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Mobility

Videoconferencing gets older adults moving

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An Osaka Metropolitan University-led research team has been exploring how videoconferencing can improve the health of older adults living in the countryside.

The COVID-19 pandemic made videoconferencing software commonplace in businesses and even schools, but this communication tool has the potential to offer benefits beyond the office or classroom.

OMU Associate Professor Kazuki Uemura of the Graduate School of Rehabilitation Science and colleagues devised a 12-week health education programme conducted using the videoconferencing software Zoom, with the aim of having participants engage in active learning. A control group was provided a similar 12-week programme by email, with attached pdf files giving health instructions in a passive learning format.

The researchers assessed the participants before and after the 12 weeks, then performed a follow-up at 36 weeks. Their results showed that compared to the control group the videoconferencing group tended to follow the health advice and showed some improvement in the amount of time spent doing physical activities as opposed to sedentary behaviour.

“This study proposes a new health education programme that is not dependent on location or distance and takes sustainable behavioural changes into consideration,” Professor Uemura suggested. “In the future, by expanding the implementation scale and conducting further verification, we aim to popularize such health programmes that everyone, everywhere can participate in.”

The findings were published in the Journal of Aging and Physical Activity.

Independence

NHS health records help predict risk of falling

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Patients’ risk of falling in the next 12 months could be predicted from their NHS data using a newly developed calculator.

eFalls is a falls prediction model which uses routinely available primary care electronic health record data, the first of its kind in the world.

Developed and tested by researchers from the University of Leeds, the University of Birmingham, and a team of collaborators*, with funding from the National Institute for Health and Care Research (NIHR), it can be used to help identify people at risk of hospitalisation or emergency department attendance after a fall over the next 12 months. This means these people can be provided with interventions to prevent falls taking place.

A research paper outlining the findings is published in Age and Ageing

Falls are common among people aged over 65 and can be devastating for people’s personal independence. The risks are multifactorial and include conditions that affect mobility or balance; medications, and home hazards. A history of falls is the strongest risk factor. The incidence of falls is also projected to rise in line with the global ageing demographic.

The findings help proactive identification of people who are at risk of experiencing a fall in the next 12 months. eFalls uses existing primary care data, reducing the need for intensive clinical falls assessment, saving doctors and nurses valuable time. Once identified as at risk of falling, people can be referred on to a specialist falls prevention service for assessment and treatment to prevent future falls.

The National Institute for Health and Care Excellence (NICE) estimates that 40% to 60% of falls result in major lacerations, traumatic brain injuries, or fractures. Other complications of falls include distress, pain, loss of self-confidence, reduced quality of life, loss of independence, and mortality.

Principal Investigator Andrew Clegg, Professor of Geriatric Medicine in the University of Leeds School of Medicine, said: “Falls are a global health problem of major importance to health and social care systems. Currently, people’s fall risk is usually only assessed when they have already experienced a fall, which means that they might have already experienced a major injury such as a hip fracture.

“Our eFalls calculator means that, for the first time, it is possible to proactively identify a person’s risk of future falls which means that they can be referred to specialist falls prevention services, reducing the risk of a fall from happening. The ability to put plans in place to protect those at risk is invaluable to the patient and their loved ones.

“The benefit to the health service is that it reduces the need for treatment and care in hospital and in the community, and the associated costs to the NHS of that treatment. We hope that eFalls will be widely adopted across the NHS to prevent falls from taking place.”

Lead author Lucinda Archer, Assistant Professor in Biostatistics at the University of Birmingham, said: “The eFalls calculator can be used to predict a person’s risk of a fall, based on information that is already included in their GP records. The accuracy of the tool has been thoroughly tested in two large datasets, containing routinely recorded information on patients from Wales and England, which has shown promising results.

“If this accuracy is consistent across the wider population, the use of eFalls to target those who would benefit from specialist assessment could vastly improve the way that falls prevention services are provided in the UK.”

Health Minister Andrew Stephenson said: “Suffering from a fall can be traumatic for both the individual and their family but innovations such as eFalls could provide a fantastic solution to prevent such incidents, saving people from a lot of pain, as well as time and resource for the NHS.

“Our ongoing work to ensure people get the right care at the right time includes giving people access to local falls services and rehabilitations services, but I’m proud that the UK is at the forefront of developing further solutions to such a widespread issue, through co-funding the development of this technology.”

