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Makizako H.,Center for Gerontology and Social Science | Kabe N.,National Center for Geriatrics and Gerontology | Takano A.,Funabashi Municipal Rehabilitation Hospital | Isobe K.,Funabashi Municipal Rehabilitation Hospital
PM and R | Year: 2015

Objective: To examine whether the Berg Balance Scale (BBS) score on admission and after 1 month can be used to predict the Functional Independence Measure (FIM) walking level 6 or 7 (modified independent and independent gait respectively) after 3 months and to determine the optimal BBS cut-off score for predicting independent gait among inpatients with first stroke in a rehabilitation facility. Design: Retrospective cohort study. Setting: Inpatient rehabilitation facility (Kaifukuki). Participants: Two hundred fifty-one consecutive patients with first stroke and nonindependent gait on admission. Outcome Measures: BBS on admission and after 1 month and FIM on admission and after 3 months. Results: Area under the receiver operating characteristic curves for predicting independent gait after 3 months were 0.81 (95% confidence interval [CI], 0.75-0.88) for BBS score on admission; the optimal cut-off score being ≥13 (63% sensitivity; 90% specificity). Achieving greater cut-off score on admission was significantly associated with subsequent independent gait (odds ratio, 9.7; 95% CI, 4.38-21.36; P < .001). A subanalysis of patients with poor balance on admission (BBS score <13; n = 191) showed area under the receiver operating characteristic curves for predicting independent gait after 3 months of 0.88 (95% CI, 0.80-0.95) for BBS scores 1 month after admission. In this subgroup, BBS scores at 1 month of ≥27 were significantly associated with subsequent independent gait (odds ratio, 21.6, 95% CI, 6.40-73.20; P < .001). Conclusions: Admission BBS scores predicted FIM walking level 6 or 7, which denotes modified independent or independent gait, after 3 months, the optimal cut-off for BBS scores being ≥13 among inpatients with first stroke in a rehabilitation facility. Patients with poor balance on admission whose BBS scores had improved to ≥27 at 1 month after admission were likely to achieve modified independent or independent gait within 3 months after admission. © 2015 American Academy of Physical Medicine and Rehabilitation. Source


Doi T.,Center for Gerontology and Social Science
Journal of neuroengineering and rehabilitation | Year: 2013

Gait variables derived from trunk accelerometry may predict the risk of falls; however, their associations with falls are not fully understood. The purpose of the study was to determine which gait variables derived from upper and lower trunk accelerometry are associated with the incidence of falls, and to compare the discriminative ability of gait variables and physical performance. This study was a 1-year prospective study. Older people (n = 73) walked normally while wearing accelerometers attached to the upper and lower trunk. Participants were classified as fallers (n = 16) or non-fallers (n = 57) based on the incidence of falls over 1 year. The harmonic ratio (HR) of the upper and lower trunk was measured. Physical performance was measured in five chair stands and in the timed up and go test. The HR of the upper and lower trunk were consistently lower in fallers than non-fallers (P < 0.05). Upper trunk HR, was independently associated with the incidence of falls (P < 0.05) after adjusting for confounding factors including physical performances. Consequently, upper trunk HR showed high discrimination for the risk of falls (AUC = 0.81). HR derived from upper trunk accelerometry may predict the risk of falls, independently of physical performance. The discriminative ability of HR for the risk of falls may have some validity, and further studies are needed to confirm the clinical relevance of trunk HR. Source


Shimada H.,Center for Gerontology and Social Science | Ishii K.,Tokyo Metropolitan University | Ishiwata K.,Tokyo Metropolitan University | Oda K.,Tokyo Metropolitan University | And 3 more authors.
Gait and Posture | Year: 2013

