Physical fitness assessment in multiple sclerosis patients: A controlled study

There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale^, test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F_1.19 = 9.420; p < 0.01), Berg (F_1.19 = 13.125; p < 0.01), handgrip MIVC (F_1.19 = 4.567; p < 0.05), lower limbs MIVC (F_1.19 = 7.429; p < 0.01), and 6MWT (F_1.19 = 28.061; p < 0.01) between groups. EDSS, Berg test and Borg scores explained 80% of 6MWT variation. Mild grade EDSS patients exhibited impaired balance, muscle strength, and low self pace-6MWT scores, whereas RPE response after the exercise was similar to that of sedentary individuals. Both groups showed similar global physiological adjustments to exercise.     

Assessment of physical fitness and exercise tolerance in children with developmental coordination disorder

Children with developmental coordination disorder (DCD) have been shown to be less physically fit when compared to their typically developing peers. The purpose of the present study was to examine the relationships among body composition, physical fitness and exercise tolerance in children with and without DCD. Thirty-seven children between the ages of 7 and 9 years participated in this study. Participants were classified according to results obtained on the Movement Assessment Battery for Children (MABC) and were divided in 2 groups: 19 children with DCD and 18 children without DCD. All children performed the following physical fitness tests: The five-jump test (5JT), the triple-hop distance (THD) and the modified agility test (MAT). Walking distance was assessed using the 6-min walking test (6MWT). Children with DCD showed higher scores than children without DCD in all MABC subscale scores, as well as in the total score (p < 0.001). Participants with DCD were found to perform significantly worse on the MAT (p < 0.001), the THD (p < 0.001) and 5JT (p < 0.05). Moreover, children with DCD had poorer performance on the 6MWT than children without DCD (p < 0.01). Our results found significant correlations among body mass index (BMI), THD (r = 0.553, p < 0.05), 5JT (r = 0.480, p < 0.05) and 6MWT (r = 0.544, p < 0.05) only in DCD group. A significant correlation between MAT and 5JT (r = −0.493, p < 0.05) was found. Similarly, THD and 5JT (r = 0.611, p < 0.01) was found to be correlated in children with DCD. We also found relationships among 6MWT and MAT (r = −0.522, p < 0.05) and the 6MWT and 5JT (r = 0.472, p < 0.05) in DCD group. In addition, we found gender specific patterns in the relationship between exercise tolerance, explosive strength, power, DCD, and BMI. In conclusion, the present study revealed that BMI was indicative of poorer explosive strength, power and exercise tolerance in children with DCD compared to children without DCD probably due to a limited coordination on motor control.     

Effects of aerobic,resistance and balance training in adults with intellectual disabilities

Adults with intellectual disability (ID) have decreased cardiovascular fitness and strength present with lower rates of physical activity (PA), and often have balance and functional impairments. The purpose of this study was to investigate the effect of a combined PA program (CPAP) utilizing aerobic, strength and balance training on cardiovascular fitness, strength, balance and functional measures in a controlled clinical trial. Adults with mild to moderate ID were assigned into either the intervention group (IG; n = 37) or the control group (CG; n = 29). The IG trained 3 day/week, 1 h/day over 14 weeks, while the CG did not participate in any exercise program. Cardiovascular fitness, strength, balance, flexibility and functional ability were assessed pre-post training. The IG increased cardiovascular fitness (26.8 vs. 29.3 ml kg⁻¹ min⁻¹), handgrip strength (19.2 vs. 21.9 kg), leg strength, and balance following the training period (p < .05). Body weight (70.1 vs. 68.1 kg) and body mass index (27.4 vs. 26.6 kg m⁻²) decreased (p < .05) in the IG group. The CG showed no changes in any parameter. These data suggest a combined aerobic, strength and balance exercise training program is beneficial among individuals with ID.     

