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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.

Leger. Doherty. Roos. McComas.. Darling et al. Cloutier. 1978. Milner-Brown. 1993. 1999. and Franklin. Gonzalez. and Vandervoort. Davies and White. Larsson and Karlsson. Stelmach. Milner. • 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. Cooke et al. and Brown. 1973.. and Petito. 1973. 1993. Aguado. and Yemm. Rice. Phillips. and Worringham. Campbell. 1983. Galganski et al. Lopez. 1993. Connelly. 1995. and Hakkinen. 1989. 1989. Clamann. . Izquierdo. 1989). Teasdale. Stein. 1996.Force Control and Regulation • Changes in the regulation of force outputs lead to decrements in the initiation and control of movements.. Singh et al. Vandervoort.. 1999. 1999.

demonstrated that older adults have reduced range of force production and higher force output variability compared with young adults. .Force Control and Regulation • Stelmach and colleagues (1989). using an isometric task. • 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.

1996. Galganski et al. 1996. Kinoshita and Francis. . young adults_ produces single burst to the targeted force level. Brown. 1993.Force Control and Regulation • Elderly produces multiple bursts of force in tasks_ to achieve targeted force levels (approaching maximum). • In contrast to above..

they do suggest a reason why control and coordination change with advanced age. .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 .

• 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 .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.

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. .

and Bimanual coordination tasks (Bennett and Castiello. 2000.Coordination_ With advancing age • Ability to control multiple movement components at any particular time becomes increasingly difficult across variety of movements. Ketcham et al. Carnahan et al.. • E.G: Aiming. 1993. Reaching and Grasping. Swinnen et al. Greene and Williams. Drawing. Wishart et al. 1998. 1994. . Handwriting... 1996. 1998.. 2001). Teulings and Stelmach.

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

Ketcham et al. tasks like drawing or handwriting require subjects to control multiple joints in a linked segment (require more regulation at fast movement speeds) Stelmach. 1993.Coordination_ With advancing age • Conversely. resulting in slower and more variable movements.5 Hz. .0 Hz (two cycles per second) compared with young adults who begin distortions at 2. (Teulings and • Ketcham and colleagues (2001) found that in a cyclical drawing task older adults begin to distort their movements at 2.. • Reason_ older adults are unable to accurately control the passive properties of linked segments. 2001).

while older adults coactivates these muscles at high levels during single joint elbow movements and reduced coactivation as shoulder involvement increases. . became less smooth and decoupled as shoulder contribution increased. • Young adults tended to increase activity of opposing muscles as shoulder involvement increases.Coordination_ With advancing age • Seidler and colleagues (2002) found that aiming movements away from the body (that required shoulder and elbow participation).

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

Wishart et al. . Greene and Williams.. with absolute errors on the order of 20 degrees of relative phase offset. 1998.. 1996.0 Hz compared with young adults.5 and 2.Bimanual coordination_ With advancing age • Older adults tend to have difficulty maintaining more complicated antiphase movements as movement speeds increase . 2000) • Older adults are less accurate at movement speeds of 1. (Swinnen et al.

.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. .

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

Muscle Activation Patterns_ Normal • For most movements. Buneo. Brown. 1994. 1996. and Flanders. a. 2 bursts of agonist muscle activity separated by. then b. the subsequent two bursts decelerate or brake the movement of the limb to the desired position Berardelli et al. 1989.. Darling et al. 1 single burst of antagonistic muscle activity Berardelli et al. Soechting. • This triphasic pattern of muscle activity produces a smooth trajectory of a body segment from one position to another. 1996. overcoming inertial forces.. with the first agonist burst initiating the movement. 1996.. . b. the underlying muscle activation patterns are organized in a triphasic pattern consisting of a.

1989.. 1996. • Antagonist burst is not well defined and occurs abnormally early Darling et al. without a clear alternating pattern of agonist-antagonist activation.. Darling et al. 1996. . 1998. Brown. Seidler-Dobrin et al. • Timing of triphasic muscle activity is highly variable. older adults often produce movements that have prolonged deceleration patterns or periods of braking of the movement Berardelli et al. • Consequently.Muscle Activation Patterns_ Elderly • Research indicates that older adults do not tightly couple the triphasic agonist-antagonist-agonist activation pattern as young adults do.. 1989..

but are unable to sustain force output for long periods of time) Yamada. Masuda. 2002. . and Okada.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.

Singh et al. Henning. causing force outputs of large incremental steps Brown. • 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. 1971. 1997. Roos et al. 1999. Larsson. Ng and Kent-Braun. activation of muscle is more bursty and less smooth compare to young adults. 1983.. whereas slow-twitch muscle fibers stay relatively stable across the life span Aniansson. 1997. 1972. 1999. and Frontera. McComas. 1997. Campbell. and Sica. .Muscle Composition and Muscle Activation Patterns_ with advancing age • Among elderly type II (fast-twitch) muscle fibers decrease by approximately 40 % . and Grimby.. 1993. Li. Roos et al.. 1986. 1999. Lexell. Fawcett. • In elderly. 2002. Yamada et al. Hedberg..

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) . 2000.. and Mansell. and Carter. Bernick and Cailliet. Wachtel et al. 1997. Stevens. Maroudas. 1995. 2002. Beaupre. Wachtel. Bailey • Loss of cartilage surface and chemical characteristic changes_ Osteoarthritis development Laver-Rubich and Silbermann. 1985.Joint Flexibility Changes • With advanced age.. . 1982. and Schneiderman.1995 Nonaka et al.

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

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

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