Short-Term and Long-Term Effects of Integrated Fall Prevention Program in the Korean Elderly

OBJECTIVE: To evaluate the short-term and long-term effects of integrated fall prevention program comprised of exercise program to improve physical function, education of fall prevention strategy and environmental improvement in elderly Korean. METHOD: Elderly who were at high risk for fall participated in 8-week integrated fall prevention program. Outcome measures including fall efficacy scale (FES), activity-specific balance confidence (ABC), flexibility test, balance function test, short physical performance battery (SPPB) and isokinetic knee strength were evaluated and compared before and after the program. One year after the program, fall experience and frequency, FES and ABC were followed up by mail questionnaire. RESULTS: Among 63 participants enrolled at the baseline, 43 completed the program. Flexibility, balance function and SPPB improved significantly whereas FES, ABC, anthropometric measure data and knee strength were not changed. One year after the program, the number of fallers decreased significantly. CONCLUSION: Integrated fall prevention program may improve flexibility and balance function, and can reduce the risk of fall in the elderly population.

Falls in a Proportional Region Population in Korean Elderly: Incidence, Consequences, and Risk Factors

BACKGROUND: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. METHODS: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arrangement (with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. RESULTS: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. CONCLUSION: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female participants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls.

The Effect of Physical Performance and Physical Activity on Quality of Life in Old People: The Korean Longitudinal Study on Health and Aging

BACKGROUND: To investigate the physical function of elderly people in Korea using quantitative and objective tools and to assess the impact of declined physical function on their quality of life. METHODS: The Korean Longitudinal Study on Health and Aging was designed as a population-based prospective cohort study on the health and aging of the elderly people in Korea aged 65 years and older. Within one city's central metropolitan area, 1,000 subjects including a simple random sample and an oldest-old subpopulation participated in a baseline study for one year. We evaluated the isokinetic peak torque of the knee extensors and flexors, grip force, and Short Physical Performance Battery (SPPB) and surveyed their daily physical activities and quality of life using the 36-Item Short Form Health Survey (SF-36). RESULTS: Overall, 676 subjects completed the evaluations of physical function and activity. The isokinetic torque of the knee extensors and flexors declined with age in both men and women. The women in the old-old (75-84 years) group showed lower SPPB and physical activity than women in the young-old (65-74 years) group, but these measures were maintained till age 85 in the men. SPPB and physical activity were significantly associated with the physical component scale (PCS) of the SF-36 in both men and women, while isokinetic torque was associated with PCS in women only. CONCLUSION: Physical performance and activity declined differently in Korean elderly men and women. Both these measures showed to be the main factors associated with quality of life.

Videofluoroscopic Findings in Infants with Aspiration Symptom

OBJECTIVE: To describe the findings of videofluoroscopic study (VFSS) and investigate the usefulness of VFSS as a predictor of aspiration pneumonia in infants with aspiration symptoms. METHOD: Thirty-eight infants with aspiration symptoms were divided into two groups: those who showed aspiration symptom but had no pneumonia (Aspiration group); those with episode of aspiration pneumonia (Pneumonia group). The subjects' medical records and the results of VFSS were reviewed. RESULTS: In aspiration group, oral phase was normal and the abnormalities were found only in pharygeal phase in a small number of subjects. On the other hand, pneumonia groups showed poor lip closure and bolus formation in oral phase. Abnormalities of pharyngeal phase were reduced laryngeal elevation, coating of pharyngeal wall, increased residue of valleculae, and delay of pharyngeal transit time. Penetration and aspiration were more frequently observed (p <0.05). Aspiration pneumonia occurred more frequently among infants who had supraglottic penetration (p <0.05). CONCLUSION: Mild abnormalities were found only in pharyngeal phase in aspiration group, whereas VFSS abnormalities were observed in both oral and pharyngeal phase in infants with pneumonia. Our results suggest that VFSS would be useful in predicting the development of pneumonia in infants with aspiration symptoms.

Changes in Evoked Potentials in Focal Cerebral Cortical Ischemia in the Rat

OBJECTIVE: To investigate the changes of motor and somatosensory evoked potentials found in focal cerebral cortical ischemia induced by endothelin-1 (ET-1), one of the common models of cerebral infarct in rats. METHOD: A total of twenty Sprague-Dawley rats were studied. Focal cerebral cortical ischemia was induced by steterotaxic injection of ET-1 into forelimb region of cerebral cortex. Pellet retrieval test, motor evoked potential (MEP), and somatosensory evoked potential (SEP) were compared before and after cerebral ischemia. The location and extent of cerebral ischemia were confirmed histologically. RESULTS: Success rate of pellet retrieval test decreased significantly after induction of cerebral ischemia, demonstrating sensorimotor deficit in the contralateral forelimb. The latency and amplitude of MEP did not changed significantly despite weakness of forelimb. However, SEP showed reversal of the positive peaks. CONCLUSION: The results suggest that the changes of MEP and SEP in focal cerebral cortical ischemia are different from those in cerebral ischemia by large artery occlusion. When evaluating MEP and SEP in focal cerebral ischemia model, interpretation of evoked potentials should be cautious.

