Entrenamiento de la musculatura intrínseca del pie para la prevención de caídas en personas mayores / Effect of a program of intrinsic musculature exercises of the foot in the prevention of risk of fall on the elderly

OBJETIVO Las personas mayores y particularmente las mujeres, son propensas a sufrir traumatismo por caídas. El objetivo de esta investigación fue mejorar la estabilidad y funcionalidad de la pisada en personas mayores, implementando un programa de entrenamiento de musculatura intrínseca del pie, y determinar sus efectos en el riesgo de caída como método de prevención. MATERIALES Y METODOS Participaron 33 personas mayores, de género femenino y autovalentes. En las participantes se evaluó el equilibrio y la velocidad de la marcha con la prueba Time up and Go (TUG), y el equilibrio dinámico se evaluó con la Escala de Tinetti (ET). La intervención constó de enteramiento de tipo short-foot de forma diaria, durante 4 semanas. RESULTADOS los tiempos del TUG disminuyeron de manera progresiva al final de la intervención, lo que indica una optimización en la velocidad de la marcha, por lo que, el entrenamiento tuvo resultados beneficios para la transferencia de carga corporal de una posición sedente a bípedo y de bípedo a marcha. En cambio, para el equilibrio y marcha según ET no se detectó una diferencia significativa. CONCLUSIONES Este entrenamiento presenta una mejoría en el ámbito funcional de cambio de posición, pero no reemplaza el ajuste postural de base de sustentación para mantener el centro de masa en su posición central.

OBJETIVE Seniors, particularly women, are at risk for suffering traumatisms from falls. The objective of this study was to improve the balance and walking functionality of seniors by implementing a program to training the intrinsic muscles of the foot. The impacts of this training on preventing fall risk were assessed. MATERIALS AND METHODS A total of 33 self sufficient, female seniors participated. Balance and the speed of walking were measured using the Timed Up and Go (TUG) test, while balance and gait were measured using the Tinetti Balance and Gait Assessment Tool (TT). Intervention consisted in four weeks of daily short foot exercises. RESULTS The TUG test times decreases progressively from the start to the end of the intervention period, indicating an optimization in walking speed. This translates into beneficial results for the transfer of body load from a sedentary to standing to walking position. In contrast, balance and gait evidenced no significant changes per the TT. CONCLUSIONS The implemented training program improved the functional sphere of position change, but this did not replace the postural adjustments needed in the base of support (i.e. the feet) to maintain a well-positioned center of mass

Efecto del Tai Chi sobre la flexibilidad, fuerza y balance en adultos mayores autovalentes de la comunidad con riesgo de caídas. Estudio piloto / Effects of Tai Chi on flexibility, strength, and balance of community-dwelling older adults with high fall risk. A pilot study

Objetivo. Determinar el efecto de un programa de 7 semanas de Tai Chi sobre la flexibilidad, fuerza y balance en adultos mayores chilenos autovalentes de la comunidad con riesgo de caídas. Métodos. En este estudio piloto participaron 4 adultos mayores de la comunidad con riesgo de caída (prueba Timed Up and Go > 10 segundos), los cuales fueron entrenados con Tai Chi durante 7 semanas, con una frecuencia de 3 sesiones semanales. Cada sesión tuvo una duración de 60 minutos. Al inicio y al final del entrenamiento, se evaluó flexibilidad (alcance de dorso y alcanzar sentado en silla), fuerza muscular (fuerza prensil, pararse y sentarse en 30 segundos) y balance (prueba Timed Up and Go). Resultados. Las cuatro participantes finalizaron el entrenamiento sin eventos adversos. En todas ellas se observaron aumentos en el rendimiento de fuerza muscular de miembros superiores e inferiores, al igual que en flexibilidad. En términos de balance dinámico, todas las participantes mostraron mejoras disminuyendo los tiempos de ejecución de la prueba Timed Up & Go. Conclusiones. En este grupo de adultas mayores, un programa de Tai Chi de 7 semanas produjo mejoras en la fuerza y flexibilidad de extremidades superiores e inferiores, además de mejorar el balance dinámico.