A physical fitness follow-up in children with cerebral palsy receiving 12-week individualized exercise training

Physical fitness in children with cerebral palsy (CP) is lower than in their peers. A 12-week individualized home-based exercise program completed by 11 children with CP 10 years earlier showed a favorable effect on physical fitness performance. We follow-up the physical fitness of those 11 children with CP, and compare their physical fitness and health-related quality of life (HRQoL) to children with CP without exercise training matched with age and motor levels. Eleven children with CP in the 2003 program as a follow-up group (FUG) and 12 volunteers recruited as a control group (CG) participated in this study. Physical fitness measures, including cardiopulmonary endurance, muscle strength, body mass index (BMI), flexibility, agility, balance, and the SF-36 Taiwan version, were assessed in both groups. After 10 years, the FUG showed better physical fitness in cardiopulmonary endurance and muscle strength (p < .05). Compared to the CG, the FUG demonstrated better muscle strength, agility, and balance (p < .05). However, the HRQoL did not show a significant difference between the FUG and the CG. Individualized home-based exercise training is beneficial for children with CP. Over 10 years, the FUG was more devoted to physical activity than was the CG. Physical exercise may not directly affect the HRQoL in this study.     

Vulnerability to exercise addiction,socio-demographic,behavioral and psychological characteristics of runners at risk for eating disorders

BackgroundExcessive exercise is frequently associated with eating disorders and may degenerate into exercise addiction. We still don't know whether runners at risk for eating disorders are at risk for exercise addiction. Our aim is to assess: 1) risk for exercise addiction in runners at risk for eating disorders and 2) socio-demographic, behavioral and psychological characteristics distinguishing runners at-risk from not-at-risk for eating disorders.MethodsWe assessed risk for eating disorders and exercise addiction using the SCOFF questionnaire and the Exercise Addiction Inventory personality traits with the Big-Five Inventory Test, socio-demographic data, eating and training habits in a sample of 154 healthy runners.ResultsTwenty five subjects had a score of ≥ 2 at the SCOFF and were included in the group “at risk for eating disorders”. In this group, we found a higher percentage of subjects at risk for exercise addiction (p = 0.01) and higher average scores at the Exercise Addiction Inventory (p = 0.01) than runners not at risk (N = 136). Runners at risk were statistically younger (p = 0.03), women (p = 0.001), started running to lose weight more often (p = 0.03), lost more kilos since affiliation in their running club (p = 0.04), and were characterized by neurotic traits using the Big-Five-Inventory Test (p = 3.10^− 6).ConclusionsScreening for exercise addiction and mood disorders could lead to a more accurate management of runners at risk for eating disorders. Identifying vulnerable individuals will facilitate the prevention of eating disorders and preserve the benefits of sport practice.     

Automatic slow eye movement (SEM) detection of sleep onset in patients with obstructive sleep apnea syndrome (OSAS): Comparison between multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT)

ObjectiveTo determine whether automatic slow eye movement (SEM) analysis performs comparably to standard sleep onset criteria at the multiple sleep latency test (MSLT) and at the maintenance of wakefulness test (MWT) in patients with obstructive sleep apnea syndrome (OSAS).MethodsWe compared sleep latencies obtained upon standard analysis of MSLT and MWT recordings with automatically detected SEM latencies in a population of 20 severe OSAS patients that randomly underwent the two tests 1 week apart.ResultsEight of 20 OSAS patients had EDS as answered by the Epworth Sleepiness Scale (ESS). Mean SEM latency performed comparably to standard sleep onset in both the MSLT (6.4 ± 5.5 min versus 7.4 ± 5.1 min, p = 0.25) and the MWT (25.2 ± 14.5 min versus 24.4 ± 14.0 min, p = 0.45) settings. Mean SEM latency significantly correlated with the sleep latency at the MSLT (r = 0.52, p < 0.05) and at the MWT (r = 0.74, p < 0.001). Finally, the Epworth Sleepiness Scale score correlated with SEM latency at the MWT (r = ?0.62, p < 0.01), but not at the MSLT.ConclusionsAutomatic SEM detection performed comparably to standard polysomnographic assessment of sleep onset, thus providing a simplified technical requirement for the MSLT and the MWT. Further studies are warranted to evaluate SEM detection of sleep onset in other sleep disorders with excessive daytime sleepiness.     