The team set out to produce and assess a robust and reliable method to proactively identify people for falls prevention interventions, due to the currently limited availability of such systems.

The team developed the eFalls tool using data from more than 750,000 healthcare records. Of these almost 35,000 people experienced a fall or a fracture resulting in A&E attendance or hospitalisation within 12 months.

The researchers now hope the eFalls prediction model to be successfully integrated into UK primary care electronic patient record systems and are keen to work with UK policymakers to explore how eFalls could be used to inform health policy.

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Mobility

New study helps shed light on why we move slower as we age

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Mary Kaupas participates in a experiment to study how humans of various ages reach for targets. Credit: Erik Summerside/Mary Kaupas

A new study led by University of Colorado Boulder engineers helps explain why the older we get, the slower we tend to move.

The research is one of the first studies to experimentally tease apart the competing reasons why people over age 65 might not be as quick on their feet as they used to be.

The research group reported that older adults may move slower, at least in part, because it costs them more energy than younger people—perhaps not too shocking for anyone who’s woken up tired the morning after an active day.

The findings could one day give doctors new tools for diagnosing a range of illnesses, including Parkinson’s disease, multiple sclerosis and even depression and schizophrenia, said study co-author Alaa Ahmed. She and her colleagues published their findings this month in the journal JNeurosci.

“Why we move the way we do, from eye movements to reaching, walking and talking, is a window into ageing and Parkinson’s,” said Ahmed, professor in the Paul M. Rady Department of Mechanical Engineering.

“We’re trying to understand the neural basis of that.”

For the study, the group asked subjects age 18 to 35 and 66 to 87 to complete a deceptively simple task: to reach for a target on a screen, a bit like playing a video game on a Nintendo Wii.

By analysing patterns of these reaches, the researchers discovered that older adults seemed to modify their motions under certain circumstances to conserve their limited supplies of energy.

“All of us, whether young or old, are inherently driven to get the most reward out of our environment while minimising the amount of effort to do so,” said Erik Summerside, a co-lead author of the new study who earned his doctorate in mechanical engineering from CU Boulder in 2018.

Using engineering to understand the brain

Ahmed added that researchers have long known that older adults tend to be slower because their movements are less stable and accurate. But other factors could also play a role in this fundamental part of growing up.

According to one hypothesis, the muscles in older adults may work less efficiently, meaning that they burn more calories while completing the same tasks as younger adults—like running a marathon or getting up to grab a soda from the refrigerator.

Alternatively, ageing might also alter the reward circuitry in the human brain.

Ahmed explained that as people age, their bodies produce less dopamine, a brain chemical responsible for giving you a sense of satisfaction after a job well done. If you don’t feel that reward as strongly, the thinking goes, you may be less likely to move to get it. People with Parkinson’s disease experience an even sharper decline in dopamine production.

In the study, the researchers asked more than 80 people to sit down and grab the handle of a robotic arm, which, in turn, operated the cursor on a computer screen. The subjects reached forward, moving the cursor toward a target. If they succeeded, they received a reward—not a big one, but still enough to make their brains happy.

Moving slower but smarter

Both the 18 to 35-year-olds and 66 to 87-year-olds arrived at their targets sooner when they knew they would hear that bing bing—roughly four to five per cent sooner over trials without the reward. But they also achieved that goal in different ways.

The younger adults, by and large, moved their arms faster toward the reward. The older adults, in contrast, mainly improved their reaction times, beginning their reaches about 17 milliseconds sooner on average.

When the team added an eight-pound weight to the robotic arm for the younger subjects, those differences vanished.

“The brain seems to be able to detect very small changes in how much energy the body is using and adjusts our movements accordingly,” said Robert Courter, a co-lead author of the study who earned his doctorate in mechanical engineering from CU Boulder in 2023.

“Even when moving with just a few extra pounds, reacting quicker became the energetically cheaper option to get to the reward, so the young adults imitated the older adults and did just that.”

The research seems to paint a clear picture, Ahmed said: Both the younger and older adults didn’t seem to have trouble perceiving rewards, even small ones. But their brains slowed down their movements under tiring circumstances.

“Putting it all together, our results suggest that the effort costs of reaching seem to be determining what’s slowing the movement of older adults,” she added.

