A cross-sectional design investigated the physical attributes of 15 dyads of people with dementia and their caregivers. Physical and cognitive markers determined deviations from clinical thresholds for loss of functional independence, where 100% of participants performed below criterion-referenced threshold values for aerobic endurance. Walking distance for people with dementia was associated with bath/shower activity (p = .007), transfers (p < .001), and mobility (p = .013). Less distance walked was associated with more assistance with self-care tasks. Physical deficits associated with low aerobic endurance and lower body strength compromised independence, placing dyads at risk for falls and mobility-related health issues.

Date Presented 03/26/20 An exploratory cross-sectional research design investigated group differences between family caregivers (FCGs) and people with dementia (PWD) in measures of fitness and cognition. Findings showed at least 40% of PWD performed below the threshold of functional mobility in every measure tested. At least 6.7% of FCGs performed below the threshold for functional mobility in five of the six measures. Despite being younger than 60 years old, FCGs still showed a risk for loss of functional mobility. Primary Author and Speaker: Rosanne DiZazzo-Miller Additional Authors and Speakers: Fredrick Pociask, Diane Adamo

Objective: A lack of confidence directly impacts caregiver distress, thereby having a tremendous influence on the overall health of caregivers. The purpose of this study examined how The Family Caregiver Training Program impacts caregiver confidence. Method: A delayed-intervention, randomized design with control group and three month follow up examined confidence with 36 family caregivers of people with dementia. Participants completed the nine-item Caregiver Confidence Scale pretest, posttest, and three months posttest; the last five-items included a program evaluation subscale administered only at posttest. Results: Caregiver confidence, regardless of group assignment, improved; however, was not maintained three months posttest. Both groups reported favorable program evaluation scores, with 83% requesting the availability of online training. Conclusion: Findings provide new evidence in caregiver literature on caregiver confidence from ADL and standard care training. Clinical implications suggest implementation of training programs that include follow-up visits to maintain confidence, and trainings in an online format.

Declining grip strength is an indicator of cognitive loss in older individuals but it has not been explored people younger than 65 years old. The purpose of this study was to investigate the relationship between grip strength and specific cognitive tests known to decline with mild cognitive impairment in young and middle-aged adults. Declines in cognitive performance in middle-aged adults may provide evidence that these changes occur earlier than previously reported. A cross sectional design was used to compare differences between young and middle-aged healthy adults and to investigate associations between cognitive and grip strength measures within groups. Healthy young (20-30 years old) and middle-aged (45-65 years old) adults completed five cognitive tests including the Stroop, California Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Tests and the Controlled Oral Word Association Test. All participants completed right and left maximum grip strength measures. Middle-aged adults performed significantly worse on right and left grip strength and the Stroop test (p<0.05) when compared to the younger group. There were no significant relationships among grip strength and cognitive performance at the whole-group level or within the younger-age group; however, weaker grip strength was significantly associated with poorer Controlled Oral Word Association Test total cluster (r = 0.458; p <.05) and Stroop interference (r = 0.471; p <.05) scores in the middle-aged group. Findings from this study suggest that cognitive changes may occur earlier than previously thought (prior to age 65). Weaker grip strength was significantly associated with poorer function in two of the cognitive measures in the middle-age group, suggesting that some domains of cognition, specifically semantic categorization and executive function, may be particularly sensitive to agerelated changes.

Date Presented 03/28/20 This study tested the effectiveness of instruction designed to reduce cognitive load under task- and performance-incentive conditions to understand the effects of achievement incentives on instructional effectiveness. Findings exemplified the importance of matching desired achievement levels with suitable curricular incentives and learner goal orientation, as the benefits of effective instructional design may only be known when combined with learner motivation to achieve educational outcomes. Primary Author and Speaker: Fredrick Pociask Additional Authors and Speakers: Rosanne DiZazzo-Miller Contributing Authors: Diane Adamo