Change in muscle strength over time in spinal muscular atrophy types II and III. A long-term follow-up study

Whether muscle strength deteriorates with time in spinal muscular atrophy (SMA) types II and III is still debated. We present a long-term follow-up study on muscle strength in 30 patients with SMA types II and III. Median follow-up time was 17 years. Median number of assessments was four. All patients were assessed by Manual Muscle Testing (MMT), Brooke upper limb scale and EK scale. There was a difference in muscle strength of the upper limbs from first to last assessment in SMA II (p < 0.0001) and SMA III patients (p < 0.02). In SMA II patients, the rate of yearly decline in strength (% MRC score) was 0.22 units (p < 0.03). The decline was independent of the grade of muscle strength at entry. In SMA II patients the decline in muscle strength was reflected in a loss upper limb function as measured by Brooke upper limb scale (p < 0.0001) and motor function as measured by EK scale (p < 0.0001), a loss of great importance to the patients’ need for practical assistance. This study demonstrates loss of muscle strength over time in SMA II and III patients. Because of the very slow deterioration, it takes years to detect this change, which has to be taken into account in future treatment trials.     

Influence of repeated maximal exercise testing on biomarkers and fatigue in sarcoidosis

Fatigue in the immune mediated inflammatory disease sarcoidosis is thought to be associated with impaired exercise tolerance. This prospective study assessed fatigue and recuperative capacity after repeated exercise, and examined whether changing concentrations in biomarkers upon exercise are associated with fatigue.Twenty sarcoidosis patients and 10 healthy volunteers performed maximal cardiopulmonary exercise tests on two successive days. Concentrations of cytokines, stress hormones, ACE and CK were assessed before and after the two exercise tests, and 3 days thereafter. All participants completed a sleep diary.Severely fatigued patients showed significant lower VO₂ max (p = 0.038, p = 0.022) and maximal workload (p = 0.034, p = 0.028) on both exercise tests compared to healthy controls. No impairment of maximal exercise testing was demonstrated during the second cycling test in any group. Fatigue was not correlated with changes in concentrations of biomarkers upon exercise. Severely fatigued patients rated both tests as significantly more fatiguing, and reported significant lower mean subjective night sleeping time during the testing period.Fatigue in sarcoidosis patients cannot be objectified by reduction of exercise capacity after repeated maximal exercise testing, and is not correlated with significant changes in biomarkers. Severe fatigue is only and consistently featured by patient reported outcomes.     

Reliability and validity of the 6-min walk test in adults and seniors with intellectual disabilities

IntroductionAdults with intellectual disabilities (ID) have significantly lower rates of physical activity and fitness than adults without ID. The 6-min walk test (6MWT) is an inexpensive and simple way to test mobility and submaximal work capacity.PurposeTo evaluate the test–retest reliability and validity of the 6MWT in adults and seniors with ID and explore factors contributing to the 6MWT distance (6MWD).Methods46 participants with mild, moderate and severe ID levels (age = 41 ± 11 years) performed the 6MWT three times (T1; T2; T3) to determine test–retest reliability. To test validity, peak oxygen uptake (VO₂ peak) was measured using a treadmill protocol. To analyze factors contributing to the 6MWD, sex, height, fat mass % and fat free mass %, ID level, isometric leg strength and relative VO₂ peak were also measured.ResultsThe walking distances for T1, T2 and T3 were 460.3 ± 76.9; 489.4 ± 81.2 and 491.4 ± 77.9 m, respectively. The 6MWDs between T1–T2 and T1–T3 were significantly different (p < 0.001), but T2 and T3 were not different. The intraclass correlation coefficient between T2 and T3 was 0.96 indicating high reliability. Relative VO₂ peak and isometric leg strength significantly contributed to the 6MWD (R² = 0.55).ConclusionsThe 6MWT is an easy, inexpensive, reliable and valid test in adults and seniors with ID. Familiarization is necessary to obtain reliable values. Relative VO₂ peak and leg strength have significant impact on the distance walked.     

