Why Functional Decrements are Reality among Elderly?

Amitesh Narayan

Force Control and Regulation

Force control is an elementary component of movement production because smooth and accurate movements require efficient modulation of force outputs.

Force Control and Regulation

Changes in the regulation of force outputs lead to decrements in the initiation and control of movements. Olders compared to young adults have decreased force outputs and inefficient force regulation making it difficult to initiate and execute movements quickly and accurately across a variety of tasks

(Brown, 1996; Campbell, McComas,

and Petito, 1973; Clamann, 1993; Cooke et al., 1989; Darling et al., 1989; Davies and White, 1983; Doherty, Vandervoort, and Brown, 1993; Galganski et al., 1993; Izquierdo, Aguado, Gonzalez, Lopez, and Hakkinen, 1999; Larsson and Karlsson, 1978; Milner-Brown, Stein, and Yemm, 1973; Milner, Cloutier, Leger, and Franklin, 1995; Roos, Rice, Connelly, and Vandervoort, 1999; Singh et al., 1999; Stelmach, Teasdale, Phillips, and Worringham, 1989).

Force Control and Regulation

Stelmach and colleagues (1989), using an isometric task, demonstrated that older adults have reduced range of force production and higher force output variability compared with young adults. Rate of force production slows down substantially {20 ms longer to achieve a force level 45 percent of their maximum (15 N)}.

Force Control and Regulation

Ng and Kent-Braun (1999) documented similar findings with older adults. They reported 60-N lower peak force output in older adults compared to young adults and a 20-ms-longer time for force production.

Force Control and Regulation

Elderly produces multiple bursts of force in tasks_ to achieve targeted force levels (approaching maximum).
Kinoshita and Francis, 1996; Brown, 1996; Galganski et al., 1993.

In contrast to above, young adults_ produces single burst to the targeted force level.

Functional Implications
All these changes are small and happenings over short periods. These changes may be a result of_ motor unit reorganization and muscle composition changes But , they do suggest a reason why control and coordination change with advanced age.

Functional Implications_ Examples

Changes in force regulation and control have large implications for most functional tasks. Turning a door knob or Picking up a glass of liquid. Tying shoe lace Eating with spoon Tying Button of shirt Stirring spoon in cup to mix sugar Climbing steps Playing with grand children ball game

Coordination_ Definition

Coordination is the ability to control a number of movement segments or body parts in a refined manner resulting in a well-timed motor output.

Coordination_ With advancing age

Ability to control multiple movement components at any particular time becomes increasingly difficult across variety of movements.

E.G: Aiming, Reaching and Grasping, Drawing, Handwriting, and Bimanual coordination tasks
(Bennett and Castiello, 1994; Carnahan et al., 1998; Teulings and Stelmach, 1993; Greene and Williams, 1996; Swinnen et al., 1998; Wishart et al., 2000; Ketcham et al., 2001).

Coordination_ With advancing age

In reach-to-grasp tasks, components involved are: a. Transport, and b. Grasp components Both must be coordinated both spatially and temporally. Researchers found that older adults exhibit unstable temporal coupling between these components
Castiello, 1994; Carnahan et al., 1998).

(Bennett and

Coordination_ With advancing age

Conversely, tasks like drawing or handwriting require subjects to control multiple joints in a linked segment (require more regulation at fast movement speeds)
Stelmach, 1993; Ketcham et al., 2001).

(Teulings and

Ketcham and colleagues (2001) found

that in a cyclical drawing task older adults begin to distort their movements at 2.0 Hz (two cycles per second) compared with young adults who begin distortions at 2.5 Hz.

Reason_ older adults are unable to accurately control the passive properties of linked segments, resulting in slower and more variable movements.

Coordination_ With advancing age

Seidler and colleagues (2002) found

that aiming movements away from the body (that required shoulder and elbow participation), became less smooth and decoupled as shoulder contribution increased.

Young adults tended to increase activity of opposing muscles as shoulder involvement increases, while older adults coactivates these muscles at high levels during single joint elbow movements and reduced coactivation as shoulder involvement increases.

Bimanual coordination
In these tasks subjects are asked to produce same movement with left and right limbs. These movements are typically either
a. In_phase, where two limbs move in the same anatomical direction (homologous muscles activated together), or b. Antiphase, where two limbs move in the same absolute direction (homologous muscles activated at 180-degree offset or opposite of each other).

Bimanual coordination_ With advancing age

Older adults tend to have difficulty maintaining more complicated antiphase movements as movement speeds increase .
(Swinnen et al., 1998; Greene and Williams, 1996; Wishart et al., 2000)

Older adults are less accurate at movement speeds of 1.5 and 2.0 Hz compared with young adults, with absolute errors on the order of 20 degrees of relative phase offset.

Bimanual coordination_ With advancing age

Older adults have increased difficulty controlling and regulating multiple segments to produce smooth motor outputs.

Bimanual coordination_ With advancing age

Coordination is a part of most tasks of daily living and therefore it is essential to understand breakdowns in control and regulation.

Proprioception_ With advancing age

Reduced ability in older adults to accurately detect movement or localize a body segment position makes it difficult to produce rapid, well-coordinated movements.

Major functional implications for older adults in a variety of tasks of daily living, a. Sitting in a chair b. Reaching for an object.
Older adults tends to underestimate their joint angle.

Muscle Activation Patterns_ Normal

For most movements, the underlying muscle activation patterns are organized in a triphasic pattern consisting of a. 2 bursts of agonist muscle activity separated by, b. 1 single burst of antagonistic muscle activity
Berardelli et al., 1996.