Question: What is the risk for loss of functional independence in individuals who suffered a stroke and healthy older adults? What physical performance measures indicate the greatest loss of functional independence for both groups? Design: Prospective, observational study. Participants: Fourteen individuals who suffered a stroke and 14 age-matched healthy controls. Outcome measures: Six performance measures (chair stand, arm curl, chair sit and reach, back scratch, 6-minute walk/2-minute march-in-place and 8-foot up and go) that comprise the Senior Fitness Test (SFT). Results: Individuals who suffered a stroke showed reduced lower body flexibility (CI [1.2 – 9.1]; p < 0.05) and took longer to perform the timed up and go task than healthy controls (CI [.18 - 11.5]; p < 0.05). Upper and lower body strength, endurance and upper body flexibility were similar between groups. However, 91% of individuals with a stroke and 71% of the healthy controls were at risk for functional loss on at least 4 / 6 SFT items. Conclusions: To delay the progressive loss of independence and eventual placement in residential care or assisted living facilities, both groups would benefit from understanding the physical attributes that place them at risk for functional loss. Thus, we propose the use of the Senior Fitness Test to identify physical attributes that place individuals at risk for loss of independence that, in turn, will help them to develop task-specific fitness goals.

Asymmetries in grasp force matching extend beyond quantifying a single measure of maximum grip strength and advance our application of side-specific treatment interventions. A cross sectional study design investigated grasp-force matching performance in right-handed individuals with a stroke and age-matched healthy controls. A visual representation of the 20% Maximum Voluntary Contraction (MVC) was matched in three conditions in the absence of visual feedback with the same (Ipsilateral Remembered - IR) or opposite hand (Concurrent CC and Contralateral Remembered - CR). Greater overall relative error (RE) was found in contralateral compared to ipsilateral matching tasks. In the CR condition, post hoc analysis revealed significant differences between control and right hemisphere damage (RHD) group (95% CI [16.41-88.59]; p < 0.01) as well as left hemisphere damage (LHD) group and RHD (95% CI [23.4-95.09]; p < 0.01). Right hand matching relative error was 2.49 times larger in the RHD compared to the LHD group. Within the RHD group, matching errors were greater for the right than left hand in both contralateral conditions (95% CI [34,25-101.07]; p < 0.001). Individuals with RHD showed greater asymmetries in contralateral matching tasks compared to LHD and controls. More specifically, the RHD group had the greatest difficulty matching tasks with their right (non-paretic) than left (paretic) hand. In order to elucidate this asymmetry in the clinic the use of complementary grasp measures may be considered.

Cognitive decline in older adults contributes to reduced ability to perform daily tasks and continued disuse leads to muscle weakness and potentiates functional loss. Despite explicit links between the motor and cognitive systems, few health care providers assess motor function when addressing the needs of individuals with cognitive loss. Early and easy measurable biomarkers of cognitive decline have the potential to improve care for individuals with dementia and mild cognitive impairment. The aim of this study was to conduct a systematic search to determine the relationship among handgrip strength, as a measure of global muscle strength, and cognitive decline over time. Fifteen prospective, cohort, longitudinal studies of adults >60years old who were healthy or at risk of cognitive decline at study onset were included in the review. Studies that investigated changes in cognition relative to baseline grip strength and, those that investigated changes in grip strength relative to cognitive function were revealed. Findings here support the use of handgrip strength as a way to monitor cognitive changes and show that reduced handgrip strength over time may serve as a predictor of cognitive loss with advancing age.

•Handgrip strength is a global indicator of muscle strength.•Handgrip strength is easily measured in the clinic setting.•Lower handgrip strength is associated with reduced cognitive performance over time.•Higher handgrip strength is protective against cognitive decline.•Monitoring handgrip strength of individuals with cognitive impairment may be useful.

