Just when the hell do we get the same for stroke? Without an objective assessment of your movement disabilities your therapists will NEVER be able to give you proper protocols to fix those disabilities. I don't give a shit that this is not available now. GET THERE! I had a PT who demonstrated proper walking for me to follow. Useless, since he had absolutely no suggestions or protocols to fix my gait. Left him, not that the next one was any better.
Mobility assessment in people with Alzheimer disease using smartphone sensors
Journal of NeuroEngineering and Rehabilitationvolume 16, Article number: 103 (2019)
Abstract
Background
Understanding the functional status of people with Alzheimer Disease (AD), both in a single (ST) and cognitive dual task (DT) activities is essential for identifying signs of early-stage neurodegeneration. This study aims to compare the performance quality of several tasks using sensors embedded in an Android device, among people at different stages of Alzheimer and people without dementia. The secondary aim is to analyze the effect of cognitive task performance on mobility tasks.Methods
This is a cross-sectional study including 22 participants in the control group (CG), 18 in the group with mild AD and 22 in the group with moderate AD. They performed two mobility tests, under ST and DT conditions, which were registered using an Android device. Postural control was measured by medial-lateral and anterior-posterior displacements of the COM (MLDisp and APDisp, respectively) and gait, with the vertical and medial-lateral range of the COM (Vrange and MLrange). Further, the sit-to-stand (PStand) and turning and sit power (PTurnSit), the total time required to complete the test and the reaction time were measured.Results
There were no differences between the two AD stages either for ST or DT in any of the variables (p > 0.05). Nevertheless, people at both stages showed significantly lower values of PStand and PTurnSit and larger Total time and Reaction time compared to CG (p < 0.05). Further, Vrange is also lower in CDR1G than in CG (p < 0.05). The DT had a significant deleterious effect on MLDisp in all groups (p < 0.05) and on APDisp only in moderate AD for DT.Conclusions
Our findings indicate that AD patients present impairments in some key functional abilities, such as gait, turning and sitting, sit to stand, and reaction time, both in mild and moderate AD. Nevertheless, an exclusively cognitive task only influences the postural control in people with AD.Introduction
Alzheimer’s disease (AD) is the primary cause of irreversible dementia among elderly people [1].
The clinical hallmark of early AD is episodic memory impairment, which
is accompanied by changes in executive control, predominantly inhibitory
control [2, 3].
This executive control deficit and the hyperexcitability of the motor cortex affect gait [3, 4]. Accordingly, several studies have suggested that changes in gait might precede AD diagnostic [6, 7]. Overall, people with AD present lower gait speed [8], shorter stride length [8, 9] and greater stride time variability [10] than their healthy counterparts. Further, these alterations in the kinematic parameters of gait have been previously associated with an increased risk of falls in this population [11].
This implies the necessity of assessing functional tasks such as gait and other more complex daily life activities (DLA) that require neuromuscular coordination planning (i.e. sitting down and getting up from a chair or turning around) in this population. This mobility function monitoring could help to predict the physical progression of the disease, since these tasks require from the integrative function, both cognitive and behavioral components, and are the basis of the ability to manage independent DLA [5]. However, these functional activities, in a real context, are not usually conducted alone but are performed simultaneously with other activities whose execution also require attention; this is known as dual tasking. Carrying out different tasks simultaneously, with diligence, requires a constant shift of the attention between the primary task (gait) and the secondary task [12]. Nevertheless, as reported, attention control, specifically the ability to divide attention in this population, is impaired [13], and also it is the prioritization of gait when performing the secondary task [5], so dual-task mobility assessment becomes even more relevant for them.
Establishing clinical markers that could predict functional mobility status in people with AD, both in single-task and dual-task activities, is important to identify subtle signs of early-stage neurodegeneration in order to understand the early neuropathological changes, prevent physical decline and better plan the treatment protocols. It is known that earlier intervention is likely to be more effective and may truncate the ill effects of secondary events due to inflammatory, oxidation, excitotoxicity, and apoptosis [14]. Further, treatment programs including dual-task activities, promoting change in attention’ prioritization, can improve mobility function and therefore reduce the risk of falling [5].