Objective: To determine the effects of a 7-weeks Tai Chi program on flexibility, strength, and balance in self-valent community-dwelling older adults with fall risk. Methods: In this pilot study, 4 community-dwelling older adults with fall risk (Up & Go > 10 seconds), which were trained with a 7-weeks Tai Chi-based training program, with a frequency of three sessions per week. Each session lasted for 60 minutes. At the beginning and end of the study, flexibility (back scratch and chair sit & reach), muscle strength (grip strength and 30-seconds sit-to-stand), and balance (Timed Up & Go). Results: The four participants finalised the training programs without adverse events. In all of them, increases in upper and lower limb muscle strength and flexibility were seen. In terms of balance, all participants showed improvements by decreasing the execution times of the Up & Go. Conclusion: In this group of older adults, a 7-weeks Tai Chi-based training program induced improvements in upper and lower limb muscle strength and flexibility, along with improvements of dynamic balance.

The effects of a half palm ankle-foot orthosis and a hollow-heel ankle-foot orthosis on the gait of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of a half palm ankle-foot orthosis and a hollow-heel ankle-foot orthosis on the gait of stroke survivors.Methods:The walking of twenty-five stroke survivors was quantified using a gait analysis system. They walked barefoot, wearing a half palm ankle-foot orthosis and wearing a hollow-heel ankle-foot orthosis. Walking speed, step frequency, duration of the swing phase on the healthy and affected sides, risk of falling and Timed Up and Go (TUG) test times were recorded and analyzed.Results:The average gait frequency when wearing the hollow-heel ankle-foot orthosis was significantly faster than that in the other two conditions. The gait asymmetry coefficient was significantly different when the subjects wore the hollow-heel ankle-foot orthosis compared with walking barefoot. Compared with being barefoot, the average TUG time was significantly shorter when wearing either orthosis and the risk of falling was significantly less. The fall risk was significantly lower when wearing the hollow-heel orthosis compared to the half palm orthosis.Conclusion:Wearing either ankle-foot orthosis can significantly correct the gait of stroke survivors and lower their risk of falling, with better effect when wearing the hollow-heel ankle-foot orthosis.

The effects of sensorimotor training on the risk of falls in hospitalized elderly patients with schizophrenic / 中国实用护理杂志

Objective:To explore the intervention effect of sensorimotor training on cognitive function, balance and fall risk of elderly patients with schizophrenia.Methods:The 60 hospitalized elderly schizophrenic patients in Wuxi Mental Health Center were randomly divided into experimental group and control group from June to September 2021, with 30 cases in each group. The control group implemented traditional exercise on the basis of routine nursing. The experimental group received 8-week and 24 times sensorimotor training on the basis of the routine nursing. The Chinese version of the Mini Mental State Examination (MMSE) was used to assess the cognitive level of patients, the Modified Morse Fall Scale (MMFS) was used to assess the risk of falls, and the Berg Balance Scale (BBS) was used to assess the balance function.Results:After 8 weeks of intervention, the total score of MMSE was (26.72 ± 1.71), higher than the total score of the control group (22.36 ± 1.93), the factor scores of temporal orientation, spatial orientation, recollection, attention and calculation, memory and language ability in the experimental group were (4.90 ± 0.31), (4.72 ± 0.53), (2.86 ± 0.35), (4.66 ± 0.61), (2.83 ± 0.47), (6.76 ± 1.09), higher than scores of the control group (4.36 ± 0.56), (3.93 ± 0.66), (2.57 ± 0.50), (3.64 ± 1.03), (2.18 ± 0.67), (5.68 ± 1.02), and the difference was statistically significant( t values were 2.53-9.06, all P< 0.05). The total score of MMFS in the experimental group was (5.93 ± 1.49), which was lower than that in the control group (8.75 ± 2.30). The difference was statistically significant ( t=-5.51, P<0.01). The total score of BBS in the experimental group was (38.83 ± 1.71), which was higher than that in the control group (30.89 ± 1.93). The difference was statistically significant ( t=16.43, P<0.01). Conclusions:Sensorimotor training can improve the level of balance, cognitive function and reduce the risk of falls in elderly patients with schizophrenia.

