Correlation between interlimb coordination with dynamic balance and cognition among geriatric population of South Delhi

Khan Minhal; A Siddiqui Hammad; Chhabra Charu; Kaushik Himani

doi:10.4103/ijptr.ijptr_155_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 5 | Issue : 1 | Page : 73-76

Correlation between interlimb coordination with dynamic balance and cognition among geriatric population of South Delhi

Khan Minhal¹, A Siddiqui Hammad¹, Chhabra Charu², Kaushik Himani³
¹ Department of Physiotherapy, School of Nursing Sciences and Allied Health, Jamia Hamdard University, New Delhi, India
² School of Physiotherapy and Rehabilitation Sciences, K.R Mangalam University, Sohna Road, Haryana, India
³ Banarsidas Chandiwala Institute of Physiotherapy, GGS Indraprastha University, Delhi, India

Date of Submission	20-Sep-2022
Date of Decision	06-Mar-2023
Date of Acceptance	22-May-2023
Date of Web Publication	11-Aug-2023

Correspondence Address:
Dr. A Siddiqui Hammad
Assistant Professor, Department of Physiotherapy, School of Nursing Sciences and Allied Health, Jamia Hamdard University, New Delhi - 110062
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_155_22

Abstract

Context: Aging involves an overall deterioration of sensory functions, affecting the coordinated behavior, and suggesting a decline in the quality of afferent information from the periphery. Extra mental effort is required for the control of these movements and performing complex tasks requiring control of balance.
Aim: The research was undertaken to determine the correlation between interlimb coordination with dynamic balance and cognition in geriatrics.
Setting and Design: Cross-sectional study was done on geriatric people from Rehabilitation Center, Jamia Hamdard, Delhi.
Subjects and Methods: A total of 35 healthy geriatrics were recruited from South Delhi by convenience sampling, based on the inclusion criteria of the study. Ethical approval was obtained from the ethics committee of the university and signed informed consent was obtained before the study. All the participants were assessed for interlimb coordination, dynamic balance, and cognition by Purdue Pegboard Test, Berg balance test, and mini–mental state examination, respectively, at Rehabilitation Center, Jamia Hamdard, Delhi.
Statistical Analysis: Statistical analysis for correlation was performed through statistical software IBM SPSS Statistics 21.0 and the Pearson correlation test was used with a significance level set at 0.01.
Results: Mean changes revealed the correlation between interlimb coordination and cognition (P = 0.000). Interlimb coordination and balance did not show any correlation (P > 0.01), and there was no adverse event during the study.
Conclusion: It was concluded from the study that interlimb coordination is related to cognition and not to dynamic balance in healthy geriatric people.

Keywords: Cognition, Dynamic balance, Geriatric people, Interlimb coordination

How to cite this article:
Minhal K, Hammad A S, Charu C, Himani K. Correlation between interlimb coordination with dynamic balance and cognition among geriatric population of South Delhi. Indian J Phys Ther Res 2023;5:73-6

How to cite this URL:
Minhal K, Hammad A S, Charu C, Himani K. Correlation between interlimb coordination with dynamic balance and cognition among geriatric population of South Delhi. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Oct 1];5:73-6. Available from: https://www.ijptr.org/text.asp?2023/5/1/73/383670

Introduction

An unprecedented growth of the aging population is taking place. As per the data of the Technical Group on Population Projections for India and States 2011–2036, 67 million males and 71 million females would make up almost 138 million elderly persons in India, in 2021.^[1] Aging is associated with physiological changes in all body systems and there occurs a significant decline in cognition, neuromuscular systems, capacity, and various other systems of an individual.

Coordination of bilateral limbs requires successive and synchronized movements using both sides of the body with a high gradation of rhythm, with much attention on the timing of motorcycles of the extremities with respect to one another.^[2] Interlimb-coordinated activities play an important role in our activities of daily living (ADLs); however, the geriatric population often showed severe deterioration in sensory and motor coordinated activities of hands, and these deficiencies were associated with the development of age-related cognitive and balance problems.^[3],[4]

As we age, cognition is affected as the prefrontal cortex grey matter starts to decrease more prominently due to neuronal death.^[4]

Timing represents an important feature of movement execution in geriatric people. Noticeable changes in the coordination process due to degeneration of central or peripheral systems.^[5]

Essential factors contributing to an adequate static and dynamic balance-confidence and control, promote mobility and improve balance are sensory inputs like visual, vestibular, proprioceptive, and mechanoreceptive systems, central nervous system functions with feedback and feed-forward loops able to withstand external and internal stimuli and musculoskeletal factors such as adequate muscle strength and range of motion in the joints for coordinated movement patterns.^[5],[6]

Cognition also plays an important role in controlling a dynamic balance in the geriatric population, whereas sensory-motor systems are integrated with the hierarchy of neurological processes. With the aging, there is a gradual deterioration in cognitive function and difficulty to control dynamic balance, carry out coordinated activities, for example, ADLs.^[7]

There was a dearth of literature on the correlation between interlimb coordination, dynamic balance, and cognition; therefore, this research was undertaken to determine the correlation between interlimb coordination, balance, and cognition among the geriatric population.