Somatropin treatment of spinal muscular atrophy: A placebo-controlled,double-blind crossover pilot study

In preclinical studies growth hormone and its primary mediator IGF-1 have shown potential to increase muscle mass and strength. A single patient with spinal muscular atrophy reported benefit after compassionate use of growth hormone. Therefore we evaluated the efficacy and safety of growth hormone treatment for spinal muscular atrophy in a multicenter, randomised, double-blind, placebo-controlled, crossover pilot trial. Patients (n = 19) with type II/III spinal muscular atrophy were randomised to receive either somatropin (0.03 mg/kg/day) or placebo subcutaneously for 3 months, followed by a 2-month wash-out phase before 3 months of treatment with the contrary remedy. Changes in upper limb muscle strength (megascore for elbow flexion and hand-grip in Newton) were assessed by hand-held myometry as the primary measure of outcome. Secondary outcome measures included lower limb muscle strength, motor function using the Hammersmith Functional Motor Scale and other functional tests for motor function and pulmonary function. Somatropin treatment did not significantly affect upper limb muscle strength (point estimate mean: 0.08 N, 95% confidence interval (CI:−3.79;3.95, p = 0.965), lower limb muscle strength (point estimate mean: 2.23 N, CI:−2.19;6.63, p = 0.302) or muscle and pulmonary function. Side effects occurring during somatropin treatment corresponded with well-known side effects of growth hormone substitution in patients with growth hormone deficiency. In this pilot study, growth hormone treatment did not improve muscle strength or function in patients with spinal muscular atrophy type II/III.     

Assessment of intramuscular lipid and metabolites of the lower leg using magnetic resonance spectroscopy in boys with Duchenne muscular dystrophy

The purpose of this study was to use proton magnetic resonance spectroscopy to assess intramuscular lipid and metabolites of lower leg muscles in boys with Duchenne muscular dystrophy (DMD) and determine its relationship with strength and functional ability. Spectroscopic measurements were obtained from four muscles of the lower leg in 25 boys with DMD (9.2 ± 3.1 years) and 10 healthy boys (10.2 ± 2.6 years). Lipid fractions and metabolite concentrations were also determined. Muscle strength, a timed functional test, and the Modified Brooke Lower Extremity Functional Scale were also determined. Lipid fractions were higher (p < 0.01) for the DMD group than healthy subjects for all muscles, and lipid fraction was found to be greater in the older DMD boys. The peroneal muscle demonstrated a significant difference in lipid fraction in all DMD age groups. Lipid fractions in all muscles correlated with functional measures (r = 0.52–0.70, p < 0.001), with smaller inverse correlations with the strength measure (r = −0.36 to −0.56, p < 0.05). These findings provide quantifiable information regarding intramuscular lipid and metabolite levels of different muscles across various age groups in boys with DMD and may be used in determining the effect of interventions in future clinical trials.     

Treadmill walking effects on grip strength in young men with Down syndrome

This study was aimed at investigating the relation between grip strength and anthropometric factors and the impact of an aerobic exercise on grip strength in young men with Down syndrome (DS). This study was a pre-post design. Twelve males with DS were assigned to an exercise group, who walked using an incremental protocol on a treadmill for 20 min at aerobic levels. Eight additional persons with DS were assigned to an attentional control group, who watched a video. Measure of grip strength was tested pre- and post-interventions. The results showed positively significant relationship among grip strength and age (r = .74, p < .01), weight (r = .52, p = .02), body mass index (r = .61, p = .01) and waist circumference (r = .54, p = .02). In addition, Grip strength was slightly improved after exercise (p = .03) but decreased after control condition. The results showed that anthropometric factors, such as age, weight, body mass index and waist circumference, were positively correlated with grip strength in young men with DS. Further, improvement in grip strength can be found even after a single exercise session. This finding emphasizes the importance of maintaining an active lifestyle in persons with DS for performing activities of daily living.     