Plantar Pressure Characteristics of the Elderly With Different Fall Risks before and after Obstacle Crossing / 医用生物力学

Objective To explore dynamic characteristics of the gait for the elderly with different fall risks before and after obstacle crossing. Methods Twenty-seven elderly people in community were graded as fall risk by using the time up and go test and five-time sit to stand test. The plantar pressure parameters of the elderly before and after obstacle crossing were measured and analyzed by foot pressure measurement system. Results There was no significant difference in the characteristic value of bimodal curve of overall plantar pressure between the high and low fall risk groups before and after obstacle crossing(P>0.05). The center of pressure (COP) trajectory in X direction of high fall risk group after obstacle crossing was significantly greater than that of low fall risk group (P0.05). Conclusions The support time of the elderly with high fall risk is longer than that of the elderly with low fall risk during obstacle crossing, the peak pressure of plantar metatarsal region of the crossing leg increases, and the plantar COP curve shows asymmetry, with an increase in transverse range of the coronal plane. In clinical evaluation, plantar pressure characteristics of people with fall risks during obstacle crossing should be focused on.

A study of timed get up and go scores as falls risk assessment in elderly in a tertiary care centre

Background: Early detection of falls risk in the community dwelling elderly helps to take preventive measures to avoid falls and hence decrease morbidity associated with falls. Falls are a serious threat to independent living and self-confidence of the elderly. Using simple tools to determine risk of falls helps in early detection and prevention of falls. Aims and objectives of the study was to establish TUG data among patients attending the geriatric clinic at MGM hospital, Kamothe and to determine risk of falls in these patients with respect to their systemic involvement.Methods: A prospective observational study of 100 geriatric age group patients were studied for their TUG scores and classified based on systems involved. TUG was performed using standard protocol and scores were stratified based on gender, age and diagnosis. Participants were required to perform TUG and were instructed to rise from an armless chair walk 3 meters and turn around at the chalk mark, walk back, and sit. They were instructed to walk at a normal pace without walking aids and shoes. Time was recorded when participants’ buttocks were lifted off the chair to stand and stopped when the buttocks touched the seat when returning to sitting position.Results: The results showed that the average TUG score of this cohort of 100 patients attending our geriatric outpatient clinic was 13 sec. 60 Males and 40 females were analyzed of which  38 patients had less than 12 s  as TUG score and 62 patients  had more than or equal to 12 sec  as TUG score. Maximum number of patients undergoing the TUG test had musculoskeletal complaints. Yet patients with respiratory conditions had the highest mean TUG score of 14 sec and patients with abdominal and CNS conditions had lowest mean TUG scores.Conclusions: This study of TUG score of cohort of 100 patients showed that average TUG score was 13 sec which was higher than  12 second mark which indicates that these patients who did not have any previous fall had a  risk of future falls and hence a requirement of  an in depth  mobility assessment and early intervention.

Early Warning Model of Fall Risk for the Elderly Based on Gait Characteristics / 医用生物力学

Objective To construct an early warning model of fall risk for the elderly based on six kinds gait parameters. Methods A digital field was used to collect parameters from six kinds of gait for the elderly with or without the history of falls, and the binomial logistic regression analysis was used to establish a regression equation for predicting the fall risks in the elderly, and an early warning model was constructed. Results The regression equations constructed according to the parameters from six kinds of gait were statistically significant. The overall correct rate was predicted from high to low: walking forward with closed eyes (97.1%), walking backward with open eyes (92.9%), walking backward with closed eyes (88.6%), walking forward with open eyes (87.1%), turning head up and down with open eyes (85.7%), turning head left and right with open eyes(82.9%). The constructed early warning model for fall risk of the elderly mainly included five steps, namely, judgment, test, extraction, calculation and early warning, which was suitable for gait testing and evaluation of the elderly in the laboratory. Conclusions Parameters from six kinds of gait could predict the fall risk of the elderly. Among them, walking forward with closed eyes was best to predict the fall risk in the elderly. The established early warning model of fall risk for the elderly could be used to predict the fall risk of 65-75 year old people within one year, which could provide early warning based on the probability of falling, playing a positive effect on preventing falls in the elderly.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia

@#Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. Methods: Tis cross-sectional study was conducted July–August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. Tey responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. Results: In the year immediately preceding the study, 29.0% of participants had sufered a fall. Approximately one-third of women (31.1%) and one-ffth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. Te overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratifed analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identifed for the population overall and for specifc populations in the home care and community setting that could help in designing fall-prevention strategies.