Previous studies have shown that asymmetries in upper limb sensorimotor function are dependent on the source of sensory and motor information, hand preference and differences in hand strength. Further, the utilization of sensory and motor information and the mode of control of force may differ between the right hand/ left hemisphere and left hand/ right hemisphere systems. To more clearly understand the unique contribution of hand strength and intrinsic differences to the control of grasp force, we investigated hand/ hemisphere differences when the source of force information was encoded at two different force levels corresponding to a 20 and 70% maximum voluntary contraction or the right and left hand of each participant. Eleven, adult males who demonstrated a stronger right than left maximum grasp force were requested to match a right or left hand 20 or 70% maximal voluntary contraction reference force with the opposite hand. During the matching task, visual feedback corresponding to the production of the reference force was available and then removed when the contralateral hand performed the match. The matching relative force error was significantly different between hands for the 70% MVC reference force but not for the 20% MVC reference force. Directional asymmetries, quantified as the matching force constant error, showed right hand overshoots and left undershoots were force dependent and primarily due to greater undershoots when matching with the left hand the right hand reference force. Findings further suggest that the interaction between internal sources of information, such as efferent copy and proprioception, as well as hand strength differences appear to be hand/ hemisphere system dependent. Investigations of force matching tasks under conditions whereby force level is varied and visual feedback of the reference force is available provides critical baseline information for building effective interventions for asymmetric (stroke-related, Parkinson's Disease) and symmetric (Amyotrophic Lateral Sclerosis) upper limb recovery of neurological conditions where the various sources of sensory -motor information have been significantly altered by the disease process.

Postural control requires the integration of sensorimotor information to maintain balance and to properly position and orient the body in response to external stimuli. Age-related declines in peripheral and central sensory and motor function contribute to postural instability and falls. This study investigated the contribution of head position, standing surface, and vision on postural sway in 26 community-dwelling older adults. Participants were asked to maintain a stable posture under conditions that varied standing surface, head position, and the availability of visual information. Significant main and interaction effects were found for all three factors. Findings from this study suggest that postural sway responses require the integration of available sources of sensory information. These results have important implications for fall risks in older adults and suggest that when standing with the head extended and eyes closed, older adults may place themselves at risk for postural disequilibrium and loss of balance.

There are few well-validated tools that focus on the assessment of walking confidence in older adults. The main objective of this study was to assess construct validity of the 10-item Modified Gait Efficacy Scale (mGES) as a measure of walking confidence in older adults. Twenty-four older females completed the mGES, the 16-item Activities-specific Balance Confidence (ABC-16) scale, and the Senior Fitness Test (SFT). Construct validity of the mGES was evaluated by quantifying relationships between the mGES and the ABC-16 and the SFT, and by examining the ability of the mGES to discriminate between known groups (no/lower fear of falling versus higher fear of falling). There was a strong correlation between mGES and the ABC-16 scale (rs = 0.85; p < 0.001). The mGES was significantly associated with SFT components that required lower extremity strength, stepping aerobic endurance, and walking agility and dynamic balance (rs = 0.45 to 0.61; p < 0.05). Relationships between the mGES and number of arm curls in 30 s, chair sit and reach test, and back scratch test were weak (rs = 0.13-0.25; p > 0.05). Mean mGES score was 91.5% in a no/lower fear of falling group, while it was 81.4% in a higher fear group (p = 0.22). There was a trend toward a significant difference in the unstandardized residuals derived from regression of ranked mGES scores on ranked covariate (age and 8 foot up and go) scores, between the no/lower versus higher fear of falling group (p = 0.095). These results support construct validity of the mGES as a measure of gait self-efficacy in community-dwelling older females.

Age-related changes in physical abilities, such as strength and flexibility, contribute to functional losses. However, older individuals may be unaware of what specific physical abilities compromise independent functioning. Three groups of women, aged 60 to 69, 70 to 79, and 80 to 92 years, were administered the Senior Fitness Test (SFT) to determine age differences in physical abilities and risk for functional losses. The oldest group showed significant differences in lower body strength, aerobic endurance, and agility and dynamic balance when compared with the other groups who performed similarly. Across all groups, a faster rate of decline was found for lower body strength (50.6%) and dynamic balance and agility (45.7%) than upper body strength (21.3%) and aerobic endurance (33.6%). Criterion-referenced (CR) fitness standards suggested that 45% of the individuals were at risk for loss of independent functioning. This study highlights age-related differences in physical abilities and the risk for the loss of independence in later life.

