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PubMed2005

[A case of tetanus showing limited mobility of the bilateral vocal cords].

Patients with tetanus complaining of common signs such as lockjaw, voice disturbance, and difficulty in swallowing, etc, should never be forgotten. A 71-year old woman complained of dyspnea and difficulty in swallowing. She had lockjaw with tongue bite soon after a tracheostomy, and she was diagnosed as having tetanus. She showed the redundant gag reflex even to a slight stimulus and limited mobility of bilateral vocal cords, which improved following intravenous administration of diazepam. This case suggests that the mobility of the vocal cords and the movement of the larynx could be limited in tetanus because even a slight stimulus caused a strong gag reflex, resulting in dyspnea or difficulty in swallowing.

Aged↗
PubMed2004

Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults.

OBJECTIVES: To assess the test-retest reliability of the 400-m usual-pace walk test (400-MWT), and to determine whether the 4-m walk test predicts inability to walk 400 m. DESIGN: Observational. SETTING: Community, 20-m tract course. PARTICIPANTS: Sixty study participants (aged>or=65) were enrolled from the community and met the following eligibility criteria: self-reported difficulty in two or more of four functional domains (mobility and exercise tolerance, upper extremity function, basic self-care, higher functional tasks of independent living) and a score of 18 or higher on the Mini-Mental State Examination. METHODS: The 400-MWT and 4-m walk test were each repeated within 7 days. RESULTS: The mean age+/-standard deviation of the study population was 84.3+/-6.3; 88.3% were women. Nineteen participants (31.7%) failed both 400-MWTs, and 41 successfully completed both tests (kappa=1). Mean walking speed for the 4-m test was 0.87+/-0.18 m/s for those who completed the 400-MWT and 0.53+/-0.17 m/s for those who failed (P<.001). The Spearman correlation coefficient between 4-m and 400-m walking speeds was 0.93. The estimated area under the receiver operating characteristic curve between 4-m walking speed and the ability to perform the 400-MWT was 0.91. The 4-m gait speed averaged less than 0.6 m/s in 80% of subjects who failed the 400-MWT. CONCLUSION: The test-retest reliability for inability to complete the 400-MWT is high. Four-m walking speed is highly predictive of ability to perform the 400-MWT. These findings may prove useful to future clinical trials and observational studies that involve assessment of mobility limitations in older adults.

Aged↗
PubMed2005

Leg extension power asymmetry and mobility limitation in healthy older women.

OBJECTIVE: To investigate the association of asymmetry in leg extension power (LEP) with walking and standing balance. DESIGN: Cross-sectional analysis. SETTING: Research laboratory. PARTICIPANTS: Healthy female twins (N=419), ages 63 to 75 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The LEP difference between the stronger and the weaker leg, measured with the Nottingham power rig, was calculated. Ten-meter maximal walking velocity was assessed in a laboratory corridor on a wide (170 cm) and narrow (35 cm) track, and the ability to maintain tandem stance for 20 seconds was recorded. RESULTS: The mean LEP difference +/- standard deviation between the legs was 15%+/-9% (P<.001). Those with large LEP difference had lower walking velocity and poorer standing balance than those with small LEP difference, in particular when the LEP of the stronger leg was below the median. CONCLUSIONS: Even in healthy older women, substantial LEP asymmetry between the lower limbs was present, encumbering walking and standing balance. Lower-limb muscle power asymmetry warrants further study in order to develop well-targeted strategies for preventing mobility limitation in older people.

Age Factors↗
PubMed2006

Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey.

BACKGROUND: Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention. OBJECTIVES: To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people. DESIGN: Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile. PARTICIPANTS: Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002. RESULTS: The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively. CONCLUSIONS: Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.

Activities of Daily Living↗
PubMed2003

Responsiveness of the index of mobility limitation: comparison with gait speed alone in the longitudinal aging study amsterdam.

BACKGROUND: Interpreting self-reported disability differences between diverse older populations is complicated by differences in attitudes and environment. We have previously reported on the index of mobility-related limitation tests (MOBLI), and shown that it predicts mortality over 4 years. In this article, we examine whether the index is responsive to changes in self-reported mobility disability. METHODS: Data on gait speed, time to complete 5 chair stands, and peak expiratory flow rate, with self-reported difficulty walking for 5 minutes, were available from the baseline and two 3-year follow-ups in the Longitudinal Aging Study Amsterdam. Analysis used data on changes in the index (or walking speed alone) and corresponding change over 3 years in self-reported difficulty or inability with a medium-distance walk. RESULTS: During all follow-ups, groups reporting deterioration in functioning had relatively larger changes in gait speed and MOBLI score than did the "no deterioration" groups. In comparative analyses of responsiveness, the MOBLI score had a larger responsiveness index, higher odds ratios, and larger receiving operating characteristic area than gait speed alone. CONCLUSIONS: The MOBLI index of mobility-related physical limitation tests is responsive to changes in self-reported mobility disability over two 3-year periods, and performs better than gait speed alone. This property is strongly supportive of its validity for epidemiological comparison of older populations across countries or over longer periods of time.

