Miglioramento della capacità motorie e funzionali dell'arto superiore di un anziano fragile e istituzionalizzato

Introduction: In elderly people, hand and upper limb function are essential to maintain independence in the activities of daily living. Living in nursing homes, due to 24h nursing assistance, reduces the amount of activities autonomously performed by the residents, hence supports the physiological age-related decline of the upper limb and hand function. In fact aging has degenerative effects on hand function, both in terms of quantity (with a reduction of finger and hand strength) and quality (with a reduction of the ability to control submaximal pinch force and maintain a steady pinch posture, manual speed and hand sensation). Benefits of physical activity have been well-documented and are universally accepted; however, to the best of our knowledge, the effect of a structured physical activity on the quality of hand and upper limb function has never been investigated in elderly nursing home residents. At the moment, no studies assessed the effect of an exercise program, focused on psychomotor skills, on hand movement quality in elderly nursing home residents. Therefore, our hypothesis is that a structured exercise program focusing on psychomotor skills can positively affect the movement quality of both hand and upper limb, by delaying or limiting the physiological age-related decline. Method/ Participants: Forty-five elderly volunteers between 63 and 95 years were recruited during years for a first study. Participants were randomly assigned to either an experimental (EG) 25 participants and a control group (CG) 20 participants. Nineteen elderly volunteers between 75 and 95 years were recruited for the second study; also in this case they were randomly assigned to either an EG 10 participants and a CG 9 participants. Finally, twenty elderly older than seventy-five years old were recruited for the third and last study. Ten participants in the EG and ten in the CG. Experimental design: Recruitment, training and testing were performed within a nursing home. EG participants in the first study underwent to a 3-month supervised exercise program focused on the development of psychomotor hand skills, while CG participants were not training and were not modifying their activities and treatments. EG participants during the second study underwent to a 1-month supervised exercise program focused on the same protocol but having more frequent sessions. In the third and last study, the same protocol underwent to a 3-month supervised exercise program, in order to verify also improvements in the strength of both the hand and the fingers. Before and after the intervention the subjects of both EG and CG performed several tests aimed to assess hand and finger function. Testing procedures: Hand dexterity, the finger dexterity and the strength of the hand and the fingers were evaluated in both dominant and non-dominant arm. Hand dexterity was evaluated by Jebsen-Taylor Hand Functional Test (JTHFT), finger dexterity was assessed by means of Nine-Hole Peg Test (NHPT) and the strength of the hand and the fingers was assessed by Handgrip and Pinch Test, both Jamar. Results: After the three month interventions (1st study), both manual dexterity and finger dexterity significantly improved in the EG compared to the CG, in both dominant and non-dominant hand. After one month (2nd study), both manual dexterity and finger dexterity both of us limbs are improved in the EG, unlike the CG that got worse in all tests. Last study (3rd ) shows that the strength significantly improved in both limbs and was preserved in fingers in the EG, while was preserved in both limbs and worse that of fingers in the CG. Conclusion: The results suggest that the psychomotor training can improve the quality of the movement and so, the functionality of the upper limb and in particular of the hand in institutionalized older people. This study justifies and supports the use of similar protocols in these age ranges because it highlights the effectiveness of the protocol but also the physiological decline of these abilities in short time as evidenced in the second study, which protocol was just one month.