There are several ways to perform functional assessments, however, due to the cognitive condition of this population, auto-reported questionnaires are not the best option. By contrast, objective tests are more appropriate in these patients, preferably short tests because of their attention control impairment [15]. In this regard, some studies have used the Timed-Up and Go test in this population because it is simple and quick [16] and includes, besides walking in a straight line, other tasks such as turning or rising from a chair that require more cognitive resources than just walking [17]. Nevertheless, in general, the resultant variable of this test is the time to complete it [9], even when a modified version of TUG is used [17].
To obtain more information, not only about the speed but also about the quality of movement in this population, other studies have conducted the assessments using likewise objective, yet more sophisticated mechanisms, such as video cameras [8, 9] or pressure sensor devices [6, 18]. Nevertheless, this approach, although necessary to assess the functionality of these patients, requires the use of expensive tools, high-level training of the clinical personnel conducting the assessments and is thus constrained to the laboratory environment.
Based on the above, this study aims to compare the performance quality of several tasks included in a simple mobility test using sensors embedded in an Android device, among people at different stages of Alzheimer and people without dementia. We further analyzed the effect of cognitive task performance on the functionality.
More at link.
This executive control deficit and the hyperexcitability of the motor cortex affect gait [3, 4]. Accordingly, several studies have suggested that changes in gait might precede AD diagnostic [6, 7]. Overall, people with AD present lower gait speed [8], shorter stride length [8, 9] and greater stride time variability [10] than their healthy counterparts. Further, these alterations in the kinematic parameters of gait have been previously associated with an increased risk of falls in this population [11].
This implies the necessity of assessing functional tasks such as gait and other more complex daily life activities (DLA) that require neuromuscular coordination planning (i.e. sitting down and getting up from a chair or turning around) in this population. This mobility function monitoring could help to predict the physical progression of the disease, since these tasks require from the integrative function, both cognitive and behavioral components, and are the basis of the ability to manage independent DLA [5]. However, these functional activities, in a real context, are not usually conducted alone but are performed simultaneously with other activities whose execution also require attention; this is known as dual tasking. Carrying out different tasks simultaneously, with diligence, requires a constant shift of the attention between the primary task (gait) and the secondary task [12]. Nevertheless, as reported, attention control, specifically the ability to divide attention in this population, is impaired [13], and also it is the prioritization of gait when performing the secondary task [5], so dual-task mobility assessment becomes even more relevant for them.
Establishing clinical markers that could predict functional mobility status in people with AD, both in single-task and dual-task activities, is important to identify subtle signs of early-stage neurodegeneration in order to understand the early neuropathological changes, prevent physical decline and better plan the treatment protocols. It is known that earlier intervention is likely to be more effective and may truncate the ill effects of secondary events due to inflammatory, oxidation, excitotoxicity, and apoptosis [14]. Further, treatment programs including dual-task activities, promoting change in attention’ prioritization, can improve mobility function and therefore reduce the risk of falling [5].
There are several ways to perform functional assessments, however, due to the cognitive condition of this population, auto-reported questionnaires are not the best option. By contrast, objective tests are more appropriate in these patients, preferably short tests because of their attention control impairment [15]. In this regard, some studies have used the Timed-Up and Go test in this population because it is simple and quick [16] and includes, besides walking in a straight line, other tasks such as turning or rising from a chair that require more cognitive resources than just walking [17]. Nevertheless, in general, the resultant variable of this test is the time to complete it [9], even when a modified version of TUG is used [17].
To obtain more information, not only about the speed but also about the quality of movement in this population, other studies have conducted the assessments using likewise objective, yet more sophisticated mechanisms, such as video cameras [8, 9] or pressure sensor devices [6, 18]. Nevertheless, this approach, although necessary to assess the functionality of these patients, requires the use of expensive tools, high-level training of the clinical personnel conducting the assessments and is thus constrained to the laboratory environment.
Based on the above, this study aims to compare the performance quality of several tasks included in a simple mobility test using sensors embedded in an Android device, among people at different stages of Alzheimer and people without dementia. We further analyzed the effect of cognitive task performance on the functionality.
More at link.
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