Introduction
Methods
Study design and participants
n | NH‑A (n = 6) | n | NH‑B (n = 13) | n | NH‑C (n = 7) | F value | p value and \(\eta _{p}^{2}\) | n | Dropouts (n = 14) | F value | p value and \(\eta _{p}^{2}\) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Age (mean ± SD) | 6 | 87.3 ± 6.1 | 12 | 87.8 ± 4.6 | 7 | 86.3 ± 5.5 | 0.15 | 0.86 0.01 | 12 | 87.4 ± 9.6 | 0.01 | 0.94 0.00 |
BMI (mean ± SD) | 6 | 30.5 ± 5.4 | 13 | 25.6 ± 5.4 | 7 | 27.5 ± 3.8 | 1.72 | 0.20 0.01 | 5 | 26.8 ± 2.9 | 2.27 | 0.14 0.07 |
MMSE (mean ± SD) | 6 | 22.5 ± 3.2 | – | – | 7 | 26.6 ± 2.1 | 6.46 | 0.03* 0.37 | 13 | 21.5 ± 8.0 | 1.58 | 0.22 0.06 |
SF-12 Mental Health (mean ± SD) | 6 | 58.4 ± 4.2 | – | – | 7 | 54.6 ± 7.7 | 1.00 | 0.34 0.08 | 12 | 51.7 ± 9.9 | 1.78 | 0.20 0.07 |
SF-12 Physical Health (mean ± SD) | 6 | 43.6 ± 10.1 | – | – | 7 | 29.1 ± 6.7 | 8.14 | 0.02* 0.43 | 12 | 42.8 ± 6.2 | 3.45 | 0.08 0.13 |
Handgrip strength right (kg) (mean ± SD) | 6 | 15.2 ± 2.2 | – | – | 7 | 18.4 ± 7.6 | 0.87 | 0.37 0.07 | 12 | 19.3 ± 5.0 | 1.08 | 0.31 0.05 |
Handgrip strength left (kg) (mean ± SD) | 6 | 17.0 ± 3.8 | – | – | 7 | 17.9 ± 4.8 | 0.11 | 0.75 0.01 | 12 | 19.7 ± 5.1 | 1.26 | 0.27 0.05 |
SWLS (mean ± SD) | 6 | 25.0 ± 7.4 | 13 | 25.4 ± 3.2 | 7 | 26.9 ± 4.2 | 0.27 | 0.77 0.02 | 13 | 24.8 ± 5.5 | 0.23 | 0.63 0.01 |
Females, N (%) Males, N (%) | – | 5 (80.3) 1 (19.7) | – | 13 (100.0) 0 (0.0) | – | 6 (85.7) 1 (14.3) | – | – | – | 12 (85.7) 2 (14.3) | – | – |
Development of spatial orientation exercises
Exercise name | Addressed spatial reference frame planned duration | Material | Description | Initial implementation session number of implementations | Progression session number of implementations |
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(1) Direction twist | Egocentric 5 min | 1 list of landmarks | Participants are standing behind a chair (grabbing it with one hand) or sitting. The trainer names a landmark/everyday object and the participants are supposed to point in the direction of it with their hands or their feet. Different foot positions are announced (parallel stand, semi-tandem stand, tandem stand) | Landmarks, which depict memorable locations/things within one’s room, the care section and the facility (life space area 1–3) Training session 1 & 2 | Landmarks, which depict memorable locations/things in and around the facility (life space area 3–4) Training session 13 & 14 |
(2) Parachute pointing | Egocentric & allocentric 5 min | 1 play parachute (diameter 3 meter) 1 Redondo ball 1 list of landmarks | Participants are sitting in a circle, each grabbing two handles of the play parachute, a ball circles and jumps on the play parachute. The direction in which the ball is moved points to landmarks in the surroundings as if on a 360° scale. The trainer names a landmark and the participants are supposed to (1) move the ball into the color field/direction in which the landmark is located and (2) move the play parachute up and down according to the height of the landmark (in floors) | Landmarks, which depict memorable locations/things within the care section and the facility (life space area 1–3) Training session 3 & 4 | Landmarks, which depict memorable locations/things in and around the facility (life space area 3–4) Training session 15 & 16 |