Identificação de fatores de risco para quedas em indivíduos com esclerose múltipla: uma revisão sistemática de estudos prospectivos / Identificación de los factores de riesgo de caídas en individuos con esclerosis múltiple: una revisión sistemática de estudios prospectivos / Identification of risk factors for falls in people with multiple sclerosis: a systematic review of prospective studies

RESUMO O objetivo deste estudo foi identificar, a partir de uma revisão sistemática, variáveis clínicas, instrumentais e demográficas associadas com maior risco de queda em indivíduos com esclerose múltipla (EM), com base em dados prospectivos. A pesquisa foi conduzida nas bases de dados Medline, Web of Science, Bireme e CINAHL, utilizando os descritores "esclerose múltipla", "quedas", "quedas acidentais", "risco de quedas", "controle postural" e "equilíbrio", seguido de buscas manuais. Foram considerados elegíveis estudos de coorte prospectivos, com período mínimo de acompanhamento das quedas de três meses, que avaliassem a associação de determinada variável demográfica, clínica ou instrumental em relação a maior risco de queda em indivíduos com EM. A escala de Newcastle-Ottawa modificada foi utilizada para avaliação da qualidade metodológica dos estudos incluídos. Foram identificados 357 estudos, 12 dos quais foram incluídos na revisão sistemática, com total de 1.270 pacientes incluídos. Destes, 740 (58,26%) pacientes apresentaram um ou mais episódios de queda, 396 (31,18%) apresentaram episódios de queda recorrentes (2≥quedas no período estipulado), e 530 (41,74%) não apresentaram nenhum episódio. Com exceção da espasticidade e do impacto da dupla tarefa na velocidade da marcha, todas as variáveis investigadas apresentaram resultados conflitantes quanto às suas associações a maior risco de quedas. São necessários mais estudos que apresentem homogeneidade dos fenótipos clínicos de indivíduos com EM, além da utilização de instrumentos de avaliação validados, a fim de estabelecer uma associação robusta de outras variáveis clínicas, instrumentais e demográficas com maior risco de queda.

RESUMEN El objetivo de este estudio fue identificar, a partir de una revisión sistemática, variables clínicas, instrumentales y demográficas asociadas con un mayor riesgo de caída en individuos con esclerosis múltiple (EM), con base en datos prospectivos. La búsqueda se realizó en las bases de datos: Medline, Web of Science, Bireme y CINAHL, utilizando los descriptores "esclerosis múltiple", "caídas", "caídas accidentales", "riesgo de caídas", "control postural" y "equilibrio", seguido de búsquedas manuales. Se consideraron elegibles los estudios de cohorte prospectivos con un período de seguimiento mínimo de caídas de tres meses, que evaluaron la asociación de una variable demográfica, clínica o instrumental en relación con el mayor riesgo de caídas en individuos con EM. La escala modificada de Newcastle-Ottawa se utilizó para evaluar la calidad metodológica de los estudios incluidos. Se identificaron 357 estudios, 12 de los cuales se incluyeron en la revisión sistemática, con un total de 1.270 pacientes incluidos. De estos, 740 (58,26%) pacientes tuvieron uno o más episodios de caída, 396 (31,18%) presentaron episodios de caída recurrentes (2≥caídas en el período estipulado), y 530 (41,74%) no presentaron ningún episodio. Con excepción de la espasticidad y del impacto de la doble tarea en la velocidad de la marcha, todas las variables investigadas presentaron resultados conflictivos en cuanto a sus asociaciones a mayor riesgo de caídas. Se requieren más estudios que presenten homogeneidad de los fenotipos clínicos de pacientes con EM, además del uso de instrumentos de evaluación validados, para establecer una asociación robusta de otras variables clínicas, instrumentales y demográficas con mayor riesgo de caída.

ABSTRACT The objective of this study was to identify demographic, clinical, and instrumental variables associated with falls in people with multiple sclerosis (MS), via systematic review, based on prospective data. The search was conducted in these databases: Medline, Web of Science, Bireme e CINAHL via a search strategy that combined the descriptors "multiple sclerosis", "falls", "accidental falls", "fall risk", "postural control" and "balance", followed by manual search. Eligibility criteria were prospective cohort studies with a minimum 3-month follow-up of falls that assessed the association of a demographic, clinical or instrumental variable in relation to a higher fall risk in people with MS. The modified Newcastle-Ottawa Quality Assessment Scale was used for study quality assessment. A total of 357 studies were identified, of which 12 were included in the systematic review and 1,270 patients were included. In this study, 740 (58.26%) patients were classified as fallers, 396 (31.18%) patients had recurrent falls (2≥falls within the stipulated period) and 530 patients (41.74%) were classified as non-fallers. Except for spasticity and dual task cost in gait speed, all investigated variables showed conflicting results regarding their association with a higher fall risk. More studies with clinical homogeneity phenotypes of MS individuals and using validated assessment instruments are necessary to establish a robust association of other clinical, instrumental, and demographic variables with a higher fall risk.

