Background
Methods/design
Participants
Sample calculation
Procedures
Intervention
Week | Activity | Cognitive domain |
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1 | 1- Colored Balloons 2- What's the word? 3- Draw the story | Attention, Memory and Learning, Executive Functioning, Social Cognition, Language |
2 | 1- What is alike? 2- Complete Drawing 3- In which song is that? | Attention, Memory and Learning, Executive Functioning, Perceptual motor, Language |
3 | 1- Count and paint 2- Whose footprint is that? 3- Sing the sayings | Attention, Memory and Learning, Executive Functioning, Social Cognition, Language |
4 | 1- Find the objects 2- Do the drawing 3- Crossword 4- Dual task | Attention, Memory and Learning, Executive Functioning, Language |
5 | 1- Copying the sticks 2- Naming 3- Left or right? | Attention, Memory and Learning, Executive Functioning, Language |
6 | 1- Paste the letter 2- Write the objects 3- Math and results | Attention, Memory and Learning, Executive Functioning, Language |
7 | 1- Find the pairs 2- Maze 3- Paint the pairs 4- Grocery Store | Attention, Memory and Learning, Executive Functioning, Language |
8 | 1- Crossword 2- Painting 3- Finding the words | Attention, Memory and Learning, Executive Functioning |
9 | 1- Finding the objects 2- What’s the contrary? 3- Circle the rhymes 4- Find the pairs | Attention, Memory and Learning, Executive Functioning, Social Cognition, Language |
10 | 1- Copy the images 2- What’s the time? 3- Circle what’s repeated 4- Complete the song | Attention, Memory and Learning, Executive Functioning, Language |
11 | 1- Find the mistakes 2- Route 3- Find the pairs 4- Dual task | Attention, Memory and Learning, Executive Functioning, Language |
12 | 1- Creating words 2- Crossword 3- Maze 4- Connecting the dots | Attention, Memory and Learning, Executive Functioning |
13 | 1- Tangram 2- Finding the mistake 3- What’s next? 4- Filling with the time | Attention, Memory and Learning, Executive Functioning, Perceptual motor |
14 | 1- What’s the intruder? 2- Painting 3- Dual task 4- Folding | Attention, Memory and Learning, Executive Functioning, Social Cognition, Language |
15 | 1- Circle the numbers 2- What’s the relationship? 3- Finding the objects 4- Puzzle | Attention, Memory and Learning, Executive Functioning, Perceptual motor |
16 | 1- Count the images 2- Crosswords 3- Daily activities 4- The colors puzzle | Attention, Memory and Learning, Executive Functioning |
Weekly description of activities
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Week 1: “Colored Balloons”, consisting of writing objects with the same colors as the illustrated balloons; “What’s the Word?”, with shuffled letters and must be ordered to form a word; “Draw the Story”, encouraging the dual task of telling a story and drawing it simultaneously.
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Week 2: “What is alike?”, in which a symbol is presented and all those that are the same should be circled; “Complete the Drawing” in which drawings half-hidden must be completed; “In which song is that?”, with random words that must be found in some song, listing the name of the song.
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Week 3: “Count e Paint”, to solve addition and subtraction gaps and coloring with the appropriate color; “Whose footprint is that?”, with the objective of identifying which animal owns each footprint and answering 2 questions related to these animals; “Complete the sayings”, consisting of 15 proverbs partially written, to be completed.
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Week 4: “Find the objects”, in an image full of objects, cleaning and hygiene items should be circulated and counted; “Do the Drawing” with gaps for the participant to draw what is requested; “Crossword”, the task is to find words vertically and horizontally, in addition to counting them and describing the relationship between them; “Double Task”, encouraging the performance of a 60-s walk, evoking fruit in the first attempt and fruit starting with the letter “A” in the second.
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Week 5: “Copying the Sticks”: 4 images with colored lines that must be memorized and replicated with colored sticks; “Naming”, to name the images; “Left or right?”: 6 figures of human hands are exposed and must be judged as left or right, also participants are required to write a sentence with the non-dominant hand.
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Week 6: “Paste the letter” with objects placed next to gaps, and the participant must paste the initial letter of each one of them; “Write the Objects”, in which the figures present in an image with several superimposed figures that must be named; “Math and Results”, consisting of two columns, one with subtraction accounts and the other with results.
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Week 7: “Find the Pairs”, with identical objects that must be circled in the same colors, in addition to answering 3 general questions about the objects; “Maze”, to find the way out of the maze; “Paint the Pairs”, in which the pairs of slippers must be identified and customized with the same colors; “Grocery store”, with a list consisting of 15 usual market items and questions to evoke them, classifying them into categories such as hygiene, food and beverages.
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Week 8: “Crossword”, with words in horizontal and vertical, which must be transcribed; “Painting” in which a black and white drawing must be colored, with the association of songs being requested while the volunteer paints; “Finding the words” in which the clues are given, the words must be thought out and written.
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Week 9: “Finding the Objects”, in which 11 objects dispersed in an image must be found; “What’s the Contrary?”, with a list of 20 words whose opposites must be thought out; “Circle the Rhymes”, in which the rhymes in the text must be circled in the same color with their pairs, then answer questions about the text and create two other rhymes; “Find the Pair” with a table of letters whose pairs must be found and circled, then think of 2 words that only use the unpaired letters and 2 words that do not use any unpaired letters.
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Week 10: “Copy the Image”, in which a figure must be copied to the side; “What’s the time?”, with 9 clocks, must note the time set by each one; “Circle what’s repeated”, finding the pairs of each word, also answering if any does not have a pair; “Complete the song”, in which a popular song will be displayed with gaps to be completed.
