The aim of the study was to assess the functional capacity in the elderly using a modified timed version of a previous test proposed by Mathias et al. The validity and the reliability of such tests has been questioned therefore a new scoring system was implemented as a result of the imprecise scoring systems used previously.
60 patients from a Geriatric Hospital in Montreal took part in the study, 23 male and 37 female, with a mean age of 79.5 years. Their instructions were to stand up from a seated position in an armchair (approximate seat height of 46cm) walk a distance of 3 meters, turn around and walk back to the chair and return to the seated position. 10 active volunteers over 70 years old were also tested and these were used as control subjects. All the other patients had been diagnosed with major medical problems such as Parkinson’s disease and osteoarthritis.
The results displayed a wide range of times amongst the 60 patients with major medical diagnoses. However, the 10 active elderly volunteers all managed to complete the timed “up and go” in 10 seconds or less. The times between 57 of the patients ranged from 10 seconds to 240 seconds. There were 3 patients who were unable to complete the task and a further 7 who started but could not finish the test. No relationship was found between the score from the timed “up and go” test and their medical diagnosis. The scores were then divided into less than 10 seconds, 20 – 29 seconds and over 30 seconds as in indication of how independent in basic transfers they were.
The timed “up and go” test is very simple in that it is easy to administer as it requires no special equipment or training. The test is reliable as the results showed little variance in their times scores either between raters or over time. However further investigation is needed with regards to the group described as a ‘grey zone’. The scores in the 20-29 seconds category vary widely, therefore making it difficult to clarify their balance, gait speed and functional capacity. The test is valid as it measures everyday life activities. It is also a good screening tool as it may reveal no improvement in the time scores, displaying a deterioration in functional mobility that a neuromuscular examination may be unable to tell us.
Thursday, 13 October 2011
Wednesday, 12 October 2011
What is an ‘older adult’?
It may seem like a fairly simple question and as soon as it’s asked many of you will instantly conjure up an image of what you perceive an older adult to be. No doubt as you yourself get older, the image or perception of an older adult is also pushed back and gradually gets older.
So when does someone become an older adult?
Is it at retirement age? I would suggest not as people retire at different ages and for different reasons. Is there a milestone or magical age where we become an older adult? Again maybe not as time and ageing treats us all differently depending on our lifestyle and genetic make-up among other things. So does this leave some measure of cognitive and/or physical functioning, that once we reach or drop below we are classified as an older adult? This seems in some part logical but there appears to be no such standard for which one is considered old or young.
It therefore seems that as beauty is in the eyes of the beholder, so is the classification of an older adult. The reason I ask this is because with my current study and recruitment drive for participants, the boundaries for older are at best vague. Using pilot data the boundaries set for this study is 50-60 but is this right? In a review article by Voelcker-Rehage (2008) there are approximately 20 different age groups categorised as older adults. These range from 50-59 to 59-81 with the oldest set at 62-95. Of the age ranges set only two cover the same period of time and these are ages 60-69. At the largest end of the scale 33 years is the difference between the extremes of older adulthood. This is so varied that at the other end of the scale, Mark Zuckerberg (aged 27) the founder of facebook has been born, educated and created a global phenomena that gives him a personal wealth of approximately $17.5 billion with 6 years left. So it seems that so much can be achieved and changed in that period of time, that maybe 33 years is just too long.
This however, still does not answer the question... What is an older adult? The review article by Voelcker-Rehage (2008) suggests that various studies found declines through all these ages with the youngest older adult group of 50-59 showing declines in their abilities to learn. This coupled with the pilot data we have used suggests that the age range of 50-60 years old we have set is right. But are they strictly an older adult? Either way when exactly should the title or classification of older adult be used to describe a vastly varied group of individuals?
This however, still does not answer the question... What is an older adult? The review article by Voelcker-Rehage (2008) suggests that various studies found declines through all these ages with the youngest older adult group of 50-59 showing declines in their abilities to learn. This coupled with the pilot data we have used suggests that the age range of 50-60 years old we have set is right. But are they strictly an older adult? Either way when exactly should the title or classification of older adult be used to describe a vastly varied group of individuals?
Voelcker-Rehage, C., Motor-skill learning in older adults - a review of studies on age-related differences. European Review of Aging and Physical Activity, 2008. 5(1): p. 5-16.
Tuesday, 11 October 2011
Motor skill learning in older adults - a review of studies on age related differences. Voelcker & Rehage.
The aim of the paper is to review studies that focus on age related differences in motor learning across life span, particularly those focused on older aged adults. Motor development; the growth of muscular co-ordination from being a child, is considered generally, yet the main focus is motor plasticity; which is the ability of the Central Nervous System to acquire different pathways for sensory perception or motor skills.
