Importance Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. Objective To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. Design, Setting, and Participants In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Exposures Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Main Outcomes and Measures Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Results Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, –0.82; 95% CI, –0.34 to –1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, –0.34 [–0.52 to –0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of –2.81 m (95% CI, –5.45 to –0.17 m) and –5.31 m (95% CI, –10.20 to –0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. Conclusions and Relevance In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

/pdf/association-of-age-related-hearing-impairment-with-physical-1r1tp3wspp.pdf

Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US

We investigated robotic methods for teaching movements to hemiparetic subjects using novel techniques for neuro-adaptive control. Eight healthy subjects and twelve hemiparetic stroke subjects were exposed to novel viscous forces during planar movement of the hand towards a visual target. These forces were initially responsible for significant movement errors, but were followed by automatic adaptation. The forces were designed so that unexpected withdrawal would result in a pronounced after-effect, consisting of movement path errors that were opposite in sign to those induced by initial application of the force filed. For healthy subjects, the desired movement was a curved sinusoid. For the hemiparetics, we chose a replicated normal trajectory. After-effect trajectories in healthy subjects' were significantly shifted toward the desired trajectory. This after-effect fully-washed out following the removal of the forces in the final 50-75 movements, regardless of whether the subjects had visual feedback of their position. After-effects also generalized to movement directions that were not practiced. Hemiparetics showed different types of results. While several of them showed minimal improvement, the remaining hemiparetics showed adaptation with beneficial after-effects. Furthermore, several in this group retained diminished features of these aftereffects for the duration of the experiment. This approach may be an effective neurorehabilitation tool because it does not require explicit instructions about the desired movement.

Altering movement patterns in healthy and brain-injured subjects via custom designed robotic forces

Biofeedback systems have been extensively used in walking exercises for gait improvement. Past research has focused on modulating the wearer’s cadence, gait variability, or symmetry, but none of the previous works has addressed the problem of inducing a desired walking speed in the wearer. In this paper, we present a new, minimally obtrusive wearable biofeedback system (WBS) that uses closed-loop vibrotactile control to elicit desired changes in the wearer’s walking speed, based on the predicted user response to anticipatory and delayed feedback. The performance of the proposed control was compared to conventional open-loop rhythmic vibrotactile stimulation with N = 10 healthy individuals who were asked to complete a set of walking tasks along an oval path. The closed-loop vibrotactile control consistently demonstrated better performance than the open-loop control in inducing desired changes in the wearer’s walking speed, both with constant and with time-varying target walking speeds. Neither open-loop nor closed-loop stimuli affected natural gait significantly, when the target walking speed was set to the individual’s preferred walking speed. Given the importance of walking speed as a summary indicator of health and physical performance, the closed-loop vibrotactile control can pave the way for new technology-enhanced protocols for gait rehabilitation.

/pdf/wearable-biofeedback-system-to-induce-desired-walking-speed-1kig5cxrwn.pdf

Wearable Biofeedback System to Induce Desired Walking Speed in Overground Gait Training

Objective The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system. Methods This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes and between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure (COP) displacement of the children, evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function. Results The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF). Conclusion The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study. Impact Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss.

The purpose of this study was to determine the effect of hierarchical goal structure of a yet-to-be performed task on gait and eye fixation behavior while walking to the location of where the task was to be performed. Subjects performed different goal-directed tasks representing three hierarchical levels of planning. The first level of planning consisted of having the subject walk to a bookcase on which an object (a cup) was located in the middle of a shelf. The second level of planning consisted of walking to the bookcase and picking up the cup which was in the middle, on the right side, or on the left side of the bookcase shelf. The third level of planning consisted of walking to the bookcase, picking up the cup which was located in the middle of the bookcase shelf, and moving it to a higher shelf. Findings showed that hierarchal goals do affect center of mass velocity and eye fixation behavior. Center of mass velocity to the bookcase increased with an increase in the number of goals. Subjects decreased gait velocity as they approached the bookcase and adjusted their last steps to accommodate picking up the cup. The findings also demonstrated the important role of vision in controlling gait velocity in goal-directed tasks. Eye fixation duration was more important than the number of eye fixations in controlling gait velocity. Thus, the amount of information gained through object fixation duration is of greater importance than the number of fixations on the object for effective goal achievement.

Hierarchical goal effects on center of mass velocity and eye fixations during gait.

Auditory feedback may provide the nervous system with valuable temporal (e. g., footstep sounds) and spatial (e.g., external reference sounds) information that can assist in the control of upright walking. As such, hearing loss may directly contribute to declines in mobility among older adults. Our purpose was to examine the impact of auditory feedback on the control of walking in older adults. Twenty older adults (65-86 years) with no diagnosed hearing loss walked on a treadmill for three sound conditions: Baseline, Ear Plugs, and White Noise. We hypothesized that in response to reduced temporal auditory feedback during the Ear Plugs and White Noise conditions, participants would adapt shorter and faster steps that are traditionally believed to increase mechanical stability. This hypothesis was not supported. Interestingly, we observed increases in step length (p = 0.047) and step time (p = 0.026) during the Ear Plugs condition vs. Baseline. Taking longer steps during the Ear Plugs condition may have increased ground reaction forces, thus allowing participants to sense footsteps via an occlusion effect. As a follow-up, we performed a Pearson's correlation relating the step length increase during the Ear Plugs condition to participants' scores on a clinical walking balance test, the Functional Gait Assessment. We found a moderate negative relationship (rho = -0.44, p = 0.055), indicating that participants with worse balance made the greatest increases in step length during the Ear Plugs condition. This trend suggests that participants may have actively sought auditory feedback with longer steps, sacrificing a more mechanically stable stepping pattern. We also hypothesized that reduced spatial localization feedback during the Ear Plugs and White Noise conditions would decrease control of center of mass (COM) dynamics, resulting in an increase in lateral COM excursion, lateral margin of stability, and maximum Lyapunov exponent. However, we found no main effects of auditory feedback on these metrics (p = 0.580, p = 0.896, and p = 0.056, respectively). Overall, these results suggest that during a steady-state walking task, healthy older adults can maintain walking control without auditory feedback. However, increases in step length observed during the Ear Plugs condition suggest that temporal auditory cues provide locomotor feedback that becomes increasingly valuable as balance deteriorates with age.

Walking With Ears: Altered Auditory Feedback Impacts Gait Step Length in Older Adults

Speed impacts frontal-plane maneuver stability of individuals with incomplete spinal cord injury.

American Society of Biomechanics Journal of Biomechanics Award 2018: Adaptive motor planning of center-of-mass trajectory during goal-directed walking in novel environments.

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Walking With Ears: Altered Auditory Feedback Impacts Gait Step Length in Older Adults

Speed impacts frontal-plane maneuver stability of individuals with incomplete spinal cord injury.

American Society of Biomechanics Journal of Biomechanics Award 2018: Adaptive motor planning of center-of-mass trajectory during goal-directed walking in novel environments.