Physical fitness and overweight in Israeli children with and without developmental coordination disorder: Gender differences

Physical fitness and overweight among children has become paramount in the general population and more so in children with developmental coordination disorder (DCD). The purpose of the current study was to examine the association between physical fitness and overweight in a sample of Israeli children in comparison to typical children, and to examine gender differences. DCD was identified through total scores on the movement assessment battery for children 2 (MABC-2) equal to or less than the 16th percentile as well as parents’ report that the child's deficits in motor skills interfered with at least two daily life activities. The sample included a group of children with DCD (n = 22, M age = 8.70 [SD = 1.36], 16 boys [73%]) and a control group of typical children (n = 47, M age = 8.90 [SD = 1.52], 34 boys [72%]). Measures included the strength subtest of the Bruininks–Oseretsky test of motor proficiency (BOT-2), the six minutes’ walk test (6MWT) with heart rate measure, BMI and the percentage of body fat. Significant differences between DCD and typical children were found on all variables of physical fitness and weight. A two-way analysis of variance (ANOVA) analysis (group/gender) also revealed significant interactions for the percentage of body fat (F = 8.51, p < .005) and BMI (F = 4.50, p < .038) meaning that less fit children are more obese. The current study supports previous findings that children with DCD are less physically fit and more overweight compared to typically developing children. Moreover, in comparing between the genders, the girls in the study sample weighed more and had a significantly higher percentage of body fat than boys, it is essential to further our understanding of the relationships between obesity, physical fitness and gender among children with and without DCD.     

Association of early-onset dementia with activities of daily living (ADL) in middle-aged adults with intellectual disabilities: The caregiver's perspective

Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the “Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach” project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r = −0.28, p < 0.001). The multiple linear regression model reported that factors of male gender (β = 4.187, p < 0.05), marital status (β = 4.79, p < 0.05), education level (primary: β = 5.544, p < 0.05; junior high or more: β = 8.147, p < 0.01), Down's syndrome (β = −9.290, p < 0.05), severe or profound disability level (β = −6.725, p < 0.05; β = −15.773, p < 0.001), comorbid condition (β = −4.853, p < 0.05) and dementia conditions (β = −9.245, p < 0.001) were variables that were able to significantly predict the ADL score (R² = 0.241) after controlling for age. Disability level and comorbidity can explain 10% of the ADL score variation, whereas dementia conditions can only explain 3% of the ADL score variation in the study. The present study highlights that future studies should scrutinize in detail the reasons for the low explanatory power of dementia for ADL, particularly in examining the appropriateness of the measurement scales for dementia and ADL in aging adults with ID.     

Assessment of cardiorespiratory and neuromotor fitness in children with developmental coordination disorder

The decreased participation in physical activity by children with probable developmental coordination disorder (pDCD) has raised concerns about their aerobic fitness and lung function levels. The purpose of the present study was to examine assessment of cardiorespiratory and neuromotor fitness, using laboratory-based tests during an incremental treadmill protocol in healthy children with and without pDCD. Twenty sex children ages 6–9 years took part in this study. Motor coordination was assessed using the Movement Assessment Battery for Children (MABC). All participants performed a cardiopulmonary exercise test (CPET) on a cycle ergometer. Pulmonary function was assessed by spirometric measurements (forced vital capacity: FVC, forced expiratory volume in 1 s: FEV₁) and walking distance (6MWD) was assessed using the 6-min walking test. The children with pDCD had lower VO_2 max than children without pDCD (p < 0.01). Moreover, FVC and FEV₁ were significantly higher in children without pDCD than in children with the disorder (p < 0.05, p < 0.01 respectively). Likewise, children with pDCD had poorer performance on the 6MWD than children without pDCD (p < 0.01). A significant correlation between the absolute value for FEV₁ and 6MWD (r = 0.637, p < 0.05) in pDCD group was observed. We found a significant correlation between VO_2 max and MABC score (r = −0.612, p < .001) and between VO_2 max and 6MWD (r = 0.502, p < .001) for all children. Moreover, a significant correlation between VO_2 max and FEV₁ (r = 0.668, p < .05) was found in children with pDCD. Overall, the reduced aerobic capacity of DCD was associated with decreased of lung function, as well as an alteration of peripheral muscle responses.     