A large number of studies are considered, focusing on a number of different aspects of motor learning. For example, for motor learning of fine motor skills, accuracy, sub movements, life-span studies, force variability, and augmented feedback. The rest of the studies consider motor learning of gross motor skills. many of them are comparative between older and younger adults, highlighting the differences of how we learn as we get older.
The findings from the studies suggest that older adults are able to gain in terms of their performance, yet the extent to which plasticity varies with age has to be carefully considered. A common result in studies of motor function show that performance levels drop in older adults compared to younger adults, regardless of any learning gains. Learning and performance differences are related to the structure, complexity, difficulty and familiarity of the task. Fine motor skill studies showed that performance gain diminished in older adults, and that performance differences between the young and old increased with practice. However, for the Gross motor skills, the results were contradictory, as some studies showed the highest improvement in older adults and others in the young.
A general overview of the findings are that decreased motor skill learning gains were interpreted as an age related performance loss in older adults, and occur due to a reduction in cognitive or motor plasticity. The causes of this are due to neuro-physiological changes; reduced nerve conduction and reaction speed, increased lateralization, diminished inhibition processes, and diminished tactile sensitivity. Despite these changes, there are considered to be compensatory processes in the cortical and sub cortical function that allow maintenance of performance. Brain imaging of the prefrontal , medio-frontal frontostriatal networks, which all relate to attention, showed age related decline.
In summary, all studies showed that performance does decline with age, yet considerable performance gains can still be seen, and that from the life span studies, we can see that decreases that occur in motor plasticity in older age can also occur in younger and middle aged adults.
A large number of studies are considered, focusing on a number of different aspects of motor learning. For example, for motor learning of fine motor skills, accuracy, sub movements, life-span studies, force variability, and augmented feedback. The rest of the studies consider motor learning of gross motor skills. many of them are comparative between older and younger adults, highlighting the differences of how we learn as we get older.
The findings from the studies suggest that older adults are able to gain in terms of their performance, yet the extent to which plasticity varies with age has to be carefully considered. A common result in studies of motor function show that performance levels drop in older adults compared to younger adults, regardless of any learning gains. Learning and performance differences are related to the structure, complexity, difficulty and familiarity of the task. Fine motor skill studies showed that performance gain diminished in older adults, and that performance differences between the young and old increased with practice. However, for the Gross motor skills, the results were contradictory, as some studies showed the highest improvement in older adults and others in the young.
A general overview of the findings are that decreased motor skill learning gains were interpreted as an age related performance loss in older adults, and occur due to a reduction in cognitive or motor plasticity. The causes of this are due to neuro-physiological changes; reduced nerve conduction and reaction speed, increased lateralization, diminished inhibition processes, and diminished tactile sensitivity. Despite these changes, there are considered to be compensatory processes in the cortical and sub cortical function that allow maintenance of performance. Brain imaging of the prefrontal , medio-frontal frontostriatal networks, which all relate to attention, showed age related decline.
In summary, all studies showed that performance does decline with age, yet considerable performance gains can still be seen, and that from the life span studies, we can see that decreases that occur in motor plasticity in older age can also occur in younger and middle aged adults.
The timed "up and go": A test of basic functional mobility for frail elderly persons. Podsialdo.D & Richardson.S.
The aim of the study was to assess physical mobility in the elderly, using a reliable method. Many other tests had already been developed, yet there seemed to be problems in terms of validity and reliability.
The method used was to see how long it took a frail elderly patient to stand up from an armchair (approximately 45cm), walk 3 metres, turn round, walk back and sit again. 60 patients were observed from a Geriatric Hospital in Montreal. 23 men and 37 women took part, and the mean age of the subjects was 79.5. All participants were aged between 60 and 90. 10 were considered healthy and active, and were aged over 70. The rest were affected by one of the following; A cerebral vascular accident, Parkinson's disease, rheumatoid osteoarthritis, cerebellar degeneration, post surgical hip fractures or general deconditioning.
The results showed that all the 'healthy' participants performed the test in 10 seconds or less. Time scores ranged between 10 and 240 seconds in 57 patients, as 3 were unable to even perform the test. 7 participants began the test but didn't have the stamina to finish. The results showed no relationship between the scores of the test and their diagnosis.
The hypothesis was supported by the results, in the fact that the timed "up and go" score correlated with patients scores on balance, gait speed and functional capacity.
The patients were divided in to 3 groups depending on their score. Those who took less than 20 seconds were considered independent, and could do everyday task without help, climb stairs, and leave the house alone. The second group consisted of those who took between 20 and 29 seconds to complete the task , who were considered mostly independent, needing help in areas such as getting off the toilet etc. The final group was those who took 30 seconds or more to complete the task, and these were considered dependant as they struggled getting up and walking without assistance.