Background and Purpose: Stroke survivors have difficulty overcoming deficits associated with grasping ability that differ for their right and left hand. However, grasp force deficits unique to each hand are not clearly characterized. The purpose of this study was to determine right and left hand differences in control of grasp force for individuals who were right handed pre-stroke. Methods: Twenty-one participants (13 with left hemispheric & 8 with right hemispheric stroke) completed clinical assessments and performed hand-grasp tasks using Instrumented Strain Gauges embedded with force sensors. Pre / post stroke hand preference scores were obtained using the self-reported Edinburgh Handedness Inventory (EHI). A right and left hand Reference Force (RF) was based on 20% of the right and left maximum grasp force. The Matching Force (MF) was performed by the opposite hand. Visual feedback represented by a horizontal line on a computer monitor displayed the 20% RF. MF, performed without visual feedback, indicated whether the participant overshot or undershot the RF and was quantified as the Constant Error. Results: EHI scores for right hemispheric stroke patients were 0.86 / 1.00 pre, and 0.92 / 1.00 post stroke, indicating greater right hand use post stroke. EHI scores for left hemispheric stroke patients were 0.91 / 1.00 pre, and 0.59 / 1.00 post stroke, indicating less right hand use and greater left hand use post stroke. The ANOVA showed a significant three-way interaction for matching hand *reference hand* affected side F(2, 38) =4.42, p < 0.05) for constant error. Right hemispheric stroke patients showed left hand MF undershoots for right hand RF (p < 0.05). Left hemispheric stroke patients showed right hand MF undershoots for left hand RF (p < 0.05). Conclusions: Shifts in handedness scores and asymmetries in force matching performance were dependent on lesion location. From a clinical perspective, stroke survivors may not be aware of how hand differences in the control of grasp force influence their ability to perform everyday tasks despite knowing that one hand may be weaker than the other. This suggests using a lesion-side specific treatment technique to improve awareness and function when performing unimanual and bimanual hand-grasp tasks.

Increased brain iron content has been linked to neural degeneration and to age-related decline of cognitive and motor functions. The basal ganglia (BG), which contain significant amount of iron, play an important role in establishing and modulating force requirements in hand grasp to meet specific task demands. However, it is unclear if increased BG iron content contributes to age differences in hand grasp performance. To investigate the relationship between BG iron content and hand grasp force matching in older (65.0 ± 8.9 years) healthy women, participants generated a 20 % maximum voluntary exertion reference force that was matched with the opposite hand in the Contralateral Remembered (CR) and Contralateral Concurrent (CC) conditions and with the same hand in the Ipsilateral Remembered (IR) condition. T2* relaxation times calculated from MRI scans served to estimate iron content in the caudate nucleus (Cd), globus pallidus (GP), and putamen (Pt). Greater iron content in all BG was associated with relatively greater number of errors committed when matching force with the opposite hand in the CR and CC conditions than with the same hand in the IR condition. Younger women with greater estimated iron content committed more errors than their older counterparts with lesser estimated iron content in Cd and Pt. Greater iron content in the BG may contribute to sensorimotor declines in healthy women, and relative iron content quantified by MRI may be a promising biomarker of such.

