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Contextual factor use by healthcare professionals has been studied mainly among nurses and physiotherapists. Preliminary results show that healthcare professionals use contextual factors without specifically labelling them as such. The main objective of this study was to evaluate knowledge and explore voluntary contextual factor use among various healthcare professions. The results aim to facilitate hypothesis-generation, to better position further research to explain and characterise contextual factor use. We conducted a web-based questionnaire cross-sectional observational study on a non-probabilistic convenience sample. Face and content validity were tested through cognitive interviews. Data were analysed descriptively. The target population was the main healthcare profession, or final year students, defined by the French public health law. The countries of distribution of the questionnaire were the French-speaking European countries. Among our 1236 participants, use of contextual factors was widespread. Those relating to the therapeutic relationship (e.g., communication) and patient characteristics (e.g., past experiences) were reportedly the most used. Meanwhile, contextual factors related to the healthcare providers’ characteristics and their own beliefs were reported as less used. Despite high variability, respondents suggested contextual effects contribute to approximately half of the overall effect in healthcare and were perceived as more effective on children and elderly adults. Conceptual variations that exist in the literature are also present in the way healthcare providers consider contextual effects. Interestingly, there seems to be common ground between how physiotherapists, nurses and physicians use different contextual factors. Finally, in the present study we also observed that while there are similarities across usage, there is lack of both an epistemological and ethical consensus among healthcare providers with respect to contextual factors.

Background Pathological aging can impair sensory information, leading to postural control disorders in older adults. Compensatory sensorial mechanisms are emerging to preserve balance function. The objective of the study was to identify sensory profiles in functionally impaired older adults, and determine if they are linked to the frequently observed cervical proprioceptive disorders in this population. Methods Fifty-one older adults (76.9 ± 7.6 years) were divided into 2 Functional Groups (FG-/FG+) according to a composite score that included 3 variables (gait speed, grip strength and fear of falling). All the participants completed the modified clinical test of sensory interaction on balance (m-CTSIB) and the cervical joint sense position error (CJPSE) test. Exploratory factor analysis was used to identify common factors among the variables. Pearson correlation was used to examine relationships between variables. Results As expected, conditions 2 and 3 of the m-CTSIB were both challenging to balance, whereas condition 4 was too difficult for several patients. Factor analysis revealed that the stabilometric variables were grouped together in factor one, and proprioceptive performance (CJPSE) and the mean CoP velocity in m-CTSIB condition 3 formed another second factor. Moreover, a significant correlation was highlighted between stability in Condition 3 and CJPSE in the FG-. Conclusion Our results revealed the predominance of both visual and podal information in functionally impaired adults to control their posture. We speculate that the observed podal preference could be consecutive to a less efficient cervical proprioceptive system.

Background At least one-third of older people experience falls each year, often resulting in a fear of falling that leads to a cycle of negative consequences. Fear of falling activates the amygdala, which triggers a complex response involving cognitive, physiological, and behavioral components. Physiologically, the stress response includes autonomic changes like increased heart rate and reduced Heart Rate Variability (HRV). Behaviorally, heightened alertness leads to fight, flight, or freeze responses, influenced by amygdala and Periaqueductal Gray activations. In conditions like post-fall syndrome fear of falling leads to freezing, involving motor rigidity and disrupted motor control. Methods This protocol aims to objectively assess fear of falling in older patients with post-fall syndrome by measuring HRV in various conditions and compare these data with short FES-I results. A gap between physiological and self-reported measures could be reported. The secondary objective will be to measure the potential increase in muscle activation during fear. Hypotheses are that HRV changes will reflect fear levels and muscle activation will increase with fear. At least 30 patients recruited in geriatric care facility, with post-fall syndrome will be included in this study. Heart Rate Variability (HRV) and Electro-Myo-Graphy (EMG) of trapezoids muscles will be measured during initial sitting position and two stand-up positions with and without worktop (involving postural threat). The primary outcome will be the Root Mean Square of successive RR interval differences (RMSSD). Secondary outcome will include standard deviation of normal-to-normal intervals (SDNN), percentage of successive RR intervals with difference bigger than 50 ms (pNN50), low-frequency power (LF) and high-frequency power (HF), short-term analysis (SD1), as well as Root Mean Square (RMS) muscle activity. All these outcomes will be computed relatively to the control condition (i.e. slow effortless breathing). ANCOVA based on HRV and EMG will assess the differences across positions, and correlation between HRV and EMG will be investigated. Key variables, such as orthostatic hypotension and depressive status, will be considered as co-variables. Discussion If successful, the results could highlight some discrepancies between self-reported and physiological measures of fear and support the use of HRV as an emotional marker for fear of falling during rehabilitation. This would offer a valuable tool for tailoring sessions to patients’ anxiety levels, using a simple ECG sensor in clinical practice. Trial registration 2024A0093542.

