Rehabilitation Clinical Trial
Official title:
Examining the Role of External and Internal Attention Focus Walking Training on Conscious Motor Processing During Rehabilitation by Older Adults at Risk of Falling in Hong Kong: A Randomized Controlled Trial.
This study aims to examine the effect of external, internal and no attention focus walking
training during gait rehabilitation on real-time conscious motor processing (reinvestment),
balance, walking ability and fear of falling by older adults at risk of falling in Hong Kong.
One-hundred and eight older adults will be recruited from elderly community centers in Hong
Kong. Participants will be randomly assigned into 3 groups (i.e., No Attention Focus Walking
Group (NAFWG; active control group, n=36), an External Attention Focus Walking Group (EAFWG,
n = 36) or an Internal Attention Focus Walking Group (IAFWG, n = 36)). Participants in
different groups will have training sessions (about 45 minutes each) three times per week for
4 weeks in a group of 6 participants. A total of 12 sessions will be completed by each
participant.
All training sessions will be conducted by experienced registered physiotherapists in Hong
Kong and a research assistant with experience in exercise training for older adults. In each
training session, all groups will have warm-up (5 minutes), balance training (5 minutes),
body transport training (5 minutes), body transport with hand manipulation training (5
minutes), walking training with various levels of difficulties in a 40-meter walkway with
different instructions in different walking groups (20 minutes) and cool down (5 minutes).
For the walking training (20 minutes), all participants will be invited to conduct walking
training on a walking field with an area of 25 meter square and a total walking distance of
about 40 meters for each walking trial from cone 1 to 9. Two screens that connected with a
laptop computer will be positioned 1 meter beside the walking field. Both screens will be
projected different digits from 0 to 9 randomly in the speed of 2 seconds per digit.
Participants in the NAFWG, EAFWG, and IAFWG will receive different instructions during
walking training.
Each participant will complete assessment sessions (total 3 assessment sessions) before
training at baseline (T0), just after completion of all training sessions (T1) and 6 months
after completion of all training sessions (T2). In the baseline assessment (T0), a structural
questionnaire will be used to ask for demographics, medical history, detailed history of fall
incident, social history and social economic status of all participants. A battery of
assessments will be conducted to assess physical and cognitive abilities of the participants
in all assessment sessions (T0, T1, & T2). Walking ability will be assessed by the 10 meters
comfortable and fast walking speed (Bohannon, 1997). Functional balance and gait assessment
will be done by the Tinetti Balance Assessment Tool (Tinetti, 1986), the Berg Balance Scale
(BBS) (Berg et al., 1989) and the Timed 'Up & Go' Tests (TU&G) (Podsiadlo & Richardson,
1991). Cognitive function will be evaluated by the Chinese version Mini-Mental State
Examination (MMSE-C) (Folstein et al., 1975; Chiu et al., 1994). The Chinese version of the
Fall Efficacy Scale International (FES-I (Ch)) (Kwan, Tsang, Close & Lord, 2013) will be
completed to assess the fear of falling. The Chinese version Movement Specific Reinvestment
Scale (MSRS-C) (Masters et al., 2005; Wong et al., 2015a; Wong et al., 2015b) will be
administered to examine the conscious motor processing propensity (i.e., movement specific
reinvestment). The alpha2 EEG coherence between T3 (verbal-analytical region of the brain)
and the Fz (motor planning region of the brain) (i.e., T3-Fz EEG coherence) of all
participants when walking at the 6-meter level-ground walkway (three walking trials) will be
determined to identify the real-time conscious motor processing propensity (Zhu et al., 2011;
Ellmers et al., 2016; Chu & Wong, 2019). All participants will be equipped with EEG
electrodes before the start of the three walking trials. EEG activity will be received using
a wireless EEG device (Brainquiry PET 4.0, Brainquiry, The Netherlands) and will be recorded
using the real-time biophysical data acquisition software (BioExplorer 1.5, CyberEvolution,
US). Previous research has demonstrated that alpha2 (10-12Hz) T3-Fz EEG coherence is
sensitive at detecting within-subject changes in real-time conscious motor processing
propensity during a postural sway task (Ellmers et al., 2016). T4-Fz EEG coherence will be
utilized to identify whether the changes in the alpha2 T3-Fz EEG coherence will be due to
global activation of the brain. The EEG electrodes are non-invasive and will not be used in
any diagnostic purpose.
All participants will be asked to record their number of falls prospectively at the time
between T1 (completion of all training sessions) and T2 (6 months after completion of all
training sessions) using a structural calendar. The number of falls within the 6-month
follow-up period will then be collected.
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