properties of older fallers and non-fallers were compared under cognitive and motor dual-task conditions. The gait kinematic properties of interest were recorded under three different conditions: walking at preferred speed, walking when performing a cognitive task (naming animals), and walking when performing a motor task (transferring a coin from one pocket to the other). The following variables were analyzed: gait speed, cadence, stride time, step length, single support, stride time variability, and the dual-task cost. In addition, functional balance was evaluated by means of the Balance Evaluation - Systems Test (BESTest). Two-way repeated-measures ANOVAs revealed significant main effects of walking conditions. However, no significant main effects of group (fallers vs. non-fallers) and no significant interaction effects between group and walking condition were observed. The BESTest revealed that functional balance in fallers was worse than in non-fallers. The cognitive task leads to more significant changes in gait kinematics than does a motor task and the step length and stride time variability were variables more sensitive to that cognitive influence.

The prevalence of sexual dysfunction in postmenopausal women is high. Theoretically pelvic floor muscle (PFM) strength could influence sexual function, but to date there is scant evidence on this topic. The aim of this study was to evaluate the relationship between PFM strength and sexual function in postmenopausal women. The relationship between reported urinary incontinence (UI) and sexual dysfunction was also investigated. This was a cross-sectional study including 113 postmenopausal women. PFM strength was evaluated using vaginal manometry. Sexual function was evaluated using the Female Sexual Function Index (FSFI). A score of ≤26.5 was considered to indicate sexual dysfunction. Urinary incontinence reports were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) Short Form. Statistical analysis was performed using Spearman’s rank correlation coefficient (ρ), the Mann–Whitney test and 95 % confidence intervals. The median age of the women was 53 years (range 42 – 65 years) and their median body mass index was 27.9 kg/m2 (range 20 – 42 kg/m2). Women without sexual dysfunction showed significantly higher PFM strength (median 41.8, range 11.3 – 94.0 cmH2O) than women with sexual dysfunction (median 30.3, range 3 – 112 cmH2O; p = 0.02). A weak correlation was found between the total FSFI score and the total ICIQ-UI score (ρ = −0.21, p = 0.03). Postmenopausal women with sexual dysfunction showed lower PFM strength than women without sexual dysfunction. There was a weak correlation between urinary incontinence severity and sexual function.

O uso de um dispositivo auxiliar da marcha (DAM), como bengala ou andador, pode auxiliar os idosos na realização de suas atividades diárias, mantendo-os funcionalmente independentes e relativamente ativos. Porém, a utilização inadequada, o mau estado e as dimensões incorretas do dispositivo, assim como erros na prescrição do tipo de dispositivo podem aumentar o risco de quedas nos idosos usuários de DAM. Diante da falta de recomendações quanto à sua prescrição, o objetivo desse artigo é discorrer sobre os pré-requisitos para a prescrição de cada dispositivo (bengala e andador), de acordo com a nossa experiência adquirida na Área de Fisioterapia em Gerontologia, no Centro de Reabilitação (CER) do Hospital das Clínicas de Ribeirão Preto, considerando as evidências científicas disponíveis até o momento. Assim, com a difusão das informações contidas nesse artigo para os profissionais da saúde que prestam assistência a idosos, espera-se aprimorar a prática de prescrição do DAM e de educação do idoso, de seus familiares e cuidadores, a fim de que sejam alcançados os benefícios do uso de um DAM e prevenidos os possíveis eventos adversos, como as quedas.