Motor deficiency is associated with cognitive frailty in patients with Mild Cognitive Impairments (MCI). In this study we aimed to test the integrity in muscle synergies involved in an arm-pointing movement in functionally unimpaired MCI patients. We hypothesized that early motor indicators exist in this population at a preclinical level. Electromyographic signals were collected for 11 muscles in 3 groups: Young Adults (YA), Older Adults (OA), and MCI patients. The OA and MCI groups presented the same functional status. Each subject performed 20 arm-pointing movements from a standing position. The main differences were (1) an earlier activation of the left Obliquus internus in MCI compared with OA group, (2) an earlier activation for the MCI compared with both OA and YA. The temporal differences in muscle synergies between MCI and OA groups were linked with executive functions of MCI patients, assessed by the trail making test. Moreover, the results show a delayed activation of the right Biceps Femoris and the right Erector Spinae at l3 in MCI and OA compared with YA. The motor program changes highlighted in our patient MCI group suggest that discrete modifications of the motor command seem to exist even in the absence of functional impairment. Instead of showing an indication of delayed muscle activation in the MCI patients, our results highlight some early activation of several trunk muscles.

The purpose of this work was to analyze and compare the movement kinematics of sit-to-stand (STS) and back-to-sit (BTS) transfers between frail aged adults and young subjects, as well as to determine the relationship between kinematic changes and functional capacities. We analyzed the Timed Up and Go (TUG) movements by using a 3D movement analysis system for real-time balance assessment in frail elderly. Ten frail aged adults (frail group [FG]) and ten young subjects (young group [YG]) performed the TUG. Seven spatiotemporal parameters were extracted and compared between the two groups. Moreover, these parameters were plotted with TUG test duration. The experiments revealed that there were significant differences between FG and YG in trunk angle during both STS and BTS, and in TUG duration. The trunk angle of the young subjects was more than two times higher than that of the FG. As expected, the TUG duration was higher in the FG than in YG. Trunk angles during both transfers were the most different parameters between the groups. However, the BTS trunk angle and STS ratio were more linked to functional capacities. There was a relationship between kinematic changes, representing the motor planning strategies, and physical frailty in these aged adults. These changes should be taken into account in clinical practice.

Background: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. Methods: Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. Results and discussion: As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.

The aim of this study was to investigate the coordination between posture and movement in pathological aging (frailty) in comparison with normal aging, with the hypothesis that in pathological aging, postural control evolves towards a more reactive mode for which the perturbation induced by the movement is not anticipated and leads to delayed and late postural adjustments. Elderly subjects performed rapid focal arm-raising movements towards a target, from an upright standing position in two stimuli conditions: simple reaction time and choice reaction time (CRT). Hand and center of pressure (CoP) kinematics were compared between a control group and a frail group of the same age. In frail individuals, the entire movement was impaired and slowed down. In addition, postural adjustments that classically precede and accompany the focal arm movement were delayed and reduced, especially in the CRT condition in which the motor prediction is more limited. Finally, a correlation between the time to CoP maximal velocity and the timed up- and-go score was observed. In these patients, it was concluded that the control of the CoP displacement evolved from a proactive mode in which the perturbation associated with the arm movement is anticipated toward a more reactive mode in which the perturbation is compensated by late and delayed adjustments.

Abstract The Health Service by Health Students (HSHS) is a French interprofessional education program implemented in 2018 across all French regions by Health Universities. It aims to train health students (HS) in prevention through primary health prevention actions (PHPA) targeting young populations. This study evaluated the impact of the HSHS program in Franche-Comté (HSHS-FC) on HS’s representations of their target public during the 2022–23 academic year. A longitudinal, observational, prospective multicenter survey was conducted using a self-administered questionnaire before (T1) and after (T2) PHPA. The variation in responses between T1 and T2 (Δ) was analyzed for each target public. Among 755 HS included, 468 (62.0%) worked with young children, 240 (32.7%) with teenagers, and 40 (5.3%) with young adults. No significant differences in representations were found at T1 and T2 between groups regarding social background or health behavior factors. However, students working with young children and teenagers showed a statistically significant change in all items between T1 and T2. At T1, HS working with young children reported lower perceptions of their ability to receive, understand, and integrate information. Students focusing on young children reported the greatest shift in representations. HSHS-FC plays a role in reshaping HS’s representations of young publics, especially children. The greater evolution in perception among HS working with young children highlights the value of initiating primary prevention early in life.

Postural stability of older subjects can be estimated during orthostatic equilibrium. However, dynamic equilibrium is also important to investigate risks of fall. It implies different interpretations of measures given by force plates. Same dependant variables (e.g. center of pressure displacement) cannot be interpreted the same ways depending of the type of equilibrium that is investigated. In particular, sways increases during dynamic equilibrium and before movement execution may reflect an improvement of feedforward control.

This internal representation of movement of part(s) of the body is involved during Implicit Motor Imagery tasks (IMI); the same representations are employed in the laterality judgment task. Few studies have looked at the consequences of aging, Alzheimer's disease (AD) and mild cognitive impairment (MCI) on the processes of motor preparation but none showed evidence of an alteration of action representation in patient with amnestic MCI. In the present study, the IMI task was used to assess the action representation abilities in MCI patients and healthy counterparts. A total of 24 elderly participants aged between 65 and 90 years old (12 women, 73.4 ± 6 years, mean ± S.D.) were recruited: 12 patients with MCI (MCI group) and 12 healthy aged adults (HAA group). The results showed that MCI patients have significantly a greater response time (RT) than HAA subjects only in IMI task and more precisely when performing their mental rotation at the challenging conditions. Furthermore, the IMI task related to the non-dominant hand induced a significant increase of RT only in MCI subjects. At the light of these results, we assume that MCI patients are able to engage themselves in IMI processes, still showing a compelling impairment of this mental ability across its complexity.