(3) Known or unknown? | Allocentric 10 min | 12 photos depicting potentially known landmarks 6 photos depicting unknown landmarks 1 massage ball per participant | Participants are standing, walking in place or sitting. The trainer shows one landmark photo at a time and the participants have to decide whether it belongs to their environment or not. (1) For the first photo set (landmark 1–9) the participants circle the ball around their heads if a known place is depicted. If not, they pass the ball from hand to hand over their heads. (2) With the second photo set (landmark 10–18), other movements are carried out. If the photo depicts a known place, the participants throw the ball with their left hand, if not, with their right hand | Photoset depicting landmarks within the care section and the facility (life space area 2–3) Training session 5 & 6 | Photoset depicting landmarks in and around the facility (life space area 3–4) Training session 17 & 18 |
(4) Mental exploration journey | Egocentric 5 min | 1 movement journey (written version) | The trainer narrates a journey and adds movements to crossed landmarks. Participants imitate the movement simultaneously. The journey proceeds twice. If there is time left, the same journey is retold backward | Movement journey narrating an activity from one’s room to the grounds of the facility (life space area 1–3). Training session 7 & 8 | Movement journey narrating an activity from one’s room to an event in the surrounding area of the facility (life space area 1–4). Training session 19 & 20 |
(5) Floor plan bingo | Allocentric 5 min | 1 floor plan per participant 1 floor plan with labeled landmarks (trainers’ plan for verification) 1 list of landmarks | Participants are standing or sitting and perform one movement continuously (e.g., walking on the spot or tapping with the tips of their feet) while holding a floor plan in their hands. The trainer names a landmark and the participants are supposed to find its location on the plan. When they find the landmark on the plan, the participants shout “Bingo!” and the trainer gives feedback. If the position was correct, the participant is allowed to pause until the next landmark is named | Floor plans showing the care section and the facility (life space area 2–3). Training session 9 & 10 | Floor plans showing the facility and maps of the surrounding area of the facility (life space area 1–4). Training session 21 & 22 |
(6) Where is mine? | Allocentric 10 min | 1 list of everyday objects | Participants are standing or sitting. The trainer associates four rooms/locations with different movements, the participants repeat them. Afterward, the trainer names an everyday object and the participants perform the movement that belongs to the room, where the object is located | Implemented rooms/locations within the own room, the care section and the facility (life space area 1–3) Training session 11 & 12 | Implemented rooms/locations within the care section, in and outside the facility (life space area 2–4) Training session 23 & 24 |
Baseline measurements
Mini Mental State Examination
12-Item Short-Form Health Survey
Hand Grip Strength
Feasibility of spatial orientation training tasks
Adherence
Completion time of the training tasks
Qualitative content analysis of the training tasks
Outcome measures
Satisfaction with Life Scale
Short Physical Performance Battery
Performance in spatial orientation exercises
Results
Feasibility
Adherence
Completion time of the training tasks
Qualitative content analysis of the training tasks
Acceptance
Instructions
Motor performance
Material/set up
Complexity
Outcome measures
Satisfaction with Life Scale and Short Physical Performance Battery
n | Baseline NH‑A (mean ± SD) | Post-training NH‑A (mean ± SD) | Wilcoxon Test (z-value; p‑value) | n | Modification 1 NH‑B (mean ± SD) | Post-training NH‑B (mean ± SD) | Wilcoxon Test (z-value; p‑value) | |
---|---|---|---|---|---|---|---|---|
SPPB | 6 | 4.3 ± 2.2 | 4.2 ± 2.4 | −0.11; 0.92 | 12 | 3.8 ± 2.7 | 5.4 ± 2.8 | −0.67; 0.51 |
SWLS | 6 | 25.0 ± 7.4 | 25.5 ± 5.3 | −0.18; 0.85 | 12 | 25.3 ± 3.3 | 26.3 ± 7.4 | −1.73; 0.08 |