The Effect Of Impaired Balance And Fall Risk On Quality Of Life In Patients With Diabetic Peripheral Neuropathy

Background and Objectives: Diabetes mellitus (DM) has become the leading chronic disorders in nearly all countries due to urbanization, changing lifestyles and lack of physical activity. Neuropathy is the commonest and most debilitating complications of diabetes. Diabetic Peripheral Neuropathy (DPN) increases balance impairment, increasing fall risk. Consequences include decline in mobility, avoidance of activity, institutionalization and mortality; thus affecting one’s Quality of Life (Quality of Life). Previous studies have focused on balance impairment and fall risk in DPN patients and also on QoL separately. Thus, the aim of this study is to find the effect of balance impairment and fall risk on QoL. Methods: A correlational study was done on 30 DPN patients, selected by purposive sampling technique. Subjects were screened for neuropathy using Toronto Clinical Neuropathy Scoring System (TCSS) and those fulfilling the inclusion criteria, underwent balance and fall risk assessment by Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test respectively. Following which, neuropathy specific quality of life questionnaire (NeuroQoL) was administered to evaluate their QoL. Results obtained were statistically analysed using SPSS 16.0, MS Word and MS Excel. Pearson’s correlation was used to find the correlation between variables. Results: The results showed statistically significant correlation between all the variables. Correlation between BBS and reduction in QoL (r=-0.540, p=0.002), TUG and reduction in QoL (r=0.531, p=0.003). Conclusion: In conclusion, physical limitations such as balance impairment and greater fall risk significantly reduces DPN patient’s QoL.

Evaluation Of Postural Balance In Third Trimester Pregnancy

Background: Pregnancy is a state of various physiological and anatomical changes in a female’s body. The increasing body weight leads to the shift in COG and increase in abdominal contents leading to reduced stability and increased use of visual cues which occur in pregnant females as pregnancy advances. Several physiological responses to pregnancy diminish the body’s ability to maintain adequate balance, and place the women at a higher risk of injury and falls. Thus assessment for postural stability is very important to prevent such complications. Objective: To evaluate postural balance in third trimester pregnant females using Four square step test. Materials and methodology: Study was cross sectional observational study. Data was collected by convenient sampling method .60 Healthy women, 30 pregnant and 30 non-pregnant, of age group 20-30 years were selected. Evaluation of postural stability was done using 4 square step test (FSST). The mean of two time trial (in seconds) was noted. The data was collected and analysed using paired t-test. Results: There was statistically significant difference in mean time taken to complete the test between pregnant group and non-pregnant group. (p<0.05) Conclusion: Thus, our study showed that pregnant females took longer time to complete the postural balance test.

Extension Force Deficiency of the Lower Extremity in Squat Contributing to Increased Fall Risk in the Female Elderly / 中国运动医学杂志

Objectives To explore the relationship between the extension force deficiency of the lower extremity and fall risks among the senior female,so as to reveal the potential factors contributing to fall.Methods Forty community-dwelling senior females aged 65 and older were assigned to the group of fallers or non-fallers according to their reported fall history and measured fall risk index (FRI).Extension force of the lower extremity was measured through 3-consecutive fast squats on a force platform.The time for 3m-time up and going (TUG),as well as static and dynamic balance were also measured.Results Compared to the non-fallers,the fallers showed lower peak extension force per body weight (PEF/BW) of the left leg and larger asymmetry of the peak extension force per body weight between the two legs in squats.Correlation analysis showed that FRI had a strong negative relation with PEF/BW of the left leg and a strong positive relation with extension force asymmetry/body weight.Also time for 3m-TUG was positively related to all the force variables standardized by the body weight,especially for the left leg.However,the analysis failed to find a relationship between the velocity of the center of pressure (COP) sway on static balance and any force variables.In addition,PEF/BW of the left leg decreased and force asymmetry/body weight between the two legs increased with aging.Conclusion Extension force measurement in squat is an effective way to assess the muscle strength deficiency related to the increased fall risk.The extension force of the lower extremity to support the body weight in squat had a strong relation to the function decline in the dynamic balance,which contributes greatly to fall risk.The extensive force asymmetry in squat between the two legs is another important fall risk factor for the senior females.

