Obstacle course training can improve mobility and prevent falls in people with intellectual disabilities.

BACKGROUND: Persons with intellectual disabilities (ID) constitute a special-needs population at high risk of falling. This is the first study to evaluate whether obstacle course training can improve mobility and prevent falls in this population. METHODS: The intervention was implemented as part of an institution-wide health care improvement plan aimed at reducing falls at a residential facility for people with ID. It comprised an annual screening of each resident for his or her individual fall risk. Subsequently, the group of ambulatory persons with a moderate to high fall risk (n = 39) were offered 10-session obstacle course training to improve their balance and gait abilities. Mobility was assessed pre-intervention, mid-term and post-intervention with the Performance Oriented Mobility Assessment (POMA), the Timed Up and Go (TUG) and the 10-meter walking test. The number of falls was compared between the year before and after intervention. RESULTS: The number of falls decreased by 82% (P < 0.001). POMA scores significantly improved from pre-intervention to mid-term (mean difference ± SD, 1.8 ± 2.9, P = 0.001), from mid-term to post-intervention (2.0 ± 2.9, P < 0.001), and from pre-intervention to post-intervention (3.8 ± 4.3, P < 0.001). Participants completed the 10-meter walking test faster at the post-intervention compared with the pre-intervention assessment (difference ± SD, 2.1 ± 5.1 s, P = 0.022). TUG scores did not improve significantly. CONCLUSIONS: The present study provides preliminary evidence for the effectiveness of obstacle course training in improving mobility and preventing falls in people with ID. As falls are a significant health concern in this population, further research is advocated to provide conclusive evidence for the suggested beneficial effects of exercise interventions.

Falls in older persons with intellectual disabilities: fall rate, circumstances and consequences.

BACKGROUND: Falling is a common cause of injuries and reduced quality of life. Persons with intellectual disabilities (ID) are at increased risk for falls and related injuries. As the number of elderly persons with ID is growing rapidly, it is imperative to gain insight into the quantity of the problem of falling, the circumstances that precipitate falls and to better understand their aetiology in persons with ID. This is the first study to prospectively investigate fall rate, circumstances and fall consequences in older adults with mild to moderate ID. METHOD: Eighty-two individuals with mild to moderate ID, 50 years and over [mean age 62.3 (SD = 7.6), 34 male], participated in this study, which was conducted at three service providers for persons with ID in the Netherlands. Falls were registered for 1 year with monthly fall registration calendars to determine the fall rate (mean number of falls per person per year). Information on fall circumstances and consequences was obtained from questionnaires completed by caregivers and study participants after each fall. RESULTS: We determined that the fall rate in this sample was 1.00 fall per person per year. Thirty-seven participants reported at least one fall (range 1-6). Sex and age were not related to falls. Most falls occurred while walking (63.3%), outside (61.7%) and in familiar environments (88.9%). Importantly, 11.5% of falls resulted in severe injuries, approximately half of which were fractures. CONCLUSION: The circumstances and consequences of falls in persons with ID are comparable to those of the general elderly population, but the rate is substantially higher. As such, appropriate fall prevention strategies must be developed for individuals with ID.

Development and Process Evaluation of a 5-Week Exercise Program to Prevent Falls in People after Stroke: The FALLS Program.

Falls are a common complication after stroke, with balance and gait deficits being the most important risk factors. Taking into account the specific needs and capacities of people with stroke, we developed the FALLS program (FALL prevention after Stroke), based on the "Nijmegen falls prevention program" (a proven-effective 5-week exercise program designed for community-dwelling elderly people). The program was tested in twelve community-dwelling persons with stroke, and a process evaluation was conducted with patients, trainers, health care professionals, and managers. The FALLS program was considered suitable and feasible by people with stroke in the study and relevant health care professionals, and recommendations for implementation in clinical practice have been suggested.

Martial arts fall training to prevent hip fractures in the elderly.