The test proved to be practical, in the sense that it was simple to carry out, no special equipment was needed and it was quick. It was also reliable, as it gave a good indication of an individuals physical mobility, correlating with scores for gait speed and balance tests.
Those who scored lower than 30 and more than 20 were harder to categorize into a certain group, as such variation was seen in their tests for balance gait speed and functional capacity, so further assessment was needed to clarify their functional level.
If this test were to be used at the beginning of an examination, they could save a lot of professional time as irrelevant questions and tests could be eliminated and can focus on the specific area causing the issue.
As a descriptive tool it is good at describing level of functional capacity, it is quick and easy to carry out and has been proven to be reliable and valid.
The method used was to see how long it took a frail elderly patient to stand up from an armchair (approximately 45cm), walk 3 metres, turn round, walk back and sit again. 60 patients were observed from a Geriatric Hospital in Montreal. 23 men and 37 women took part, and the mean age of the subjects was 79.5. All participants were aged between 60 and 90. 10 were considered healthy and active, and were aged over 70. The rest were affected by one of the following; A cerebral vascular accident, Parkinson's disease, rheumatoid osteoarthritis, cerebellar degeneration, post surgical hip fractures or general deconditioning.
The results showed that all the 'healthy' participants performed the test in 10 seconds or less. Time scores ranged between 10 and 240 seconds in 57 patients, as 3 were unable to even perform the test. 7 participants began the test but didn't have the stamina to finish. The results showed no relationship between the scores of the test and their diagnosis.
The hypothesis was supported by the results, in the fact that the timed "up and go" score correlated with patients scores on balance, gait speed and functional capacity.
The patients were divided in to 3 groups depending on their score. Those who took less than 20 seconds were considered independent, and could do everyday task without help, climb stairs, and leave the house alone. The second group consisted of those who took between 20 and 29 seconds to complete the task , who were considered mostly independent, needing help in areas such as getting off the toilet etc. The final group was those who took 30 seconds or more to complete the task, and these were considered dependant as they struggled getting up and walking without assistance.
The test proved to be practical, in the sense that it was simple to carry out, no special equipment was needed and it was quick. It was also reliable, as it gave a good indication of an individuals physical mobility, correlating with scores for gait speed and balance tests.
Those who scored lower than 30 and more than 20 were harder to categorize into a certain group, as such variation was seen in their tests for balance gait speed and functional capacity, so further assessment was needed to clarify their functional level.
If this test were to be used at the beginning of an examination, they could save a lot of professional time as irrelevant questions and tests could be eliminated and can focus on the specific area causing the issue.
As a descriptive tool it is good at describing level of functional capacity, it is quick and easy to carry out and has been proven to be reliable and valid.
Learning to throw maximum distances: summary
The aim of this study was to find out how changes in object size and weight alter during the process of learning to throw, and also how do these factors affect throwing once the skill has been aquired.
This was done by testing 18 female students, who were capable, but had little previous experience of overarm throwing. They were split into 3 groups, each having a different set of objects to throw, one group had objects of constant density, one group objects of constant size, and the other threw objects of constant weight. The study involved a pre-test, training period, and post-test throwing trials. Three criteria were measured; Throwing distance, angle of release and speed of release.
The results of this study state that overall, in all 3 categories, throwing distance improved, although the way in which they improved was varied. Throughout practice, the increasing distances being thrown were affected by the objects in the practice set. This suggests that the physical properties of the objects did play a part in the outcome of the distances thrown.
The angle of release results did not show significant mean changes in angle of release. The average angles of release remained close to 33 degrees in all categories, through all training and testing, which is in turn close to the optimal angle of 36 degrees as found in previous studies.
However, upon examining the variability of the angle of release showed that angle of release did become more consistent throughout practice. This was calculated by the standard deviations from the first and last weeks of practice, and a 3 - way mixed design ANOVA conducted on them.
In constant the density and constant weight categories, the smaller the object showed a greater variability in release angle. The constant size group showed only variations in object weight and showed no object effect, showing that the size of the object played little part in angle of release.
Finally, speed of release increased up to 50% throughout practice but each category displayed a different pattern. Separate ANOVAs were performed in order to determine the effect of objects on release speed in each category and practice week. With practice, release speeds were increasingly affected by objects for all groups. Tukey HSD post-hoc analyses showed that consistently greater release speeds came from the lighter objects in the constant density and size categories. The lightest object was thrown with the highest speed. In the constant weight group however, release speed increased consistently regardless of the size of the object. This suggests that release speed varied with object weight but not object size.
It was found that improvements in throwing performance were mainly due to an increase of release speeds. Analysis found that release speeds varied with object weight but not size.
Subscribe to:
Posts (Atom)