This study describes and contrasts the kinematics and kinetics of stair ambulation in people with chronic stroke and healthy control subjects. Three-dimensional motion data were collected from 10 persons with stroke (7 males) and 10 sex and age-matched older adults as they ascended and descended an instrumented staircase at self-selected speed with and without a handrail. Ankle, knee and hip joint angle and moment profiles were generated during stance and range of motion and peak moments were contrasted between groups, sides (stroke only) and condition. Cadence was lower in stroke than controls, although the kinematic profiles appeared similar during ascent and decent. Notable differences in joint kinetics were evident as the peak extensor moments were typically lower on the affected side in stroke compared with controls and the less affected side. These differences accounted for the lower magnitude net extensor support moment. The lower affected side hip abductor moments likely limited lateral stability. Handrail use tended to reduce the peak moments on the affected side only leading to more side-to-side differences than occurred without the handrail. The findings reveal differences in task performance between stroke and healthy groups that help inform rehabilitation practice.
Alison C. Novak and Brenda Brouwer
Ursina Arnet, Stefan van Drongelen, DirkJan Veeger and Lucas H. V. van der Woude
The aim of the study was to evaluate the external applied forces, the effectiveness of force application and the net shoulder moments of handcycling in comparison with handrim wheelchair propulsion at different inclines. Ten able-bodied men performed standardized exercises on a treadmill at inclines of 1%, 2.5% and 4% with an instrumented handbike and wheelchair that measured three-dimensional propulsion forces. The results showed that during handcycling significantly lower mean forces were applied at inclines of 2.5% (P < .001) and 4% (P < .001) and significantly lower peak forces were applied at all inclines (1%: P = .014, 2.5% and 4%: P < .001). At the 2.5% incline, where power output was the same for both devices, total forces (mean over trial) of 22.8 N and 27.5 N and peak forces of 40.1 N and 106.9 N were measured for handbike and wheelchair propulsion. The force effectiveness did not differ between the devices (P = .757); however, the effectiveness did increase with higher inclines during handcycling whereas it stayed constant over all inclines for wheelchair propulsion. The resulting peak net shoulder moments were lower for handcycling compared with wheelchair propulsion at all inclines (P < .001). These results confirm the assumption that handcycling is physically less straining.
R. Barry Dale and Danny Myers
Edited by Monique Mokha
Column-editor : James M. Mensch
Wayne T. Phillips
Li-Tang Tsai, Merja Rantakokko, Anne Viljanen, Milla Saajanaho, Johanna Eronen, Taina Rantanen and Erja Portegijs
This cross-sectional study investigated associations between reasons to go outdoors and objectively-measured walking activity in various life-space areas among older people. During the study, 174 community-dwelling older people aged 75–90 from central Finland wore an accelerometer over seven days and recorded their reasons to go outdoors in an activity diary. The most common reasons for going outdoors were shopping, walking for exercise, social visits, and running errands. Activities done in multiple life-space areas contributed more to daily step counts than those done in the neighborhood or town and beyond. Those who went shopping or walked for exercise accumulated higher daily step counts than those who did not go outdoors for these reasons. These results show that shopping and walking for exercise are common reasons to go outdoors for community-dwelling older people and may facilitate walking activity in older age. Future studies on how individual trips contribute to the accumulation of steps are warranted.
Addie Middleton, George D. Fulk, Michael W. Beets, Troy M. Herter and Stacy L. Fritz
Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R 2 = .51), MWS (R 2 = .35), and WSR calculated as a ratio (R 2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 −LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 −LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.
George J. Holland, Kiyoji Tanaka, Ryosuke Shigematsu and Masaki Nakagaichi
This review examines the influences of physiological aging processes on connective tissue, joint integrity, flexibility (range of motion [ROM]), and physical functions of older adults. Studies that attempted to improve older adults' ROM are also critiqued. Multiple mechanisms of musculoskeletal and soft-tissue degeneration, as well as disease processes (osteoporosis, arthritis, atherosclerosis), contribute to significant decreases in neuromuscular function and ROM in older adults, all of which can be exacerbated by disuse influences. No delineation of disuse effects on the rate of aging-related decrements in ROM can be provided, however, because long-term investigations (with physical activity controls) have not been conducted. Research efforts have documented both upper and lower extremity decrements in ROM with development of physical impairments, reductions in basic and instrumental activities of daily living, and progression of disability. There is limited research evidence that either specialized stretch-training or general-exercise intervention protocols moderately improve ROM in older adults and the frail elderly.
Kyle Kiesel, Lee Burton and Gray Cook
Column-editor : Carl G. Mattacola
Anat V. Lubetzky, Bryan D. Hujsak, Gene Fu and Ken Perlin
Postural sway does not differentiate between balance disorders. Head kinematics within a salient, immersive environment could potentially help identifying movement patterns that are unique to vestibular dysfunction. We describe a virtual park scene, where participants are asked to avoid a virtual ball approaching their head, to target dynamic balance and quantify head movement strategy. Sixteen patients with vestibular dysfunction and 16 healthy controls were wearing the Oculus Rift and performed the “park” scene on floor and stability trainers. Significant between-group differences emerged in head path (patients rotated their head sideways more), head acceleration (controls had higher acceleration, especially on translation movements), and peak frequency (controls peaked around the frequency of the ball whereas patients were variable). Those findings demonstrated good to excellent test–retest reliability. There were no significant between-group differences in postural sway parameters. Future studies should establish norms across different levels of balance dysfunction and investigate the underlying mechanism leading to the movement strategy observed.