The experiment can’t completely rule out the brain’s reward centres as a culprit behind why we slow down when we age. But, Ahmed noted, if scientists can tease out where and how these changes emerge from the body, they may be able to develop treatments to reduce the toll of aging and disease.

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News

Revolutionary Scottish trial aims to improve outcomes for stroke survivors through exercise

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A trailblazing rehabilitation hub using exercise and other therapies to help boost stroke survivors’ recovery has opened its doors at one of Scotland’s largest hospitals – with evidence already pointing towards its life-changing impact on patients.

The hub is part of a trial being conducted by the University of Strathclyde in partnership with NHS Lanarkshire, to meet the overwhelming demand for intensive stroke rehabilitation.

It’s already known that the sooner a patient can begin stroke rehabilitation, the more likely they are to regain lost abilities, such as speech and movement. It’s a common practice for therapy to start as soon as 24 to 48 hours after a stroke, while a patient is still in hospital.

New National Institute for Health and Care Excellence (NICE) guidelines in the UK suggest stroke patients receive three hours of rehabilitation a day, five days a week.

This is a significant increase from the previous NICE advice of 45 minutes per day.

However, due to the overwhelming demand for rehabilitation, the NHS has struggled to meet the minimum recommended level, with current data suggesting that on average patients receive just 14 minutes of physiotherapy, 13 minutes of occupational therapy, and seven minutes of speech therapy a day.

But the new technology-enriched stroke rehabilitation hub (TERHS) at the University Hospital in Wishaw, which lies 11 miles south east of Glasgow, allows patients to access therapy more quickly at the required frequency.

Just weeks after its launch, proof is already emerging that the hub, which has been designed to holistically address the physical and cognitive harm caused by a stroke, has the potential to positively transform the recovery process for survivors.

Now it’s hoped if further evaluation backs up the preliminary findings the concept could be rolled out not just across Scotland, but all four UK nations within the next two years, putting the NHS at the forefront of treating patients in the chronic stage of stroke recovery.

Dr Gillian Sweeney

Dr Gillian Sweeney, an occupational therapist with NHS Lanarkshire and advanced practitioner for stroke survivors, who has led on the development of the trial and set up the hub, told Agetech World the model could receive a wider launch if health trusts are presented with concrete evidence of its physical and financial benefits.

Referring to the hospital trial currently underway and research being done by the University of Strathclyde’s Department of Biomechanical Engineering into the use of such hubs, Dr Sweeney said: “This is groundbreaking, a life-changing trial for those who have had a stroke. I’m a therapist myself and I’ve worked in the NHS for around 20 years, and what I would say is, we have never been able to deliver enough rehabilitation within the current model and resources, and things are getting more pressurised.

“I think every therapist that works in stroke would probably say ‘We know we are not delivering the level of intensity that we should be.’ We know from evidence that the greater the intensity the better the outcomes.

“But we have been on a hamster wheel for a number of years, and I think we are now at the point where this model, with modest investment – and I don’t want to say within current resources because we need the investment in the equipment and staff to run the groups – but with a realistic, modest investment, could actually achieve those levels of rehab activity that we never foresaw we could do without making a huge investment in staffing for one-to-one treatment.

“For me, the feedback from participants, both within the university and even in the early stages on the hospital ward, is that the difference that makes is massive.

“I think for me, as well, what it does, is that it brings back the person’s control of their own rehabilitation. They have the opportunity to attend this hub and with the minimum amount of support, they are back in control of their own rehab.

“They can choose how often they come for and how long they stay. That, in itself, has been huge.”

Even more remarkable is that participants from the community that have taken part in the university-based study – some of whom suffered a stroke up to a decade ago – have seen functional improvements.

“It wasn’t what we expected to see, but we did,” Dr Sweeney said.

“The study initially was just to look at, ‘is it safe, and do people like it?’ Ten years after a stroke there wasn’t a huge amount of expectation that things like arm function or walking speed would improve.

Dr Andy Kerr working with a stroke survivor at the University of Strathclyde. Credit: University of Strathclyde

“But with the outcome measures we have taken, pretty much everybody has improved in one or more areas.

“If you look at that and think ‘we can make those improvements 10 years down the line,’ what could you do in the very early phases after a stroke when your brain is more likely to make the changes to see improvement?