Curative effect observation of intermediate care on patients with after acute stage / 中国综合临床

Objective To observe the clinical efficacy of intermediate care in patients with after acute stroke.Methods Six hundred cases patients with after acute stroke were divided into experimental group with 301 cases and control groups with 299 cases according to the opinions of patient and family members.The experimental group was given intermediate care for 2 weeks.The control group was given the basic treatment of cerebral infarction.Activities of Daily Living (ADL) score,fall risk score and geriatric depression scale (GDS) were compared between the two groups at the time of entry,2 weeks after treatment,6 months and 12 months of follow-up.Results There were no significant differences in terms of ADL score,fall risk score and GDS between the two groups at the time of entry(P＞0.05).Compared with at the time of entry,ADL score and fall risk score were decreased of two group after 2 weeks after treatment,6 months and 12 months of follow-up(P ＜0.05),and ADL score and fall risk score of the experimental group both were lower than of the control group after 2 weeks after treatment,6 months and 12 months of follow-up(P＜0.05).Compared with at the time of entry and 2 weeks after treatment,GDS of two groups both were decreased 6 months and 12 months of follow-up (P ＜0.05),but there was no significant difference between the two groups in different time periods(P ＞0.05).Conclusion Intermediate care has a significant effect on improving the activities of daily living and reducing the risk of falls in patients with after acute stroke,and can reduce the GDS score.

Efectos del entrenamiento en superficies inestables sobre el equilibrio y funcionalidad en adultos mayores / Effect of training on an unstable balance and function in eldery people

OBJETIVO: determinar los efectos de un programa de ocho semanas de entrenamiento en superficies inestables con y sin trabajo de fuerza, sobre el equilibrio y la capacidad funcional en adultos mayores de 60 años, pertenecientes al programa "Escuelas populares del deporte" del INDER Medellín. METODOLOGIA: se llevó a cabo un estudio experimental simple, ciego y enmascarado con asignación al azar de 34 sujetos a dos grupos de intervención con y sin trabajo de fuerza sobre superficies inestables; se midió el equilibrio unipodal, bipodal con ojos abiertos y cerrados, además de pruebas funcionales como Up and Go, arm curl y chair test. RESULTADOS:las intervenciones con y sin trabajo de fuerza mejoraron el equilibrio total en 57,0 y 69,5 segundos respectivamente, sin diferencias estadísticamente significativas en la comparación entre los grupos (p= 0,13). Se mejoró la velocidad de la marcha con ambas intervenciones sin diferencias intragrupos estadísticamente significativas (p= 0,33) pero importantes para la práctica. CONCLUSION: ambas intervenciones mejoran el equilibrio, sin embargo existen diferencias importantes para la práctica a favor del programa sobre superficies inestables sin trabajo de fuerza, pues la intervención tiene un mejor efecto sobre el equilibrio unipodal y bipodal tanto con ojos abiertos como con cerrados.

OBJECTIVE:to determine the effects of an eight-week training program on unstable surfaces with and without strength work regarding balance and functional capacity in adults over 60 who belong to the inder sport schools program in Medellín. METHODOLOGY: simple single-blind and masked experimental trials were conducted on 34 subjects who were randomly assigned to two intervention groups with and without strength work on unstable surfaces. Unipodal and bipodal balance was measured while the subjects' eyes were open and closed. In addition, functional tests such as Up and Go, Arm Curl and Chair Test were conducted. RESULTS : interventions with and without strength work improved total balance in 57.0 and 69.5 seconds respectively. The differences between the groups were not statistically significant (p = 0.33), nonetheless they were important. CONCLUSION: both interventions improve balance, however there are differences that are important in practice. These differences favor the program involving unstable surfaces without an unstable without strength work because the intervention has a better effect on unipodal and bipodal balance both with open and closed eyes.

Application of fall risk factors assessment scale by different position nurses in geriatric ward / 现代临床护理

Objective To investigate the status quo of application of fall risk factors assessment scale in nurses of different position in geriatric ward . Method Eighty-six nurses in different position were investigated by fall risk factors assessment scale . Results About 89 . 5%of the nurses could assess the fall risk factors on time and 80 . 2%could do it accurately , and only 62 . 8%of them worked out their nursing orders based on the possible falls. In terms of the accuracy in using fall risk factors assessment, the primary nurses was poorer than the senior nurses, with statistically significant difference between them (P0.05). Conclusion We should strengthen the training to the clinical nurses in correctly using the fall assessment scale , in order to exert the diagnostic value of the fall assessment scale, reduce the incidence of falls and ensure the safety of the patients.

