Neelesh K Nadkarni1, Subashan Perera2, Stephanie A Studenski2, Caterina Rosano3, Howard J Aizenstein4, Jessie M VanSwearingen5. 1. Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: nkn3@pitt.edu. 2. Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA. 3. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 4. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 5. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVE: To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions. DESIGN: Single-blind randomized controlled trial of 2 types of gait exercises in older adults. SETTING: Research center in an academic institution. PARTICIPANTS: Ambulatory adults (N=44) aged ≥65 years with a slow and variable gait. INTERVENTION: Twelve-week physical therapist-guided trial of a conventional walking, endurance, balance, and strength (WEBS) intervention (n=20) versus a timing and coordination of gait (TC) intervention (n=22). MAIN OUTCOME MEASURE: Gain in gait speed after the intervention and its relation to callosal hyperintensities in the genu and splenium of the corpus callosum. RESULTS:Gait speed improved in both the WEBS group (mean change, 0.16m/s) and the TC group (mean change, 0.21m/s; both P<.05). The volume of white matter hypertintensities (WMHs) in the genu was differentially associated with gait speed gain (group × genual WMH interaction, P=.05). Greater genual WMH volume was related to a smaller gait speed gain in the WEBS group (P=.01) but not in the TC (P=.10) group. Splenial WMH volume was not differentially associated with gait speed gain (interaction, P=.90). CONCLUSIONS: Callosal hyperintensities differentially influence gait speed gain by the type of gait rehabilitation. Mobility impaired older adults with genual hyperintensities may benefit from a rehabilitation program focused on motor skill learning rather than on strength and endurance training.
RCT Entities:
OBJECTIVE: To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions. DESIGN: Single-blind randomized controlled trial of 2 types of gait exercises in older adults. SETTING: Research center in an academic institution. PARTICIPANTS: Ambulatory adults (N=44) aged ≥65 years with a slow and variable gait. INTERVENTION: Twelve-week physical therapist-guided trial of a conventional walking, endurance, balance, and strength (WEBS) intervention (n=20) versus a timing and coordination of gait (TC) intervention (n=22). MAIN OUTCOME MEASURE: Gain in gait speed after the intervention and its relation to callosal hyperintensities in the genu and splenium of the corpus callosum. RESULTS: Gait speed improved in both the WEBS group (mean change, 0.16m/s) and the TC group (mean change, 0.21m/s; both P<.05). The volume of white matter hypertintensities (WMHs) in the genu was differentially associated with gait speed gain (group × genual WMH interaction, P=.05). Greater genual WMH volume was related to a smaller gait speed gain in the WEBS group (P=.01) but not in the TC (P=.10) group. Splenial WMH volume was not differentially associated with gait speed gain (interaction, P=.90). CONCLUSIONS: Callosal hyperintensities differentially influence gait speed gain by the type of gait rehabilitation. Mobility impaired older adults with genual hyperintensities may benefit from a rehabilitation program focused on motor skill learning rather than on strength and endurance training.
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