Could sport specialization influence fitness and health of adults with mental retardation?

Although several studies showed the positive effects of exercise and physical activity on health and well-being for individuals with ID, there is a lack of information about the influence of sport specialization on fitness and health components. Therefore, the aims of this study were to assess: (a) physical fitness of athletes with intellectual disability (ID) compared with individuals included in recreational and leisure activity programs (non-athletic people); (b) contribution of sport specialization on athletes’ fitness; and c) correlation of each fitness variable with subjects’ ID levels. Twenty-two track and field, 19 basketball, and 23 non-athletic adults were recruited. Before and after a 9-month period, all participants performed fitness tests assessing body composition, flexibility (SR), arm muscular strength (HG), lower and upper-body muscular strength and endurance (SUP and PUP), explosive leg power (SLJ), cardiovascular endurance (ST), balance ability (FT), motor coordination (TUGT). The results showed that participants’ weight, BMI and FT were significantly affected by time; SLJ by activity; ST, HG, PUP, SUP, and TUGT by both time and activity. Only track and field athletes increased significantly ST. All athletes improved significantly HG, PUP and SUP, instead non-athletic people decreased significantly SUP (p < 0.01). TUGT improved significantly in track and field athletes (p < 0.05), and decreased significantly in non-athletic people. ID level was positively correlated to TUGT. Findings of this study showed that physical activity improved fitness in adult athletes with ID, decreasing health risks. Athletes with lower ID obtained higher performance scores in motor coordination test.     

Sleepiness is not always perceived before falling asleep in healthy,sleep-deprived subjects

ObjectiveTo test whether subjects spontaneously signal sleepiness before falling asleep under monotonous conditions.MethodsTwenty-eight healthy students were deprived of sleep for one night and then underwent a “maintenance-of-wakefulness test” (MWT) consisting of four 40-min trials. They were told to give a signal as soon as they felt sleepy and to try to stay awake as long as possible. In a first series of tests, the subjects were given no reward (nr); in a second series, monetary rewards (wr) were given both for an accurate perception of sleepiness and for staying awake longer.ResultsSeventeen of the 28 subjects (60.7%) did not signal sleepiness before a sleep fragment occurred in at least one of the four MWT trials. Women were more reliably aware of sleepiness than men in the nr trials (p = .02), while the men’s performance improved in the wr trials (p < .02), becoming equivalent to the women’s performance.ConclusionsOur results cast doubt on the general assumption that one cannot fall asleep without feeling sleepy first. If similar results can be obtained in monotonous driving or working situations, this will imply that accidents caused by sleepiness or by falling asleep cannot necessarily be attributed to an individual’s negligence.     

Abnormal glucose tolerance,white blood cell count,and telomere length in newly diagnosed,antidepressant-naïve patients with depression

Chronic mood disorders have been associated with a shortened telomere, a marker of increased mortality rate and aging, and impaired cellular immunity. However, treatment may confound these relationships. We examined the relationship of glucose tolerance, white blood cell count and telomere length to depression in newly diagnosed, antidepressant-naïve patients. Subjects with major depression (n = 15), and matched healthy control subjects (n = 70) underwent a two-hour oral glucose tolerance test and evaluation of blood cell count and telomere content. The depression group had significantly higher two-hour glucose concentrations and a lower lymphocyte count than control subjects (respective means [SD] for two-hour glucose were 125.0 mg/dL [67.9] vs 84.6 [25.6] (p < .001); for lymphocyte count 2.1 × 10⁹/L [0.6] vs 2.5 × 10⁹/L [0.7] p = .028). Telomere content was significantly shortened in the depression group (87.9 [7.6]) compared to control subjects (101.0 [14.3]; p < 0.01). Abnormal glucose tolerance, lymphopenia and a shortened telomere are present early in the course of depression independently of the confounding effect of antidepressant treatment, supporting the concept of major depression as an accelerated aging disease.     