[TAG:2]Subjects and Methods [/TAG:2]

Subjects

For this cross-sectional study, 35 healthy geriatric people with a mean age of 58.3 years were called to participate from Rehabilitation Center, Jamia Hamdard, Delhi. Sample size calculation was done by G*power. Thirty-five participants were selected by convenience sampling. Participants between the age 50 and 60 years; those with normal cognition (mini–mental state examination [MMSE] ≥24), intact hearing, and visual abilities; able to ambulate independently; and those with near-normal Asian body mass index were included in the study. Those with impaired cognitive and mental abilities (MMSE <24), a history of vestibular disorders, vertigo, neuromuscular disorder, recent fall, chronic ankle instability, and those dependent on walking aids for ambulation were excluded from participation in the study. Ethical permission was obtained from the Jamia Hamdard Ethics Committee and signed informed consent was obtained from the participants before the study.

Outcome measures

Outcome measures used in this study for interlimb coordination – Purdue Pegboard Test,^[8] and balance outcome was measured by Berg balance test.^[9] Furthermore, MMSE was used in this study for the cognitive examination.^[10]

Procedure

Data collection was done at the Rehabilitation center, Jamia Hamdard, Delhi. Baseline anthropometric traits, as well as a history of the participants, were obtained by personal interview. Questions of the interview were closed-ended. Baseline anthropometric traits and history included age, gender, occupation, past ailment history, drug history, typical personal manners, and motor or sensory abnormalities. [Flowchart 1] shows the outline of the study procedure.

Data interpretation

The statistical software IBM SPSS Statistics 21.0 (IBM Corporation, Armonk, NY, USA) was used for the analyzes of the data and managed on Microsoft Excel. The significance value was ≤0.01. Values for measures of central tendency and dispersion to assess the sample were noted and Pearson's test for correlation was performed to find any relationship between interlimb coordination, dynamic balance, and cognition.

Results

A total of 35 geriatrics were recruited for the correlational study. The average age was 53 years. The mean of the Berg Balance Scale (BBS) score and MMSE score was 50.22 ± 5.23 and 28.05 ± 7.38, respectively. A noteworthy correlation was found between interlimb coordination of the dominant hand (DH) (significance value ≤0.01), non-DH (NDH) (significance value ≤0.001), right–left – both hands (BH) (significance value ≤0.001), and assembly (significance value ≤0.01) with cognition as measured by MMSE. It swas seen that interlimb coordination was not related to dynamic balance as measured by BBS. [Table 1] and [Table 2] show the correlation coefficient and the significance value of the variables of interlimb coordination, BBS, and MMSE, respectively. [Graph 1] and [Graph 2] show the scatterplot of the correlation between interlimb coordination with dynamic balance and MMSE, respectively.

Table 1: Pearson correlation and P value of interlimb coordination and Berg Balance Scale

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Table 2: Pearson correlation and P value of interlimb coordination and mini–mental state examination

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Discussion

This study was undertaken to investigate whether there exists any correlation between interlimb coordination, dynamic balance, and cognition in the geriatric population. A noteworthy correlation was found among interlimb coordination of DH, NDH, right–left – BHs, and assembly with cognition as measured by mini–mental state examination. It was seen that interlimb coordination was not related to dynamic balance as measured by BBS. Interestingly, our results are also supported by previous studies that aging may increase the chances of cognitive decline, in coordination and balance affection. Rattanawan revealed in his study showed in older persons with MCI, DH dexterity had a significant impact on domestic and complicated ADL. There were lateral asymmetrical motor decrease age-related alterations, particularly in cognitive activities. However, complicated cognitive activities may call for bimanual, nondominant, and DH dexterity.^[11] Kang et al. concluded that while controlling isometric pressures bilaterally with visual feedback, elderly individuals exhibit lower bilateral motor synergies than younger adults. In addition, older persons exhibited higher asymmetrical force variability and positive correlations between the two hands under circumstances of vision and absence of vision. The ability to synergistically coordinate and choose the best pairings of bilateral force outputs over numerous trials may deteriorate with age.^[12] These findings suggested that all these factors are responsible for reducing the overall quality of life of the individual. However, our results are not so promising because the study had numerous limitations. This study was conducted during COVID-19 due to the less footfall of geriatric people in rehabilitation centers and we were not able to increase our sample size. Results may be affected as the same person collected data leading to assessor bias. In the future, a similar study can be done on a larger population to increase the reliability of the data and prevent extrapolation of data and can be done with more reliable and validated tools for measurement of the outcomes.

Conclusion

It was concluded from the results of the cross-sectional study that interlimb coordination was significantly correlated positively with cognition, but there was no relationship between interlimb coordination and dynamic balance as measured by BBS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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