Assessment of balance in unsupported standing with elderly inpatients by force plate and accelerometers.

BACKGROUND AND AIMS: Unsupported standing is one of the most important functional tasks involving balance control. Unlike younger people, who have been shown to counteract imbalance preferably with an ankle strategy, older people tend to do so with a hip strategy. These strategies can be described by matching balance measures at floor and hip level, a good match representing an ankle-dominant strategy and a low one a hip-dominant strategy. The aim of this study was to show possible change in the association between force platform measurement at floor level and accelerometry at hip level in elderly inpatients standing unsupported during rehabilitation. METHODS: Forty four elderly inpatients (mean age 82.5 yrs) after hip fracture or stroke were recruited for the study. Balance was assessed after admission and 2 weeks later on a force platform at floor level and simultaneously by a tri-axial accelerometer at hip level. RESULTS: The correlation between the 2 measures was initially poor to fair (r=0.04 to r=0.51), but increased after 2 weeks of rehabilitation (r=0.30 to r=0.66). CONCLUSIONS: A change in the association between measures obtained at lower back level and floor level may indicate a change from a hip- to an ankle-dominant strategy, to counteract imbalance during unsupported standing.

Assessing Physical Activity in Inpatient Rehabilitation: validity, practicality, and sensitivity to change in the physical activity in inpatient rehabilitation assessment.

OBJECTIVE: To validate a novel assessment of inpatient physical activity. DESIGN: Prospective cohort study for the evaluation of a novel questionnaire for physical activity in geriatric inpatients. SETTING: German geriatric inpatient rehabilitation unit. PARTICIPANTS: Patients (N=96; 67 [72%] women; median age, 81y) with a variety of main underlying diagnoses, including musculoskeletal diseases, hip fracture, cardiovascular diseases, stroke, and others. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ceiling and floor effects and administration time were measured. For criterion-related concurrent validity (convergent and discriminative), the Physical Activity in Inpatient Rehabilitation Assessment (PAIR) was administered in parallel to self-rated, proxy-rated, and performance-based measures of physical function at admission. Measurements were repeated at discharge and 4-month follow-up in the home environment, including a standard physical activity questionnaire to determine predictive validity. Spearman correlation coefficients were calculated to describe associations between parameters. Sensitivity to change was estimated using standardized response means (SRMs). RESULTS: Administration time of the PAIR ranged from less than 1 to 4 minutes. Ceiling effects occurred mainly at discharge (5%-14%), and floor effects (5%-11%), at admission. There were no missing values. Associations between convergent and predictive validity measures and functional measures (r=.43-.53, r=.49-.54, respectively) were clearly better when cognition was intact. Discriminative validity expressed as effect sizes ranged from .27 to 1.44. The SRM to describe sensitivity to change was .65 for the total score. CONCLUSIONS: The PAIR is the first validated questionnaire to assess physical activity in geriatric inpatients. It is practical and its validity and sensitivity to change are similar to existing physical activity questionnaires for community-dwelling older persons.

Audio-biofeedback training for posture and balance in patients with Parkinson's disease.

BACKGROUND: Patients with Parkinson's disease (PD) suffer from dysrhythmic and disturbed gait, impaired balance, and decreased postural responses. These alterations lead to falls, especially as the disease progresses. Based on the observation that postural control improved in patients with vestibular dysfunction after audio-biofeedback training, we tested the feasibility and effects of this training modality in patients with PD. METHODS: Seven patients with PD were included in a pilot study comprised of a six weeks intervention program. The training was individualized to each patient's needs and was delivered using an audio-biofeedback (ABF) system with headphones. The training was focused on improving posture, sit-to-stand abilities, and dynamic balance in various positions. Non-parametric statistics were used to evaluate training effects. RESULTS: The ABF system was well accepted by all participants with no adverse events reported. Patients declared high satisfaction with the training. A significant improvement of balance, as assessed by the Berg Balance Scale, was observed (improvement of 3% p = 0.032), and a trend in the Timed up and go test (improvement of 11%; p = 0.07) was also seen. In addition, the training appeared to have a positive influence on psychosocial aspects of the disease as assessed by the Parkinson's disease quality of life questionnaire (PDQ-39) and the level of depression as assessed by the Geriatric Depression Scale. CONCLUSIONS: This is, to our knowledge, the first report demonstrating that audio-biofeedback training for patients with PD is feasible and is associated with improvements of balance and several psychosocial aspects.

Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture.

BACKGROUND AND AIMS: Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association. METHODS: Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants' home. The data of 51 participants living in the community at the time of fracture could be analysed. MAIN MEASURES: Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance. RESULTS: Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model. CONCLUSIONS: Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes.

Clinical and dual-tasking aspects in frequent and infrequent fallers with progressive supranuclear palsy.

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease with no sufficient therapeutic options to date. Falls are the most devastating feature. The causes of these falls are not well understood. To test the impact of PSP-associated motor and cognitive features on falls, 26 PSP patients were prospectively recruited and divided into frequent fallers (> one fall/month, 18 patients) and infrequent fallers (

Day-to-day variability of physical activity of older adults living in the community.

The purpose of the study was to investigate whether a 24-hr recording period is sufficient to describe physical activity (PA) of 1 week for intraindividual comparison in older adults. Furthermore, the authors analyzed whether physical performance can be used as a surrogate marker of PA. PA was captured on 7 consecutive days by a body-fixed sensor in 44 community-dwelling older adults (80.75 +/- 4.05 yr). Mean times of walking and of "time on feet" of the group were 10.2 hr (+/- 3.5) and 35.1 hr (+/- 9.43), respectively. Intraindividual variabilities of walking and of time on feet were 31.9% +/- 10.79% and 19.4% +/- 8.76%, respectively. Accumulated time of variables of PA showed no differences between weekdays, with variabilities of 3.8% and 1.8% for walking and time on feet, respectively. Association between Short Physical Performance Battery and PA was limited (walking r = .397, time on feet r = .41).