Analyzing the History of Falls in Patients with Severe Knee Osteoarthritis

BACKGROUND: One out of three adults over the age of 65 years and one out of two over the age of 80 falls annually. Fall risk increases for older adults with severe knee osteoarthritis, a matter that should be further researched. The main purpose of this study was to investigate the history of falls including frequency, mechanism and location of falls, activity during falling and injuries sustained from falls examining at the same time their physical status. The secondary purpose was to determine the effect of age, gender, chronic diseases, social environment, pain elsewhere in the body and components of health related quality of life such as pain, stiffness, physical function, and dynamic stability on falls frequency in older adults aged 65 years and older with severe knee osteoarthritis. METHODS: An observational longitudinal study was conducted on 68 patients (11 males and 57 females) scheduled for total knee replacement due to severe knee osteoarthritis (grade 3 or 4) and knee pain lasting at least one year or more. Patients were personally interviewed for fall history and asked to complete self-administered questionnaires, such as the 36-item Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and physical performance test was performed. RESULTS: The frequency of falls was 63.2% for the past year. The majority of falls took place during walking (89.23%). The main cause of falling was stumbling (41.54%). There was a high rate of injurious falling (29.3%). The time patients needed to complete the physical performance test implied the presence of disability and frailty. The high rates of fall risk, the high disability levels, and the low quality of life were confirmed by questionnaires and the mobility test. CONCLUSIONS: Patients with severe knee osteoarthritis were at greater risk of falling, as compared to healthy older adults. Pain, stiffness, limited physical ability, reduced muscle strength, all consequences of severe knee osteoarthritis, restricted patient's quality of life and increased the fall risk. Therefore, patients with severe knee osteoarthritis should not postpone having total knee replacement, since it was clear that they would face more complicated matters when combining with fractures other serious injuries and disability.

Adaptación y validación de un instrumento de valoración de riesgo de caída en pacientes pediátricos hospitalizados / Adaptation and validation of a hospitalized pediatric patients fall risk assessment instrument

Introducción: Un número significativo de pacientes que asisten a instituciones de salud tienen riesgo de caída en cualquier momento de su hospitalización, cuidarlos implica una serie de intervenciones que requieren una previa valoración clínica. Objetivo: Adaptar y validar un instrumento de valoración de caídas en el paciente pediátrico hospitalizado. Métodos: Se adaptó y validó el instrumento J. H. Downton. Se realizó evaluación de la sensibilidad, especificidad, valor predictivo positivo y negativo, así como la consistencia interna del instrumento por medio de la prueba Kuder-Richardson (KR) y resumen de curvas ROC, mediante el programa estadístico SPSS® versión 15 y Epidat 3.1. Resultados: Se obtuvo consistencia interna por KR de 0.92, sensibilidad de 86.92, especificidad de 99.4, valor predictivo positivo (PP) 99.56, y valor predictivo negativo (PN) 81.52, con un índice de confianza del 95%. Conclusiones: Las escalas validadas como la St. Thomas, se encuentra con buena sensibilidad y especificidad 93% y 88%, respectivamente, sin embargo está adaptada para pacientes mayores. La escala validada en el presente estudio tuvo mejores valores de sensibilidad y especificidad que otras 2 escalas específicas de población pediátrica, la escala Humpty Dumpty y la escala CHAMPS, por lo que se concluye que la escala J. H. Downton modificada es altamente sensible y específica para predecir riesgo de caídas en el paciente pediátrico hospitalizado.