This study evaluated brain activity during unaccustomed treadmill walking using positron emission tomography (PET) and [18F]fluorodeoxyglucose. Twenty-four healthy elderly females (75-82years) participated in this study. Two PET scans were performed after 25min of rest and after walking for 25min at 2.0km/h on a treadmill. Participants were divided into low and high step-length variability groups according to the median coefficient of variation in step length during treadmill walking. We compared the regional changes in brain glucose metabolism between the two groups. The most prominent relative activations during treadmill walking compared to rest in both groups were found in the primary sensorimotor areas, occipital lobe, and anterior and posterior lobe of the cerebellum. The high step-length variability group showed significant relative deactivations in the frontal lobe and the inferior temporal gyrus during treadmill walking. There was a significant relative activation of the primary sensorimotor area in the low step-length variability group compared to the high step-length variability group (P=0.022). Compared to the low step-length variability group, the high step-length variability group exhibited a greater relative deactivation in the white matter of the middle and superior temporal gyrus (P=0.032) and hippocampus (P=0.034) during treadmill walking compared to resting. These results suggest that activation of the primary sensorimotor area, prefrontal area, and temporal lobe, especially the hippocampus, is associated with gait adaptability during unaccustomed treadmill walking. © 2012 Elsevier B.V. Source


Shimada H.,Center for Gerontology and Social Science | Makizako H.,Center for Gerontology and Social Science | Doi T.,Center for Gerontology and Social Science | Yoshida D.,Center for Gerontology and Social Science | And 6 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objective: Preventive strategies for frailty and mild cognitive impairment (MCI) are important for avoiding future functional decline and dementia in older adults. The purpose of this study was to use a population-based survey to ascertain the single and combined prevalence of frailty and MCI and to identify the relationships between frailty and MCI in older Japanese adults. Design: Cross-sectional study. Setting: General community. Participants: A total of 5104 older adults (aged 65 years or older, mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE). Measurements: Each participant underwent detailed physical and cognitive testing to assess frailty and MCI. We considered the frailty phenotype to be characterized by limitations in 3 or more of the following 5 domains: mobility, strength, endurance, physical activity, and nutrition. Screening for MCI included a standardized personal interview, the Mini-Mental State Examination, and the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT), which included 8 tasks used to assess logical memory (immediate and delayed recognition), word list memory (immediate and delayed recall), attention and executive function (tablet version of Trail Making Test-part A and B), processing speed (tablet version of digit symbol substitution test), and visuospatial skill (figure selection). Results: The overall prevalence of frailty, MCI, and frailty and MCI combined was 11.3%, 18.8%, and 2.7%, respectively. We found significant relationships between frailty and MCI (the odds ratio adjusted for age, sex, and education was 2.0 (95% confidence interval 1.5-2.5). Conclusions: Using the OSHPE criteria, we found more participants with MCI than with frailty. The prevalence of frailty and MCI combined was 2.7% in our population. Future investigation is necessary to determine whether this population is at increased risk for disability or mortality. © 2013 American Medical Directors Association, Inc.. Source


Kitamura I.,Aichi Gakuin University | Koda M.,Chubu University | Otsuka R.,Center for Gerontology and Social Science | Ando F.,Aichi Shukutoku University | Shimokata H.,Nagoya University of Arts and Sciences
Geriatrics and Gerontology International | Year: 2014

Aim: Little is known about longitudinal changes of body composition measured by dual-energy X-ray absorptiometry (DXA) in middle-aged and elderly individuals. We evaluated longitudinal changes of body composition, and age and sex differences in appendicular skeletal muscle mass. Methods: Participants were 1454 community-dwelling Japanese men and women aged 40-79 years. Body composition at baseline and 6-year follow up was measured by DXA. Results: Fat increased significantly in men of all ages, and in women aged in their 40s and 50s. Among men, arm lean tissue mass (LTM) changed by 0.9%, -0.5%, -1.4% and -3.7%, respectively, for the 40s to the 70s, and decreased significantly in the 60s and 70s. Leg LTM in men changed by -0.4%, -1.3%, -1.7% and -3.9%, respectively, and decreased significantly from the 50s to the 70s. Compared with the preceding age groups, significant differences were observed between the 60s and 70s in arm and leg LTM change in men. Among women, arm LTM changed by 0.7%, 0.2%, 1.6% and -1.5%, respectively, which was significant in the 60s and 70s. Leg LTM decreased significantly in all age groups of women by -2.0%, -2.8%, -2.4% and -3.9%, respectively. With respect to sex differences, leg LTM loss rates were significantly higher in women than men at the 40s and 50s. Conclusions: Longitudinal data suggest that arm and leg LTM decreased markedly in men in their 70s, and leg LTM had already decreased in women in their 40s. © 2013 Japan Geriatrics Society. Source

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