Graded Motor Imagery and Fall Risk in Older Adults

Study Overview
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Brief Summary
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To determine if there is any carry over effect of sensation training for the feet, officially called Graded Motor Imagery (GMI), will impact balance and fall risk factors in older individuals. This will be looked at to see if there is a difference in balance and sensation before and right after the training.

Detailed Description
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In order to increase acuity of body maps, various tactile and movement-based strategies have been recommended and supported for research focusing on sensory discrimination. Current evidence, specific to painful conditions related to altered cortical mapping, have shown growing evidence in reducing pain and disability. In regards to it's ability to alter foot pain in older adults and decreasing fall risk, prior conference case study and case series presentations have suggested potential clinical benefit, but it has not been formally studied. The aim of this study is to determine if a sensory discrimination training for feet in older adults can alleviate pain, improve sensory discrimination, and also decrease fall risk. Specifically, does a 20 minute training session improve pain, balance (Brief-BEST test), and sensory discrimination in individuals over 65 years of age. Secondary analysis may exam characteristics that best identify those who benefit from this training.

Official Title
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Graded Motor Imagery and Fall Risk in Older Adults: An Exploratory Study

Conditions
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Balance, Fall Risk

Intervention / Treatment
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* Procedure: Graded Motor Imagery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be able to read and understand English Be over the age of 65 Be independent with ambulation (with or without an assistive device) Not have any skin condition or injury to the plantar or dorsal part of the foot Have the visual ability to view images on a tablet to partake in a test Exclusion Criteria: No existing skin conditions on the bottom of the foot that would impair sensation No current injury to the plantar or dorsal side of the foot No prior surgery or major injury to the plantar or dorsal side of the foot Lacking sensation in the foot Unable to read and understand English Lacking ability to view images on a tablet to partake in a test Unable to ambulate (with or without an assistive device)

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental group<br>A convenience sample of older adults (65 and older). | Procedure: Graded Motor Imagery<br>* GMI consisting of education, sensory integration of the foot using contact, flooring samples, immersion, and two point discrimination.<br>* Other names: GMI;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lower extremity pain rating | Change (from before treatment to immediately after treatment) in pain for the lower extremity using the numeric pain rating scale (NPRS - 0 to 10 where 0 = no pain and 10 + maximum pain) | self-reported, change from before to immediately after treatment | 
| Laterality Speed | Change (from before treatment to immediately after treatment) in speed of foot recognition using Recognize (TM) (speed in seconds to recognize each of 40 images as right or left foot) | tested for 60 seconds before and immediately after treatment | 
| Laterality Accuracy | Change (from before treatment to immediately after treatment) in accuracy of foot recognition using Recognize (TM) (percent accurately correctly identified as right or left foot of those 40 images) | tested for 60 seconds before and immediately after treatment | 
| Balance / fall risk | Change (from before treatment to immediately after treatment) in Brief-BESTest (6 task subsets to assess static and dynamic balance) (0 - 15 scale where 0 - lowest score / unstable and 15 = highest / no balance issues) | Assessed before and immediately after treatment | 
| Nerve Sensitivity Dorsum of dominant hand | Change (from before treatment to immediately after treatment) in Pain Pressure Threshold (PPT) on dorsum of web space of dominant hand (in pounds) | Assessed before and immediately after treatment | 
| Nerve Sensitivity Dorsum of Right Foot | Change (from before treatment to immediately after treatment) in Pain Pressure Threshold (PPT) on dorsum of right foot (in pounds) | Assessed before and immediately after treatment | 
| Nerve Sensitivity Dorsum of Left Foot | Change (from before treatment to immediately after treatment) in Pain Pressure Threshold (PPT) on dorsum of left foot (in pounds) | Assessed before and immediately after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Graded Motor Imagery, Balance, Fall Risk, Elderly