“For me, it is groundbreaking. If you use this model and put some of this equipment in so people can do the things they need to, it is a total no-brainer.

“Yet it (the resource) is not there. There are reasons for it not being there, and part of that has to do with people within healthcare systems often working so hard and under such pressure they don’t get the space to think about new ways of working or to test them.

“There are traditional ways of working and it takes a long time within the NHS to adopt new ways and to embed that.”

The impact of stroke can be profound and the months immediately after suffering one are key to recovery.

Located within the University Hospital’s stroke unit, the TERHS hub has a virtual reality treadmill with a specialist harness, a balance trainer, and power-assisted equipment from UK-based wellness and wellbeing supplier Innerva, which supports users to exercise allowing them to work passively or actively, depending on where they are in their recovery stage.

The technology also incorporates ‘gamification’, such as virtual reality, puzzles and problem-solving activities, which helps to improve the engagement with and response to therapy.

In addition, the hub houses specialist cognitive and VR equipment, helping to enrich the environment and improve users engagement with and response to rehabilitation therapy.

The hub builds on the research being carried out by the University of Strathclyde which has seen a team led by Dr Andy Kerr and Professor Philip Rowe in the Department of Biomechanical Engineering, set up a gym-like space offering an eight-week programme to survivors under the supervision of Dr Sweeney and research physiotherapist, Mel Slachetka, in the Sir Jules Thorn Centre for Co-Creation of Rehabilitation Technology.

The hospital hub has attracted 15 patient recruits so far, all of whom have been “extremely positive” about the programme, Dr Sweeney said, with some managing three hours of rehabilitation a day.

“People are getting much more activity time than would have been the case. Patients like the Innerva equipment as all they have to do is press a button, and they feel they are in control.

The University of Strathclyde’s technology-enriched rehabilitation hub. Credit: University of Strathclyde

“The setting seems to be popular, and what we are finding is that patients are coming up in a group. Having a stroke can be isolating, but the feedback we are getting is that users value the opportunity to meet people who are going through the same experience as them.

“We know that on stroke wards across the country there isn’t enough staff. Often what happens is that the nursing staff will help patients get out of bed and then they will sit in a chair for hours.

“But with the hub they are using their brain, they are being active, they are off the ward, and they are having the opportunity to socialise.”

The hub can support five patients at a time alongside two support staff.

Given the evidence already accrued through the University of Strathclyde’s rehabilitation programme in which every person using the Sir Jules Thorn Centre facility has seen an improvement, mostly in walking speed but also in some cases speech, it seems difficult to understand why the hub idea isn’t being rolled out as a priority.

Especially as Dr Sweeney admits her ambition is to see technology-driven rehabilitation hubs established in community settings across the UK to provide stroke survivors with easily accessible therapy for optimal recovery.

But whilst the idea may indeed, to quote Dr Sweeney, be a ‘no-brainer,’ even the most obvious concepts need to be proved on a number of levels.

With funding from the Engineering and Physical Science Research Council’s Impact Acceleration Account, a research assistant will assess the impact of the hub on inpatients in the early phase of their recovery with the aim of enabling them to achieve, or even exceed, the recommended levels of rehabilitation.

“We need to look at the costs and the harsh economics,” Dr Sweeney said. “From a research point of view, we must prove that. We are often not very good at proving that something is cost-effective.

“Rehabilitation in general has been run in the same way for a long time and it can be difficult to change traditional practices. And rehabilitation therapists as well as the public can be frightened of technology.

“There is often a feeling that if somebody who has had a stroke is elderly, they won’t be able to cope with technology. But one of our patients is 94, and we are finding that age isn’t as much of a barrier as people may think it is.

“But we need to prove all these things as well as the positive impact this approach can have on stroke survivors. At the minute we have tried it with people who are in the very early stages of stroke rehab, we have tried it in an acute inpatient ward, and we know it is safe and that it is acceptable.

“But we need to prove that people like the hub idea, that they get great intensity of rehabilitation, and that it improves people’s outcomes. Once we do that that will hopefully allow us to make a case that these facilities should be in place.

“Obviously, there are initial costs in terms of buying equipment, and there needs to be a discussion around how do we change the pathways and how do we change the ways the services work to allow this to become part of the normal treatment.

“But at the end of the day, what we want is to keep people out of hospital so they can go home and lead as normal a life as possible in the community.”

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