Introduction: A significant number of patients who attend health institutions have a risk of fall anytime during their hospitalization. Taking care of these patients requires diverse interventions and clinical assessments. Objective: To adapt and validate a hospitalized pediatric patient fall risk assessment instrument. Methods: The J. H. Downton instrument was adapted and validated. Specificity and sensibility tests, negative and positive predictive value, and Kuder-Richardson (KR) and ROC curve analysis internal consistency were all assessed using the SPSS® v. 15 and Epidat 3.1 statistics programs. Results: KR internal consistency of 0.92, sensibility of 86.92, specificity of 99.4, PP of 99.56, and PN of 81.52 with a confidence interval of 95% were obtained. Conclusions: Validated scales such as the St. Thomas have good sensibility and specificity values (93% and 88%), but this scale is adapted for elder patients. The validated scale of this study had better sensibility and specificity values than two other hospitalized pediatric population scales: the Humpty Dumpty and the CHAMPS, suggesting that the modified H. Downton scale is highly sensible and specific to predict hospitalized pediatric patient fall risks.

The Effects of Changes of Ankle Strength and Range of Motion According to Aging on Balance

OBJECTIVE: To investigate the changes of ankle strength and range of motion with aging and which of the ankle strength and range of motion are contributed to balance. METHODS: Sixty healthy people (24 men and 36 women) have undergone tests for ankle strength and range of motion, using Biodex System 4 Pro; a one-leg balance, including postural sway and stability index using a Balance System; in which data were collected in a self-reported Desmond fall risk questionnaire. RESULTS: Participants are classified into 3 groups by age (group 1, 20-40 years; group 2, 40-65 years; group 3, over 65 years). Stability index and postural sway is significantly increased with aging. Ankle plantarflexor strength and ankle eversion range of motion is significantly decreased with aging. Pearson's correlation revealed that ankle plantarflexor strength is significantly correlated with anterior/posterior sway, and ankle eversion range of motion is significantly correlated with medial/lateral sway in the aged group (over 65 years). CONCLUSION: Stability, ankle plantarflexor strength, and eversion range of motion is declined with aging. In addition, strength of ankle plantarflexor and eversion range of motion is significantly correlated with balance stability. Further studies are needed for programs to improve the strength of plantarflexor, and range of motion of eversion of the ankle are beneficial in improving balance, stability, and prevention of falling in the elderly.

Fall Risk Assessments Based on Postural and Dynamic Stability Using Inertial Measurement Unit

OBJECTIVES: Slip and fall accidents in the workplace are one of the top causes of work related fatalities and injuries. Previous studies have indicated that fall risk was related to postural and dynamic stability. However, the usage of this theoretical relationship was limited by laboratory based measuring instruments. The current study proposed a new method for stability assessment by use of inertial measurement units (IMUs). METHODS: Accelerations at different body parts were recorded by the IMUs. Postural and local dynamic stability was assessed from these measures and compared with that computed from the traditional method. RESULTS: The results demonstrated: 1) significant differences between fall prone and healthy groups in IMU assessed dynamic stability; and 2) better power of discrimination with multi stability index assessed by IMUs. CONCLUSION: The findings can be utilized in the design of a portable screening or monitoring tool for fall risk assessment in various industrial settings.

Effects of calcitriol, training on balance and lower extremity muscle strength on fall risk of postmenopausal osteoporotic women / 中华健康管理学杂志

ObjectiveTo investigate the effects of caleitriol,training on balance and lower extremity muscle strength on fall risk of postmenopausal women with osleoporosis or osteopenia.Methods A total of 200 postmenopausal women with osteoporosis or osteopenia,whose balance test confirmed higher fall risk,were randondy assigned to group A or B.Those of group A received the following intervention:( 1 ) 0.25 μg calcitriol,QD; (2) general information on fall and osteoporosis; (3) balance training; (4) lower extremity muscle strength exercises.Those of group B were only treated with 0.25 μg calcitriol.All the participants were supplemented with 600 mg/d calcium and 125 IU/d vitamin D.Fall index,bone mineral density,serum levels of calcium and phosphorus,and adverse reactions were record.Results After 3 months' intervention,the fall index of both groups was significantly decreased ( group A:t =2.16,P＜0.05 ; group B:t =2.08,P＜0.05 ).After 6 months' intervention,the fall index of both groups went on decreasing,and significant difference of fall index between 6 month and baseline of group A and between group A and group B at 6 months was found.After 1-year intervention,the fall index of group A was further decreased in comparison with group B ( t =2.66,P＜0.05 ).No hypercalcemia occurred during the study period.Conclusion The fall risk of the patients with postmenopausal osteoporosis or osteopenia was reduced after 3 months' intervention.Twelve months' active vitamin D intervention could either reduce the risk of fall or improve bone mineral density.Patient education,balance training and muscle exercise may be effective intervention to reduce fall risk.