Alexandre Kubicki

Rehabilitation. Societe Française de Physiotherapie

Introduction: The Balance Evaluation System Test (BESTest) and the Mini-BESTest were developed to assess the complementary systems that contribute to balance function. These tests include functional tasks involving several high-level exercises to assess the balance function, which may be even more difficult in case of frailty. The Frail’BESTest has been developed to make it possible to include frail older adults in systemic assessment. In this first paper, the objective is to present the Frail’BESTest and to describe the usefulness and complementarity of each system and to test the inter-rater reliability of the score measurements in two health centers. Methods: In the first center, 192 frail and non-frail older patients were enrolled to test I) the contribution of each system, II) internal consistency, and III) the threshold and ceiling effects. The scores of 32 patients from center 1 and 32 patients recruited in another center (center 2) were used to measure the inter-rater reliability of the measurements by means of Kendall’s tau coefficients. Results: The internal consistency was moderate to good for five systems and limited for “biomechanical constraints”. The distribution of the Frail’BESTest was more centered than that of the Tinetti and Mini-Motor tests. The Kendall’s tau showed strong concordance in center 1 for all systems and only for 4 on 6 systems in center 2. Discussion: Completing a systemic evaluation, the therapist may prioritize the patient’s needs identifying the most challenging systems. This paper presents the Frail’BESTest and confirms the psychometric properties at a first step level.

OBJECTIVES: Motor deficiency is associated with cognitive frailty in patients with Mild Cognitive Impairments (MCI). In this study we aimed to test the integrity of the muscle synergy involved in an arm-pointing movement in MCI patients, non-impaired functionally. Thus, we were able to test the hypothesis that early motor indicators exist in this population at a preclinical level. METHODS: The electromyographic signals were collected for 11 muscles in 3 groups: Young Adults (YA), Aged Adults (AA), and MCI patients. The AA and MCI groups presented the same functional status. Each subject performed twenty arm-pointing movements from a standing position. RESULTS: The main differences were (1) delayed activation of the right Biceps Femoris and the right Erector Spinae at L3 in MCI patients and AA compared with YA groups ; (2) earlier activation of the left Obliquus internus in MCI compared with AA group and (3) concerning the left Erector spinae at L3, a delay for the AA compared with YA but an earlier activation for the MCI compared with both AA and YA. These temporal differences in muscle synergies were linked with executive functions of MCI patients. INTERPRETATION: The motor program changes highlighted in our patient (MCI) group suggest that discrete modifications of the motor command seem to exist even in the absence of functional impairment. Instead of showing an indication of delayed muscle activation in the MCI patients, our results highlight some early activation of several trunk muscles, probably used in a more cautious motor behavior.

Kinematic analysis of motor strategies in frail aged adults during the Timed Up and Go: how to spot the motor frailty? Asma Hassani,1 Alexandre Kubicki,2,3 Vincent Brost,1 France Mourey,2,4 Fan Yang1 1Laboratoire LE2I CNRS 6306, Université de Bourgogne, Dijon, France; 2Institut National de la Santé et de la Recherche Médicale (INSERM), Cognition Action et Plasticité Sensori-Motrice, Campus Universitaire, Université de Bourgogne, Dijon, France; 3Centre Hospitalier Universitaire de Dijon, Hôpital de Champmaillot, Dijon, France; 4Faculté de Médecine, Université de Bourgogne, Dijon, France Objective: The purpose of this work was to analyze and compare the movement kinematics of sit-to-stand (STS) and back-to-sit (BTS) transfers between frail aged adults and young subjects, as well as to determine the relationship between kinematic changes and functional capacities. Methods: We analyzed the Timed Up and Go (TUG) movements by using a 3D movement analysis system for real-time balance assessment in frail elderly. Ten frail aged adults (frail group [FG]) and ten young subjects (young group [YG]) performed the TUG. Seven spatiotemporal parameters were extracted and compared between the two groups. Moreover, these parameters were plotted with TUG test duration. Results: The experiments revealed that there were significant differences between FG and YG in trunk angle during both STS and BTS, and in TUG duration. The trunk angle of the young subjects was more than two times higher than that of the FG. As expected, the TUG duration was higher in the FG than in YG. Trunk angles during both transfers were the most different parameters between the groups. However, the BTS trunk angle and STS ratio were more linked to functional capacities. Conclusion: There was a relationship between kinematic changes, representing the motor planning strategies, and physical frailty in these aged adults. These changes should be taken into account in clinical practice. Keywords: aging, Timed Up and Go test, kinematics, frailty effects