The Association of Balance Confidence with Physical Performance and Strength in Community-Dwelling Elderly Persons

BACKGROUND: To investigate the physical performance and changes in function by age and sex in community dwelling elderly and to assess the associations between balance confidence and physical performance and functioning. METHODS: We recruited 180 people aged 65 years or older capable of independent ambulation and activities of daily living. They were divided into three groups according to age: 65-74 years, 75-84 years and 85 years or older, to assess the differences in physical functioning between the groups. Short physical performance battery (SPPB), activity based balance confidence (ABC) and hand and thigh strengths were measured as variables of physical performance. Pain related disabilities and body composition were also included in the analysis. RESULTS: SPPB scores in women decreased more than that of men in those younger than 85 years, but this difference was not significant for those older than 85 years. ABC scores showed the same decreasing pattern, and sex difference continued in the oldest group. For pain related disabilities, a remarkable gender gap was identified. Hand and thigh strengths decreased with age, with the more prominent decrease seen in men than in women from the older age group. Although most variables correlated with the physical performance evaluated by the SPPB, only the ABC significantly influenced the SPPB after controlling for the covariates. CONCLUSION: Balance confidence in the specific activity plays a major role in physical performance and function.

Follow Up of Asymptomatic Hands in the Patients with Unilateral Carpal Tunnel Syndrome

OBJECTIVE: To know whether nerve conduction study (NCS) could predict later development of carpal tunnel syndrome (CTS) in asymptomatic hands of the patients with unilateral CTS. METHOD: Thirty four patients with unilateral CTS were studied. Subjects were divided into groups with or without the delay of latency, based on the results of initial NCS of asymptomatic hands. After follow up for more than 6 months clinically and electrodiagnostically, the development of CTS in initially asymptomatic hands was compared between groups. RESULTS: At follow up, CTS was diagnosed in 83% of the subjects in the group with motor latency delay at first study, while it was diagnosed in 32% of the subjects in the group without motor latency delay. In the group with sensory latency delay at first study, CTS was diagnosed in 78% of subjects at follow up, whereas only 19% of the subjects developed CTS in the group without sensory latency delay. The incidence of CTS at follow up was significantly higher in the group with motor or sensory latency delay at first study. CONCLUSION: In unilateral CTS, latency delay in motor or sensory NCS of asymptomatic hands may suggest a greater risk of later development of CTS.

The Development of Abnormal Spontaneous Activities in the Experimental Radiculopathy in the Rat

OBJECTIVE: Through a animal study using rats, we investigated whether abnormal spontaneous activities (ASAs) could be observed in the radiculopathies of biochemical and mechanical model. METHOD: A total of 30 Sprague-Dawley male rats were randomly assigned into sham, nucleus pulposus (NP) and ligation groups. In the sham group, the right L4 and L5 nerve roots were exposed by laminectomies. In the NP group, nucleus pulposus was transplanted onto nerve roots from tail. In the ligation group, exposed nerve roots were ligated by silk ligatures. All rats were evaluated by mechanical allodynia, motor paresis, and the needle electromyography (EMG) examination. RESULTS: Mechanical allodynia was observed on the 4th and 7th postoperative days in NP and ligation groups. Motor paresis was observed only in the ligation group. The needle EMG showed ASAs on the 4th postoperative day, but decreased in incidence and amount on the 7th postoperative day in the NP and ligation groups. CONCLUSION: The ASAs can be observed by the biochemical action of nucleus pulposus as well as the mechanical compression. The results of this study may help explain the discrepancy between radiologic and electrodiagnostic findings.

Effect of Low Power Laser Irradiation on the Proliferation and Differentiation of PC12 Nerve Cells

OBJECTIVE: We examined the effect of low power laser irradiation (LPLI) on the proliferation and differentiation of PC12 nerve cells. METHOD: After seeding 4x10(5) PC12 nerve cells each in the 24 well-culture dishes, we cultured them for 6 days with RPMI1640 media. LPLI (650 nm, 5 mW, 5 sec) was applied for 1 day, 2 days and 3 days (1, 2 and 3-day-LPLI groups) consecutively. For the degree of proliferation of PC12 nerve cells, we compared the total cell number at 6th day after LPLI by MTT cell proliferation assay. For the degree of differentiation, we compared the length of neurite out-growth and the expression of RT97 at 6th day after adding nerve growth factor on each group. RESULTS: The total cell numbers were increased significantly after LPLI, but those increments were not significant among 1, 2, and 3-day-LPLI groups. The numbers of the differentiated PC12 nerve cells and the expressions of RT97 were diminished serially according to the number of days of LPLI. CONCLUSION: We conclude that LPLI increased the proliferation and decreased the differentiation of PC12 nerve cells. We could suggest that single or short-term use of LPLI on the injured nerve should be helpful for enhancing the neural regeneration in vivo.