Objectives: The cervical range of motion device (CROM) has been shown to provide reliable forward head position (FHP) measurement when the upper cervical angle (UCA) is controlled. However, measurement without UCA standardization is reflective of habitual patterns. Criterion validity has not been reported. The purposes of this study were to establish: (1) criterion validity of CROM FHP and UCA compared to Optotrak data, (2) relative reliability and minimal detectable change (MDC95) in patients with and without cervical pain, and (3) to compare UCA and FHP in patients with and without pain in habitual postures.Methods: (1) Within-subjects single session concurrent criterion validity design. Simultaneous CROM and OP measurement was conducted in habitual sitting posture in 16 healthy young adults. (2) Reliability and MDC95 of UCA and FHP were calculated from three trials. (3) Values for adults over 35 years with cervical pain and age-matched healthy controls were compared.Results: (1) Forward head position distances were moderately correlated and UCA angles were highly correlated. The mean (standard deviation) differences can be expected to vary between 1.48 cm (1.74) for FHP and -1.7 (2.46)degrees for UCA. (2) Reliability for CROM FHP measurements were good to excellent (no pain) and moderate (pain). Cervical range of motion FHP MDC95 was moderately low (no pain), and moderate (pain). Reliability for CROM UCA measurements was excellent and MDC95 low for both groups. There was no difference in FHP distances between the pain and no pain groups, UCA was significantly more extended in the pain group (P<0.05).Discussion: Cervical range of motion FHP measurements were only moderately correlated with Optotrak data, and limits of agreement (LOA) and MDC95 were relatively large. There was also no difference in CROM FHP distance between older symptomatic and asymptomatic individuals. Cervical range of motion FHP measurement is therefore not recommended as a clinical outcome measure. Cervical range of motion UCA measurements showed good criterion validity, excellent test-retest reliability, and achievable MDC95 in asymptomatic and symptomatic participants. Differences of more than 6 degrees are required to exceed error. Cervical range of motion UCA shows promise as a useful reliable and valid measurement, particularly as patients with cervical pain exhibited significantly more extended angles.

Although controversial, muscular effort perception is frequently attributed to the efferent copy of the associated motor command. While peripheral/sensory information is thought to be necessary for force modulation/control, it is not involved in initial force production. We recently showed in right-handers, that perception of effort was asymmetric for grasp-force tasks. This asymmetry was related to individual differences in right and left hand strength and an intrinsic component. A difference in gain (input/output magnitude relationship) for each limb/hemisphere system was proposed as the mechanism explaining intrinsic asymmetries. To further investigate the relative contributions of efferent copy and sensory feedback to the sense of effort, vibration was used to distort sensory information from the muscles providing the reference force. Visual feedback (vision) of the reference hand force was also manipulated. The absolute error (AE) was generally larger in the vision than no-vision condition and the influence of reference hand vibration was significant for left hand matching of the right hand reference force. However, this effect was negligible when matching in the reverse condition. These two results may reflect an interaction between two phenomena: (1) visual feedback, which represents the total output force may not be congruent with the internal representation of effort associated with the efferent copy and eventually the proprioceptive feedback; and (2) a vibration-induced larger AE for left than right hand contralateral matching indicates that the contribution of proprioceptive feedback to force matching is significant for the left but not the right hand/hemisphere system. Overall, it may be suggested that in right-handers, the sense of effort associated with the right hand may be primarily based on the efferent copy while the left hand/hemisphere system may use a combination of efferent copy and proprioceptive feedback. However, the weight of each type of information may depend on the association between motor command and representation of the execution of the motor command (visual vs. internal).

Postural control requires the integration of sensory information and is essential for performing every day movements and activities. Integrating sensory information from multiple sources may be challenging when competing sources of sensory information are affected. To further understand this complex relationship, this study investigated the contribution of varying sources of sensory information to postural control in healthy, young participants. Sixty young healthy adults (n=22 males; mean age, 24.6 ± 2.1 SD years and (n=38 females, mean age 24.0 ± 1.4 SD years) were asked to maintain a stable posture under conditions that varied standing surface, head position and the availability of visual information. Sway velocity was largest when standing on foam with eyes closed and head extended (2.07°/s) however, under the same visual-surface conditions with the head in a neutral position, sway velocity (1.59°/s) was smaller yet remained significant. Findings from this study suggest that postural sway responses are dependent on the combined integration of available sources of sensory information. It is anticipated that such baseline information will allow us to apply our findings to the clinical management of individuals suffering from balance and vestibular impairments.