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Toosizadeh N.,Interdisciplinary Consortium on Advanced Motion Performance ICAMP | Bunting M.,University of Arizona | Howe C.,University of Arizona | Mohler J.,University of Arizona | And 3 more authors.
Gerontology | Year: 2014

Background: Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths. Objective: The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: (1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; (2) to identify types of driving skills/performance that might be improved by training/intervention, and (3) to identify the use of technology in improving MMS performance or training procedure. Methods: Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems, intervention or targeted training, and clinical trial. Outcomes included: MMS skills/performance. Results: Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e. in the community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e. The minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance. Conclusions: Results from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis. © 2014 S. Karger AG, Basel.

Toosizadeh N.,Interdisciplinary Consortium on Advanced Motion Performance ICAMP | Mohler J.,University of Arizona | Wendel C.,University of Arizona | Najafi B.,Interdisciplinary Consortium on Advanced Motion Performance ICAMP | Najafi B.,University of Arizona
Gerontology | Year: 2014

Background: As the population of older adults quickly increases, the incidence of frailty syndrome, a reduction in physiological reserve across multiple physiological systems, likewise increases. To date, impaired balance has been associated with frailty; however, the underlying frailty-related postural balance mechanisms remain unclear. Objective: The aim of the current study was to use open-loop (OL; postural muscles) and closed-loop (CL; postural muscles plus sensory feedback) mechanisms to explore differences in postural balance mechanisms between nonfrail (n = 44), prefrail (n = 59) and frail individuals (n = 19). Methods: One hundred and twenty-two older adults (age ≥65 years) without major mobility disorders were recruited, and frailty was measured using Fried's criteria. Each participant performed two 15-second trials of Romberg balance assessment, once with their eyes open and once with their eyes closed. Body-worn sensors were used to estimate center of gravity (COG) plots. Body-sway (traditional stabilogram analysis) and OLCL (stabilogram diffusion analysis) parameters were derived using COG plots and compared between groups using ANOVA. Frailty and prefrailty were estimated using a multiple variable logistic regression while controlling for age, body mass index, body-sway and OLCL parameters. Results: Between-group differences in the parameters of interest were more pronounced during the eyes-closed condition, for which OL duration was approximately 33 and 22% shorter, respectively, in the frail and prefrail groups when compared to nonfrail controls (mean = 1.9 ± 1.1 s, p = 0.01). The average rate of sway during the OL was 164 and 66% higher, respectively, in frail and prefrail when compared to nonfrail subjects (0.03 ± 0.02 cm2/s, p < 0.001). Results also suggest that OLCL parameters can predict frail and prefrail categories when compared to nonfrail controls. Using this method, frailty was identified with a sensitivity and specificity of 97 and 88% (as compared to nonfrail), and prefrailty with 82 and 92%, respectively. Conclusions: This study suggested an innovative method to differentiate between frailty status using sensory dependency characteristics of postural control. Results suggest that postural muscle deconditioning may compromise balance in frail elders, leading to dependency on somatosensory feedback to compensate for errors and stabilize the system. © 2014 S. Karger AG, Basel.

Toosizadeh N.,Interdisciplinary Consortium on Advanced Motion Performance ICAMP | Lei H.,University of Arizona | Schwenk M.,Interdisciplinary Consortium on Advanced Motion Performance ICAMP | Schwenk M.,University of Arizona | And 5 more authors.
Gerontology | Year: 2014

Background: Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies. Objective: The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture (EA) as an alternative therapy. Methods: 15 aging adults (71.2 ± 6.3 years) with idiopathic PD and 44 healthy age-matched participants (74.6 ± 6.5 years) were recruited. The PD participants were randomly assigned (at a ratio of 2:1) to an intervention (n = 10) or to a control group (n = 5). The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks, while the control group received a sham treatment. Outcomes were assessed at baseline and after the final therapy. Measurements included balance assessment, specifically the ratio of medial-lateral (ML) center-of-gravity (COG) sway to anterior-posterior (AP) sway (COGML/AP) and ankle/hip sway during eyes-open, eyes-closed, and eyes-open dual-task trials, the Unified Parkinson's Disease Rating Scale (UPDRS), as well as quality of life, concerns for fall, and pain questionnaires. Results: No difference was observed for the assessed parameters between the intervention and the control group at baseline. After treatment, an improvement in balance performance was observed in the intervention group. Compared with the healthy population, PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance. Following EA therapy, COGML/AP sway was reduced by 31% and ankle/hip sway increased by 46% in the different conditions (p = 0.02 for the dual-task condition). The clinical rating revealed an overall improvement (p < 0.01) in mentation, behavior, and mood (UPDRS part I, 49%), activities of daily living (UPDRS part II, 46%), and motor examination (UPDRS part III, 40%). There was a significant reduction (p < 0.02) in the specific items regarding UPDRS fall status (67%) and rigidity (48%). Changes were small and nonsignificant in the controls (p > 0.29). Conclusions: This pilot study demonstrates improvement in rigidity and balance following EA. These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD. © 2014 S. Karger AG, Basel.

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