UNLABELLED: Hip fractures are a common and serious consequence of falls. Training of proper fall techniques may be useful to prevent hip fractures in the elderly. The results suggested that martial arts fall techniques may be trainable in older individuals. Better performance resulted in a reduced impact force. INTRODUCTION: Hip fractures are a common and serious consequence of falls. Fall training may be useful to prevent hip fractures in the elderly. This pilot study determined whether older individuals could learn martial arts (MA) fall techniques and whether this resulted in a reduced hip impact force during a sideways fall. METHODS: Six male and nineteen female healthy older individuals completed a five-session MA fall training. Before and after training, force and kinematic data were collected during volitional sideways falls from kneeling position. Two MA experts evaluated the fall performance. Fear of falling was measured with a visual analog scale (VAS). RESULTS: After fall training, fall performance from a kneeling position was improved by a mean increase of 1.6 on a ten-point scale (P < 0.001). Hip impact force was reduced by a mean of 8% (0.20 N/N, P = 0.016). Fear of falling was reduced by 0.88 on a VAS scale (P = 0.005). CONCLUSION: MA techniques may be trainable in older individuals, and a better performance may reduce the hip impact force in a volitional sideways fall from a kneeling position. The additional reduction of fear of falling might result in the prevention of falls and related injuries.

Obstacle avoidance in persons with rheumatoid arthritis walking on a treadmill.

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk of falling. In healthy elderly persons with a history of falling, a reduced ability to avoid obstacles while walking has been shown to relate to increased fall risk. The aim of this study was to determine whether this potential risk factor for falls would also be present in persons with RA. METHODS: Twelve RA patients and twelve controls performed an obstacle avoidance task on a treadmill. The obstacle was released during three different phases of the gait cycle (late stance, early swing and mid swing) to create increasing difficulty levels. The primary outcome measure was failure rate. RESULTS: Overall, the RA patients had significantly higher obstacle avoidance failure rates. To avoid an obstacle, a long or a short stride strategy can be used, the choice of which depends on the phase of obstacle release. There were no significant group differences in the distribution of obstacle avoidance strategies. However, the RA patients made significantly more failures when performing a short stride strategy in mid swing obstacle release trials (the condition which gave the patients the least time to react; available response time). In addition, compared to the controls, the RA group approached the obstacle more closely prior to obstacle crossing (shorter toe distance), thereby increasing the risk of stumbling. CONCLUSION: Obstacle avoidance performance in persons with RA is significantly deteriorated compared to age- and gender-matched controls, especially when available response time is low. This deficit may contribute to their higher fall risk.

Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials.

SUMMARY: Exercise can reduce falls and fall-related fractures in healthy individuals; however, evidence for individuals with low BMD is limited. The results from this systematic review indicate that exercise interventions for individuals with low BMD to reduce falls and fractures should include balance, muscle strengthening, and weight-bearing exercises. INTRODUCTION: The purpose of this systematic review was to investigate which exercise interventions are effective in individuals with low bone mineral density (BMD; osteopenia or osteoporosis) in reducing (1) falls and fractures and (2) risk factors for falls and fractures. METHODS: Databases were searched for relevant studies between 1996 and June 2008. Methodological quality was assessed with the Jadad score and the PEDro scale. RESULTS: Of the 1,369 publications found, 23 met the inclusion criteria. Five additional articles were included after checking reference lists and searching author's names and related articles. Interventions with balance exercises reduced falls or fall-related fractures and improved balance in the majority of the studies. Muscle strengthening exercises were effective in improving lower extremity strength and back extensor strength; however, not all RCT's reported positive effects. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening exercise when the duration of the intervention was at least a year. CONCLUSIONS: Exercise can reduce falls, fall-related fractures, and several risk factors for falls in individuals with low BMD. Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk.

maintenance and rehabilitation strategy for water supply systems in The Netherlands

El articulo trata sobre el desafio que implica el mantenimiento y la rehabilitacion de los sistemas de suministro de agua y, especificamente, sobre el modelo desarrollado por Holanda dentro de su programa de investigacion en la industria del agua. El modelo para el mantenimiento del sistema de suministro de agua identifica los elementos necesarios para un mantenimiento racional, y las relaciones entre dichos elementos; y puede emplearse para tomar decisiones respecto a la rehabilitacion, y para preveer necesidades de rehabilitacion futuras

Maintenance and rehabilitation strategy for water supply systems in The Netherlands

El articulo trata sobre el desafio que implica el mantenimiento y la rehabilitacion de los sistemas de suministro de agua y, especificamente, sobre el modelo desarrollado por Holanda dentro de su programa de investigacion en la industria del agua. El modelo para el mantenimiento del sistema de suministro de agua identifica los elementos necesarios para un mantenimiento racional, y las relaciones entre dichos elementos; y puede emplearse para tomar decisiones respecto a la rehabilitacion, y para preveer necesidades de rehabilitacion futuras