None listed
Conditions
Brief summary
This research project will investigate the feasibility and acceptability of combined Errorless Learning (EL) and Spaced Retrieval (SR) techniques in a safe transfer program to improve gait and prevent falls in adults aged 65 and over with mild to moderate cognitive impairment and higher level gait disorders. The assessments and intervention will be conducted at participants' home by a senior occupational therapist who is a co-investigator of the study. The 3 week intervention program starts with more intensive therapy in week 1 (4 sessions, 30min each session) and gradually decreases the intensity in week 2 (2 sessions, 30min each session) and week 3 (1 session, 30min each session). Following demonstration of the transferring task by the therapist, participants are provided with verbal cues prior to each step when performing the task (EL) and the time intervals between each session gradually increase (SR). The transfer training practice will be generalised into real life activities in week 2 and week 3 of the program. Follow up assessments at 3 months post intervention will also be conducted at the participants home. This project will form the pilot study for a larger multi-centre clinical trial, which will assess the long-term effect of this novel falls prevention program targeting older adults with cognitive impairment and higher level gait disorders.
Interventions
The 3 week intervention program uses combined Errorless Learning (EL) and Spaced Retrieval (SR) techniques to improve safety in transfers. A transfer is defined as a person moving from one position to another, such as standing up from a chair, getting in or out of a bed, etc. The intervention will be delivered by a senior occupational therapist with 13 years clinical experience. It starts with more intensive therapy in week 1 (4 sessions, 30 minutes each session) and gradually decreases the inte
The 3 week intervention program uses combined Errorless Learning (EL) and Spaced Retrieval (SR) techniques to improve safety in transfers. A transfer is defined as a person moving from one position to another, such as standing up from a chair, getting in or out of a bed, etc. The intervention will be delivered by a senior occupational therapist with 13 years clinical experience. It starts with more intensive therapy in week 1 (4 sessions, 30 minutes each session) and gradually decreases the intensity in week 2 (2 sessions, 30 minutes each session) and week 3 (1 session, 30 minutes each session). The sessions are one on one and are carried out at participants' home. The therapist demonstrates the transferring task in 3 steps: initiate walking after standing up from a chair, walk 3-metre distance and back, approach the chair and plan sitting. The instruction "take big steady steps" is emphasised at each step by the therapist. Following the demonstration, participants are provided with verbal cues/instructions prior to each step when performing the task to prevent errors (for example, small, shuffling gait) from happening (EL) and the time intervals between transfer practice sessions gradually increase (SP). The transfer training practice will be generalised into real life activities such as getting in/out of bed, getting on/off toilet seat, getting in/out of lounge chair and getting on/off garden chair, in week 2 and week 3 of the program.
Sponsors
Weihong Zhang
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Community dwelling adults aged 65 years and over * History of falls within the last 3 years * Higher-level gait disorders: characterised by slow gait, postural instability and one of the following styles/patterns of gait: - Start hesitation - Shuffling steps with little lifting of the feet - Shallow and short steps - Stepping not fluent - Stepping with various stride length - Wide base - Cautious gait * Able to mobilise with or without walking aid independently * Cognitive screening: - All participants will be screened with RUDAS, a score of 18-26/30 is for inclusion. - If RUDAS score is>=27/30 (normal range), a more sensitive tool MoCA will be used and a score of <26/30 is for inclusion. * Informed consent obtained from patient or primary carer/person responsible. A person responsible is required if RUDAS is <=20/30.
Exclusion criteria
* Unstable medical conditions * Impaired ability to engage in intervention: inability to comprehend or follow simple task instructions, acute confusional state (e.g. delirium), active depression or other psychiatric disorders, severe behavioural disturbances * Gait disorders with known neurological causes, e.g. Parkinson's Disease, cerebellar ataxia, hemiparetic gait, etc. * Residents at Aged Care facilities who receive high level care * Cognitively intact patients, i.e. MoCA >=26/30
Outcome results
None listed