Older Adults, Fall Patients
Conditions
Keywords
balance, gait, variability
Brief summary
The overall goal of this research is to compare the effects of two different exercise programs on gait function in older adults. The investigators want to determine if participation in lateral stepping exercise program for six weeks will improve gait functions compared to forward walking exercise program.
Detailed description
The overall goal of this research is to compare the effects of two different exercise programs on gait function in older adults. It is expected that improved control of foot placement in the lateral stepping task will transfer to improved control during typical forward walking. Moreover, it is expected that lateral stepping gait training will have a greater effect on recurrent fallers older adults than on the non-fallers older adults and young adults. It is also expected that the above beneficial results will be retained in a follow-up test six weeks after completion of the intervention and will result in improvements in common clinical balance tests that are used to assess fall risk. Therefore, in the current proposal, older adults aged 65 years of age and over are being asked to participate.
Interventions
BEHAVIORALLateral stepping
Subjects will step laterally, changing direction every 10 m, thus alternating lead and lag limbs.
BEHAVIORALForward walking
Subjects will have a typical forward walking
Sponsors
National Institute of General Medical Sciences (NIGMS)
University of Nebraska
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Older adults will be screened and will be randomly assigned to three groups - (i) non-fallers, (ii) recurrent fallers - control group, and (iii) recurrent fallers - intervention group. A fourth group consisted of healthy young adults. This group will receive lateral stepping intervention and outcomes will be measured as a reference.
Eligibility
Sex/Gender
ALL
Age
19 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
Subjects must * be aged between 19 and 35 for the young adult group * be over 65 years of age for the older adult groups * be independently residing in the community * be able to provide informed consent * be able to walk independently without an assistive device or 30 minutes in three-minute sections interspersed with rest periods. The older participants must either have sustained two or more falls in the past year (i.e. Fallers) or not have sustained any falls in the past year (i.e. Non-Fallers).
Exclusion criteria
* Neurological disorder or progressive neurologic condition - epilepsy, Alzheimer disease and other dementias, stroke, multiple sclerosis, Parkinson's disease, brain infections, brain tumors. * Movement disorder - ataxia, dystonia, Huntington's disease, myoclonus, Parkinson disease, progressive supranuclear palsy, Wilson disease. * History of Cardiovascular events this includes any history of heart problems (such as heart attack, chest pain, or conditions which affect the heart's muscles, valves, or rhythm) * Current injury or moderate to severe pain affecting the lower limbs, pelvis, back, trunk. * Surgery within the past 6 months. * Current participation in any other study that involves walking, balance, or training. Medications will not prevent inclusion in the study however they will be recorded to enable consideration in subsequent post-hoc analyses.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Berg Balance Test (BBS) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The Berg Balance Test (14 items, max score: 56) is used to measure the functional balance in older adults. It consists of 14 tasks performed in a standardized order with each task scored on a five-point scale according to quality or time ranging from 0 (lowest level of function) to 4 (highest level). |
| Stride time variability | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The standard deviation of stride time. Stride time was measured as the time between 2 consecutive ipsilateral heel strikes. |
| Stance time variability | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The standard deviation of stance time. Stance time was measured as the time elapse during the stance phase of a leg. |
| Step width variability | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The standard deviation of step width. Step width was measured as the mediolateral distance between the locations of the sequential left and right heel strikes |
| Step length variability | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The standard deviation of step length. Step length was measured as the anteroposterior distance between the locations of the sequential left and right heel strikes. |
| Timed-Up-and-Go (TUG) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The Timed-Up-and-Go test is used to assess mobility in older adults. It measures the time to get up from chair, walk 3 m, turn around, walk back, and sit down |
| Swing time variability | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The standard deviation of swing time. Swing time was measured as the time elapse during the swing phase of a leg. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Walking speed | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | Self-selected forward walking and sideways walking speed |
| Falls Efficacy Scale-International (FES-I) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The Falls Efficacy Scale-International (FES-I) questionnaire (16 items, max score: 64) is used to assess confidence in the performance of activities relevant to daily life. Participants rate 16 individual activities on a scale from 1 (not at all concerned) to 4 (very concerned). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Mini-Mental State Examination (MMSE) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The Mini-Mental State Examination (MMSE) (11 items, max score: 30) is used to measure cognitive impairment. It consists of 11 questions grouped into 7 cognitive tasks. A score of 30 suggests no presence of cognitive impairment. |
| Geriatric Depression Scale - short form (GDS) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The Geriatric Depression Scale - short form (GDS) (15 items, max score: 15) is used to measure self-rated depressive symptoms of depression. A score of 5 or more suggests depression. |
| Brief Pain Inventory - short form (BPI) | Baseline and Post-Intervention: immediate, and 6 weeks after the completion of the intervention | The short form of Brief Pain Inventory score (BPI) (4 Pain severity items, max score: 40; 7 Pain interference items, max score: 70) is used to measure the impact of pain on daily functions. Higher score suggests higher pain intensity (severity), and/or higher impact of pain on functioning (interference). |
Countries
United States
Outcome results
None listed