Aged↗
PubMed2007

Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Chronicity of muscle weakness from cancer and its treatment may be problematic, particularly in those treated for cancer during childhood. We compared body composition, muscle strength, and mobility between 75 adult survivors of childhood acute lymphoblastic leukemia (ALL) and expected values based on population normative data. METHODS: Subjects were young adults treated for childhood ALL between 1970 and 1986, selected randomly from participants in an ongoing study of cancer survivors. DeXA scans were performed to evaluate body composition, and myometry used to measure strength. Mobility was evaluated with the Timed Up and Go (TUG) and 2-min walk (TMW). One sample t-tests compared ALL survivors to population norms. RESULTS: Males had 4.5% and females had 2.3% more body fat than expected (expected males 21.5%, females 36.0%). Males were 76.7 Newtons and females were 58.6 Newtons weaker in quadriceps strength than expected (expected males 569.87 N, females 464.67 N). Males walked 100.88 m and females walked 85.38 m less on the TMW (expected values: males 304.23 m, females 276.26 m), and took longer to complete the TUG (males 5.82 vs. 2.84 sec, females 5.88 vs. 3.00 sec) than expected. Treatment with cranial radiation and current growth hormone (GH) deficiency were associated with lower body weakness among females. CONCLUSIONS: Young adult survivors of childhood ALL have strength and mobility deficits. Decreased strength may reduce ability to participate in physical activity, perpetuating fitness deficits in survivors of childhood ALL.

Adult↗
PubMed2006

The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury.

OBJECTIVE: To investigate the concurrent validity and responsiveness of the High-Level Mobility Assessment Tool (HiMAT) in people after traumatic brain injury (TBI). DESIGN: This study compared the concurrent validity and responsiveness of the motor subsection of the FIM instrument and the gross function component of the Rivermead Motor Assessment (RMA) with the HiMAT, a new measure of high-level mobility developed for use in TBI. SETTING: A major rehabilitation hospital. PARTICIPANTS: A convenience sample of 103 participants with TBI were recruited from a major rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: HiMAT, motor FIM, and the gross function RMA. RESULTS: The correlation between the HiMAT and motor FIM was moderate (r=.53, P<.001), largely because of a ceiling effect in the motor FIM. The correlation between the HiMAT and gross function RMA was strong (r=.87, P<.001), yet the gross function RMA was also susceptible to a ceiling effect, with 51.5% of subjects achieving the maximum score. The HiMAT was more responsive than the motor FIM and the gross function RMA on all indices. CONCLUSIONS: The HiMAT is a new unidimensional scale with moderate concurrent validity for measuring high-level mobility. The HiMAT is more responsive and has less of a ceiling effect than either the motor FIM or the gross function RMA.

Adolescent↗
PubMed2006

Selenoprotein N muscular dystrophy: differential diagnosis for early-onset limited mobility of the spine.

Early spinal rigidity is a nonspecific feature reported in diseases such as neuromuscular and central movement disorders. We present a male patient with rigid spine muscular dystrophy caused by newly identified compound heterozygote mutations of the selenoprotein N gene and discuss this disease as a possible differential diagnosis for early-onset reduced spine mobility. Rigid spine muscular dystrophy is a rare myopathy presenting in childhood with a typical combination of stable or slowly progressive mild to moderate muscle weakness, limitation in flexion of the spine, and progressive restrictive ventilatory disorder. The clinical features of our patient include early-onset rigidity of his spine, scoliosis, mild muscular weakness predominantly of neck and trunk flexors, and restrictive ventilatory disorder. Biopsy of the biceps muscle revealed nonspecific myopathic changes, and molecular analysis confirmed the diagnosis of rigid spine muscular dystrophy. Thus, neuromuscular diseases such as muscular dystrophy must be considered in all patients presenting with early spinal rigidity, and genetic determination is a possible way to determine the diagnosis.

Adult↗
PubMed2004

Use of self-report to predict ability to walk 400 meters in mobility-limited older adults.

OBJECTIVES: To determine whether the ability to walk 400 m could be predicted from self-reported walking habits and abilities in older adults and to develop an accurate self-report measure appropriate for observational trials of mobility when functional measures are impractical to collect. DESIGN: Cross-sectional. SETTING: University-based human physiology laboratory. PARTICIPANTS: One hundred fifty community-dwelling older men and women (mean age+/-standard error= 79.8+/-0.3). MEASUREMENTS: An 18-item questionnaire assessing walking habits and ability was administered to each participant, followed by a 400-m walk test. Ninety-eight (65%) volunteers were able to complete the 400-m walk; 52 (35%) were unable. Logistic regression was performed using response items from a questionnaire as predictors and 400-m walk as the outcome. RESULTS: Three questions (Do you think you could walk one-quarter of a mile now without sitting down to rest. Because of a health or physical problem, do you have difficulty walking 1 mile? Could you walk up and down every aisle of a grocery store without sitting down to rest or leaning on a cart?) were predictive of 400-m walking ability and were included in the model. If participants answered all three questions compatible with the inability to walk 400 m, there was a 91% probability that they were unable to walk 400 m, with a sensitivity of 46% and a specificity of 97%. CONCLUSION: A three-item self-report developed in the study was able to accurately predict mobility disability. The utility of this instrument may be in evaluating self-reported mobility in large observational trials on mobility when functional mobility tasks are impractical to collect.