This triphasic pattern of muscle activity produces a smooth trajectory of a body segment from one position to another,
a. with the first agonist burst initiating the movement, overcoming inertial forces; then b. the subsequent two bursts decelerate or brake the movement of the limb to the desired position Berardelli et al., 1996; Brown, 1996; Buneo, Soechting, and Flanders,
1994; Darling et al., 1989.

Muscle Activation Patterns_ Elderly

Research indicates that older adults do not tightly couple the triphasic agonist-antagonist-agonist activation pattern as young adults do. Timing of triphasic muscle activity is highly variable, without a clear alternating pattern of agonist-antagonist activation. Antagonist burst is not well defined and occurs abnormally early
Darling et al., 1989.

Consequently, older adults often produce movements that have prolonged deceleration patterns or periods of braking of the movement Berardelli et al., 1996; Brown, 1996; Seidler-Dobrin et al., 1998; Darling et al., 1989.

Muscle Composition and Muscle Activation Patterns_ with advancing age

Number and size of muscle fibers decrease in older adults Most substantial decrease_ happens in fast-twitch fibers (which can be activated quickly for large force outputs, but are unable to sustain force output for long periods of time)
Yamada, Masuda, and Okada, 2002.

Muscle Composition and Muscle Activation Patterns_ with advancing age

Among elderly type II (fast-twitch) muscle fibers decrease by approximately 40 % , whereas slow-twitch muscle fibers stay relatively stable across the life span Aniansson, Hedberg, Henning, and Grimby, 1986; Lexell,
1993; Singh et al., 1999; Yamada et al., 2002.

In elderly, activation of muscle is more bursty and less smooth compare to young adults, causing force outputs of large incremental steps Brown, 1972; McComas, Fawcett, Campbell, and Sica, 1971; Roos et al., 1997, 1999.

Contractile speed of muscles in older adults is slower than in young adults, which also influences the ability to ramp forces in any given muscle Davies and White, 1983; Larsson, Li, and Frontera, 1997; Ng and Kent-Braun, 1999; Roos
et al., 1997.

Joint Flexibility Changes

With advanced age, the length of muscles around the joints is reduced due to reduced flexibility of joint structures (changes in hydration and microstructure of collagen within the joint) .
and Mansell, 1997; Wachtel et al.,1995

Nonaka et al., 2002; Wachtel, Maroudas, and Schneiderman, 1995; Bailey

Loss of cartilage surface and chemical characteristic changes_ Osteoarthritis development

Laver-Rubich and Silbermann, 1985; Beaupre, Stevens, and Carter, 2000; Bernick and Cailliet, 1982.

Joint Flexibility Changes_ Functional Implications

Decreased flexibility has implications for tasks of daily living a. Putting on socks or stockings, b. Safely pulling out into traffic, c. Picking up a dropped object,
Gehlsen and Whaley, 1990; Nonaka et al., 2002; Shepard et al., 1990; Spirduso, 1995).

References
Bennett, K.M., and Castiello, U. (1994). Reach to grasp: Changes with age. Journal of Gerontology, 49(B1), P1-P7. Berardelli, A., Hallett, M., Rothwell, J.C., Agostino, R., Manfredi, M., Thompson, P.D., and Marsden, C.D. (1996). Single-joint rapid arm movements in normal subjects and in patients with motor disorders. Brain, 119, 661-674. Buneo, C.A., Soechting, J.F., and Flanders, M. (1994). Muscle activation patterns for reaching: The representation of distance and time. Journal of Neurophysiology, 71(4), 1546-1558. Campbell, M.J., McComas, A.J., and Petito, F. (1973). Physiological changes in ageing muscles. Journal of Neurology, Neurosurgery and Psychiatry, 36(2), 174-182. Carnahan, H., Vandervoort, A.A., and Swanson, L.R. (1998). The influence of aging and target motion on the control of prehension. Experimental Aging Research, 24(3), 289-306. Cerella, J. (1985). Information processing rates in the elderly. Psychological Bulletin, 98(1), 67-83. Clamann, H.P. (1993). Motor unit recruitment and the gradation of muscle force. Physical Therapy, 73(12), 830-483.

References
Contreras-Vidal, J.L., Teulings, H.L., and Stelmach, G.E. (1998). Elderly subjects are impaired in spatial coordination in fine motor control. Acta Psychologica, 100(1-2), 25-35. Cooke, J.D., Brown, S.H., and Cunningham, D.A. (1989). Kinematics of arm movements in elderly humans. Neurobiology of Aging, 10(2), 159-65. Darling, W.G., Cooke, J.D., and Brown, S.H. (1989). Control of simple arm movements in elderly humans. Neurobiology of Aging, 10(2), 149-157. Davies, C.T., and White, M.J. (1983). Contractile properties of elderly human triceps surae. Gerontology, 29(1), 19-25. Doherty, T.J., Vandervoort, A.A., and Brown, W.F. (1993). Effects of ageing on the motor unit: A brief review. Canadian Journal of Applied Physiology, 18(4), 331-358. Drowatzky, K.L., and Drowatzky, J.N. (1999). Physical training programs for the elderly. Clinical Kinesiology, 53(3), 52-62. Gauchard, G.C., Jeandel, C., Tessier, A., and Perrin, P.P. (1999). Beneficial effect of proprioceptive physical activities on balance control in elderly human subjects. Neuroscience Letters, 273(2), 81-84.