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Week 11: “Find the mistakes”, with two similar images whose differences must be found; “Route” in which a course must be made on a squared “map” with barriers, after making the route, it must be narrated; “Find the Pairs”, in which scattered letters must be circled in the same colors as their pairs and then form words that do not use the circled letters; “Dual Task”, applied again, during the same period and with evocation of animals and then animals with the letter “C”.
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Week 12: “Creating Words”, in which 8 example words are given and other words that do not have any letter already used in the example word should be thought; “Crossword”, applied again with words in horizontal and vertical, and questions related to the words found; “Maze”, in which the way out of the labyrinth must be found and colored; “Connecting the dots”, consisting of 37 dots that must be connected to form a pattern.
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Week 13: “Tangram” in which the 7 tangram pieces were provided and volunteers must replicate the images; “Finding the mistakes”, in which the differences between the two images must be circled; “What's Next?”, the symbol of the logical sequence must be identified and drawn; “Filling with the time”, in which the hands of the clock must be placed according to the indicated hour;
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Week 14: “What is the intruder?”, in which the “intruder” word must be selected and justified; “Painting”, in which the drawing with gaps must be colored, requesting the evocation of the alphabet during the painting; “Dual Task”, reapplied during the same period and with the evocation of women’s names and then women’s names with the letter “M”; “Folding”, featuring a step-by-step process for making a fold.
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Week 15: “Circle the Numbers”, in which, inside a table, the numbers must be circled according to the coordinates; “What is the relationship?” in which the relationship between each trio of words must be explained; “Find the Objects”, with 8 objects that must be found in the presented image; “Puzzle”, with the assembly of a puzzle and questions about it.
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Week 16: “Count the image”, in which the indicated symbols must be searched for in an image and counted; “Crossword”, applied again with words in horizontal and vertical, with related questions; “Daily Activities”, in which the description of the figures with actions must be performed; “Color Puzzle”, consisting of 9 pieces, which must be positioned properly to meet the requested requirements.
Outcomes
Assessment
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Participant Characterization Instrument—composed of questions related to: Identification (name, gender, age); Sociodemographic information (ethnicity, education, marital status); Health conditions (use of medications, associated diseases, self-perception of health, vision, hearing, pain); Basic assessment and self-report of falls, including incidence/history, fear of falling, description of the environment and previous fractures.
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Timed “Up and Go”—TUG: aims to assess balance and mobility. It consists of timing the time taken to get up from a chair, walk 3 m (marked on the ground), rotate, return the same 3 m and again sit leaning against the backrest. The instrument score adopted as a risk of falls for elderly Brazilians is 12.47 s. The modified version of the instrument will also be used, associated with the cognitive task, in which the elderly person must speak, without stopping, names of animals during the course of the simple TUG [22, 23].
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Short Physical Performance Battery—SPPB: aims to assess balance, muscle strength and gait speed. The battery is divided into: balance test, which consists of remaining standing for 10 s in three different positions/difficulties; gait speed test, timing and recording the seconds spent to walk 2 times 3 or 4 m, considering the shortest time between attempts; five times standing up from a chair test, performed after a pretest of standing up. With partial scores at each stage and the participant's ability/speed to perform the activities. The overall cutoff score is the sum of the partial scores of the three dimensions, ranging from 0–3 (poor performance/disability), 4–6 (poor performance), 7–9 (moderate performance) and 10–12 (good performance) [24].
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Geriatric Depression Scale – GDS (15-item version): with the objective of verifying depressive symptoms. The 15 questions have the answer option “yes” or “no”, each question has a score equal to 1. The final score is obtained by the sum of all questions. 0 to 5 points indicate normality, 6 to 10 points for mild depressive symptoms and 11 to 15 points for severe depressive symptoms [23, 25].
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Falls Effectiveness Scale – International – (FES-I): has the purpose of evaluating the fear of falling when performing certain external activities and social participation. The scores for each question range from 1 (not at all concerned), 2 (somewhat concerned), 3 (very concerned), and 4 (extremely concerned). The final score is the sum of the scores, ranging from 16 (no concern) to 64 (extreme concern), with 23 points being the cutoff for sporadic falls and 31 points for recurrent falls [26].
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Assessment of Lawton's activities of daily living: aims at evaluating performance in Instrumental Activities of Daily Living (IADL). The instrument has questions related to telephone use, shopping, travel, preparing meals, housework, using medication and handling money. The total score ranges from 0 to 21 points, and for each criterion, total need for assistance scores 3, partial need scores 2 and no need scores 1. The final score equivalent to 7 points is indicative of total dependence [23, 27].
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Addenbrooke Cognitive Examination—Revised Version (ACE-R): aims to evaluate cognitive global functioning. The instrument consists of the Mini Mental State Examination (MMSE) and an assessment of five cognitive domains, with partial grades, including: attention and orientation (0 to 18 points), memory (0 to 26 points), fluency (0 to 14 points), language (0 to 26) and visual-spatial skills (0 to 16 points). The final score is composed of the MMSE score (0 to 30 points) and the evaluation of the domains, obtained by partial sums, ranging from 0 to 100, the closer to the maximum score, the better the cognitive status [28].
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Digit Span: aims to examine attention, immediate memory and working memory, using the digit repetition feature in forward and reverse order. The range of digits in the forward order checks attention deficit and/or immediate memory (score less than 6), the reverse order checks attention deficit and/or working memory (score less than 4). The digits are divided into seven series, consisting of two to nine digits each.
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Geriatric Anxiety Inventory (GAI): assesses anxiety. Composed by 20 items focused on aspects of anxiety, the answer varies according to whether the individual agrees or disagrees with the statements presented. The score of each answer varies from 0 to 1, in positive answers, 1 point is scored. The final score is obtained by summing the scores, with 10/11 points being the cutoff indicative of the presence of generalized anxiety [29].