Jessie M. VanSwearingen

The rationale for the development and the intent for use of a research agenda for the Academy of Geriatric Physical Therapy is described. The reasons for the research agenda for geriatric physical therapy are (1) to have a broad representation of the research conducted by physical therapist(s) working with older adults, (2) to provide guidance and assistance to emerging investigators to aid the trajectory of a research career, and (3) as a document to engage potential funding agencies, foundations, and individuals in support of physical therapist-conducted research. The design was based on the Research Agenda for Physical Therapy (APTA document), formatted to be consistent with the World Health Organization International Classification of Functioning, Disability and Health, priority ratings for the research statements, and specific examples of research questions for each category of the Research Agenda. The Academy of Geriatric Physical Therapy Research Agenda generated to be a living document, with revisions to research questions and priority ratings expected in the future to enable the agenda to adapt to changes in science, practice, workforce, education, and health policy.

Background: Wellness program participation may reduce the risk of falling, emergency department-use, and hospitalization among older adults. “On the Move” (OTM), a community-based group exercise program focused on the timing and coordination of walking, improved mobility in older adults, but its impact on falls, emergency department-use, and hospitalizations remains unclear. The aim of this preliminary study was to investigate the potential long-term effects that OTM may have on downstream, tertiary outcomes. Methods: We conducted a secondary analysis of a cluster-randomized, single-blind intervention trial, which compared two community-based, group exercise programs: OTM and a seated exercise program on strength, endurance, and flexibility (i.e. ‘usual-care’). Program classes met for 50 min/session, 2 sessions/week, for 12 weeks. Older adults (≥65 years), with the ability to ambulate independently at ≥0.60 m/s were recruited. Self-reported incidence of falls, emergency department visitation, and hospitalization were assessed using automated monthly phone calls for the year following intervention completion. Participants with ≥1 completed phone call were included in the analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated (reference = usual-care). Results: Participants (n = 248) were similar on baseline characteristics and number of monthly phone calls completed. Participants in the seated exercise program attended an average of 2.9 more classes (p = .017). Of note, all results were not statistically significant (i.e. 95% CI overlapped a null value of 1.0). However, point estimates suggest OTM participation resulted in a decreased incidence rate of hospitalization compared to usual-care (IRR = 0.88; 95% CI = 0.59–1.32), and the estimates strengthened when controlling for between-group differences in attendance (adjusted IRR = 0.82; 95% CI = 0.56–1.21). Falls and emergency department visit incidence rates were initially greater for OTM participants, but decreased after controlling for attendance (adjusted IRR = 1.08; 95% CI = 0.72–1.62 and adjusted IRR = 0.96; 95% CI = 0.55–1.66, respectively). Conclusion: Compared to a community-based seated group exercise program, participation in OTM may result in a reduced risk of hospitalization. When OTM is adhered to, the risk for falling and hospitalizations are attenuated. However, definitive conclusions cannot be made. Nevertheless, it appears that a larger randomized trial, designed to specifically evaluate the impact of OTM on these downstream health outcomes is warranted. Trial registration: Clinical trials.gov (NCT01986647; prospectively registered on November 18, 2013).

Mobility is fundamental for living. As walking is the most common form of mobility for humans, disorders of gait impact multiple aspects of our existence, including independence, social function, health, and the ability to explore and understand ourselves in relation to the world. Because of the breadth of the impact of gait disorders, the intent of this chapter is to provide clinicians with an adequate background in the basic physiology and mechanics of normal gait, and an observational approach to recognize deviations from the normal pattern-types of gait abnormalities. While the type of gait disorder does not directly lead to the treatment prescription, we describe various approaches to the management (including assistive devices) and rehabilitation that may have potential to impact related gait abnormalities. Lastly, we highlight rising concerns and directions in the assessment and management of subclinical gait problems in walking.

Background and Purpose: Increased carriage loads have been found to alter gait biomechanics in young healthy adults and military personnel; however, less is known regarding the influence of added carriage load on the gait characteristics of older adults—especially those with mobility limitations. The purpose of this study was to examine spatial and temporal gait characteristics during instrumented and noninstrumented overground walking in a sample of older adults with slow gait. Methods: Forty older adults with slow gait completed 2 bouts of walking (instrumented and noninstrumented) over a computerized walkway during 1 clinic visit. Mean spatial-temporal characteristics, gait variability, and gait speed over 8 passes were recorded. Paired t tests and intraclass correlation coefficients were used to quantify differences. Results and Discussion: Nine of the 10 gait variables did not differ statistically between instrumented and noninstrumented gait (P < .05). Intraclass correlation coefficients (ICCs) for mean gait characteristics were excellent (range ICC = 0.94-0.98; 95% confidence interval = 0.89-0.99), and for gait variability ranged from fair to excellent (range ICC = 0.56-0.79; 95% confidence interval = 0.28-0.89). Our study was able to demonstrate no significant impact of instrumentation on gait characteristics in a sample of older adults with slow gait. Conclusion: Our findings begin to fill in the gaps in the literature regarding the impact of added carriage loads on more vulnerable populations and lend support for the use of similar weighted metabolic devices as a component of gait assessment in older adults with confidence that the additional carriage-load will not significantly impact concurrent measures of gait.

Gait is a complex process involving both cognitive and sensory ability and is strongly impacted by the environment. In this paper, we propose to study of the impact of a cognitive task during gait on the cerebral blood flow velocity, the blood flow signal features and the correlation of gait and blood flow features through a dual task methodology. Both cerebral blood flow velocity and gait characteristics of eleven participants with no history of brain or gait conditions were recorded using transcranial Doppler on mid-cerebral artery while on a treadmill. The cognitive task was induced by a backward counting starting from 10,000 with decrement of 7. Central blood flow velocity raw and envelope features were extracted in both time, frequency and time-scale domain; information-theoretic metrics were also extracted and statistical significances were inspected. A similar feature extraction was performed on the stride interval signal. Statistical differences between the cognitive and baseline trials, between the left and right mid-cerebral arteries signals and the impact of the antropometric variables where studied using linear mixed models. No statistical differences were found between the left and right mid-cerebral arteries flows or the baseline and cognitive state gait features, while statistical differences for specific features were measured between cognitive and baseline states. These statistical differences found between the baseline and cognitive states show that cognitive process has an impact on the cerebral activity during walking. The state was found to have an impact on the correlation between the gait and blood flow features.

Background. Age-associated neural changes profoundly affect the biomechanics and energetics of walking, increase energy cost, and require novel approaches to exercise that focus on motor learning theory. Methods. We present a conceptual framework for motor skill in walking, its effect on the energy cost of walking, and the influence of the aging brain. Results. Motor learning theory and practice can be incorporated into interventions to promote skilled, energy efficient walking in older people. Conclusions. An extensive literature on motor skill and motor learning, derived from neuroscience, sports medicine, and neurorehabilitation, can be applied to problems of walking in late life.

Interventions to improve walking in older adults have historically been multifactorial (i.e., strengthening, endurance and flexibility programs) focusing on improving the underlying impairments. These impairment-based programs have resulted in only modest improvements in walking. In older adults, walking is slow, less stable, inefficient, and the timing and coordination of stepping with postures and phases of gait is poor. We argue the timing and coordination problems are evidence of the loss of motor skill in walking. Taking a lesson from the sports world and from neurorehabilitation, task-oriented motor learning exercise is an essential component of training to improve motor skill and may be a beneficial approach to improving walking in older adults. In this article we: (1) briefly review the current literature regarding impairment-based interventions for improving mobility, (2) discuss why the results have been only modest, and (3) suggest an alternative approach to intervention (i.e., task-oriented motor learning).