Afferent control of walking: Are there distinct deficits associated to loss of fibres of different diameter?

ObjectivesTo compare the gait pattern in patients affected by different types of neuropathy.MethodsWe recruited healthy subjects (HS, n = 38), patients with Charcot–Marie–Tooth disease type 1A (CMT1A) (n = 10) and patients with diabetic neuropathy (DNP) (n = 12). Neuropathy impairment score and neuropathy score were assessed. Body sway during quiet stance, and spatio-temporal gait parameters were recorded.ResultsMost patients had reduced or absent tendon-tap reflexes. Strength of foot dorsiflexor muscles (p < 0.05) and conduction velocity (CV) of leg nerves (p < 0.0001) were more impaired in CMT1A than DNP, whereas joint-position sense was more affected (p < 0.05) in DNP. Body sway while standing was larger in DNP compared to CMT1A and HS (p < 0.01 and p < 0.0001 respectively). During gait, the distribution of foot sole contact pressure was abnormal in CMT1A (p < 0.05) but not in DNP. Velocity and step length were decreased, and foot yaw angle at foot flat increased, in DNP with respect to CMT1A and HS (both variables, p < 0.001). Gait velocity and step length were decreased (p < 0.005) also in CMT1A, but to a smaller extent than in DNP, so that the difference between patient groups was significant (p < 0.0005). Duration of the double support was protracted in DNP compared to CMT1A and HS (p < 0.0005). For DNP only, velocity of gait and duration of single support were correlated (p < 0.05) both to sway path and lower limb muscle strength.ConclusionsChanges in both body sway and stance phase of gait were larger in DNP than CMT1A, indicating more impaired static and dynamic control of balance when neuropathy affects the small in addition to the large afferent fibres. Diminished somatosensory input from the smaller fibres rather than muscle weakness or foot deformity plays a critical role in the modulation of the support phase of gait.SignificanceThe analysis of balance and gait in patients with neuropathy can offer a tool for understanding the nature and functional impact of the neuropathy and should be included in their functional evaluation.     

Caregivers’ reported functional limitations in activities of daily living among middle-aged adults with intellectual disabilities

This study was conducted to describe the functioning of Activities of Daily Living (ADL) and to examine socio-economic effects on ADL functioning among adults with intellectual disabilities (ID) aged 45 years and older (N = 480) in Taiwan. The Barthel Index (BI) was used to determine a baseline level of ADL functioning in the study participants. There are five categories of functional impairment using the following cut-off values in Taiwan: total dependence (BI score 0–20), severe (BI score 21–60), moderate (BI score 61–90), mild (BI score 91–99), and total independence (BI score 100) (Taiwan Department of Health, 2012). The results revealed that 2.3% of adults with ID were in total dependence, 11.9% were in severe dependence, 27.9% were in moderate dependence, 8.1% had a mild dependence, and 49.8% were totally independent. In the multiple linear regression model of the ADL score, we determined that educational level, comorbid Down's syndrome, and disability level are the variables able to significantly predict ADL score (R² = 0.190) after controlling for the factors of age, marital status, and other comorbidity conditions. Those ID adults with a lower education level (primary vs. literate, β = 4.780, p = 0.031; intermediate vs. literate, β = 6.642, p = 0.030), with comorbid Down's syndrome (β = ?7.135, p = 0.063), and with a more severe disability condition (severe vs. mild, β = ?7.650, p = 0.007; profound vs. mild, β = ?19.169, p < 0.001) had significantly lower ADL scores. The present study highlights the need to support mobility in older adults with ID as much as possible to optimize independence in this group.