Aged↗
PubMed1985

Theoretical support for the heart phosphocreatine energy transport shuttle based on the intracellular diffusion limited mobility of ADP.

Flux rates for phosphate metabolites were calculated using the equation for radial diffusion, assuming heart intracellular conditions and a 5% concentration gradient. The data show that while the flux of phosphocreatine is about 3 times faster than ATP, both are more than two orders of magnitude greater than the known maximum rate of ATP utilization. In contrast, since the concentration of free ADP is very low, its flux is below the maximum rate of ATP turnover, while the flux of creatine is almost 3 orders of magnitude greater than ADP. The data suggest that the rate of high-energy phosphate production could be limited by ADP diffusion, with creatine thus substituting as the primary cytoplasmic-mitochondrial phosphate acceptor.

Adenosine Diphosphate↗
PubMed1992

The cost of assistive devices for children with mobility limitation.

This study evaluated the costs of assistive devices for children with motor limitations at home, in day care, and in school, and the effect of diagnosis and severity of disabilities on costs. 201 children (mean age 7.4 years) who used 1274 various assistive devices (85.7% at home, 6.1% in day care, and 8.2% in school) were studied. The cost per device varied from $8.14 to $8138 with an average value of $539 per device. The distribution of costs per capita was unequal: 52.2% of children used 15.6% of total costs and 4.5% of children used 20.8% of total costs. The severity of motor impairment and the age of the child were the most important indicators associated with the need and cost of assistive devices. Assistive devices for basic needs, such as sitting, mobility, and personal hygiene, had a relatively low effect on costs in comparison with the high-technology devices, like powered wheelchairs and computers. Better cooperation with day care and school professionals, better assessment of needs, follow-up and recirculation of assistive devices are ways to promote rehabilitation services and partly solve the discrepancies between the costs of available technology and the resources to pay for it.

Adolescent↗
PubMed1996

The limiting mobility of DNA sequencing fragments for both cross-linked and noncross-linked polymers in capillary electrophoresis: DNA sequencing at 1200 V cm-1.

The mobility of DNA sequencing fragments was measured in Long-Ranger gels at an electric field ranging from 200 to 1200 V cm-1 and in noncross-linked polyacrylamide at electric fields ranging from 100 to 300 V cm-1. In both cases, N*, the fragment length that denotes the onset of biased reptation with orientation, is inversely proportional to electric field. The inverse dependence of N* is inconsistent with the original biased reptation model but is consistent with modern models of DNA migration. While separation speed increases dramatically with electric field, the number of bases determined in a separation decreases in proportion to field strength. We present a DNA sequencing run at an electric field of 1200 V cm-1. Roughly 200 bases of sequence are determined in 3.5 min.

Base Sequence↗
PubMed1984

Interaction of proteins of the adenylate cyclase complex: area-limited mobility or movement along the whole membrane? Analysis with the application of the percolation theory.

Extraction of the 'fluid' lipid fraction from rat reticulocyte plasma membranes by phospholipase/BSA treatment leads to a reduction in the percentage of beta-adrenoreceptors complexed with the regulatory N-proteins and to a decrease of adenylate cyclase stimulation with a beta-agonist. Analysis of the data obtained on the basis of the percolation theory suggests that proteins of the adenylate cyclase complex move along the whole membrane.

Adenylyl Cyclases↗
PubMed2002

Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III.

OBJECTIVES: To assess the association between functional limitations and body composition indices, including percentage of body fat, muscle mass, and body mass index (BMI). DESIGN: A cross-sectional, population-representative sample. SETTING: All noninstitutionalized people living in the United States (National Health and Nutrition Examination Survey). Data were collected between 1988 and 1994. PARTICIPANTS: One thousand five hundred twenty-six women and 1,391 men aged 70 and older. MEASUREMENTS: Independent variables included BMI, muscle mass, and percentage of body fat; the latter two were assessed using predictive equations. The dependent variable, functional limitations, was defined as difficulty in performing at least three of five functional living tasks, such as carrying a 10-pound bag of groceries. RESULTS: Women in the highest quintile for percentage of body fat and women with a BMI of 30 or greater were two times more likely to report functional limitations than women in the comparison groups. Similar, but weaker, relationships were found among men; men in the highest quintile for body fat and men with a BMI of 35 or greater were 1.5 times more likely to report limitations. Low muscle mass (sarcopenia) and sarcopenia in combination with high percentage of body fat (sarcopenic obesity) were not associated with a greater likelihood of reporting functional limitations. CONCLUSIONS: Prevention of excessive accumulation of body fat and maintenance of a BMI in the normal range may reduce the likelihood of functional limitations in old age.

Adipose Tissue↗