Association between vertebral fragility fractures, muscle strength and physical performance: A cross-sectional study.

BACKGROUND: Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass. OBJECTIVES: To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture. METHODS: Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer. RESULTS: We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgm-2). VFF was only associated with low peak hip abductor torque (p = 0.001) after adjustments. In the VFF group (n= 47), each 1 Nmkg-1 increase: in knee extensor torque was associated with improved 5MWT (p = 0.005), TUG (p = 0.002) and 5TSS (p = 0.005) performances; in knee flexor torque was associated with improved 5MWT speed (p = 0.003) and TUG time (p = 0.006); in hip abductor torque was associated with improved 5MWT speed (p = 0.003); and in hip extensor torque with improved TUG time (p = 0.046). CONCLUSION: VFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance.

Diagnostic accuracy of the five times stand-to-sit test for the screening of global muscle weakness in community-dwelling older women.

BACKGROUND: Although the 5 times stand-to-sit test (5TSST) is indicated for screening for muscle weakness in older adults, its validity is based only on the correlation with quadriceps muscle strength or with the muscle strength of a few muscle groups of the lower limbs. Thus, the objective of the present study was to verify whether in independent older women, the 5TSST can really estimate global muscle strength, considering the sum of muscle strength of the trunk, hip, knee and ankle, which are important for functional activities. METHODS: 119 independent older women participated in this cross-sectional study, undergoing the 5TSST and an isometric muscle strength assessment of the trunk, hip, knee and ankle, using an isokinetic dynamometer. The accuracy of the 5TSST for the discrimination of older women with reduced global muscle strength was evaluated by the ROC curve. RESULTS: The ROC curve showed that the 5TSST may discriminate older women with reduced global muscle strength with moderate accuracy (AUC = 0.783; 95 % CI = 0.681-0.886; p < 0.001). The 5TSST score with the best accuracy (sensitivity: 80.0 % and specificity: 61.8 %) to evaluate global muscle strength was 11.64 s. CONCLUSION: 5TSST can be used to identify reduced global muscle strength in independent older women, standing out as an accessible tool for the screening of muscle weakness.

Prediction of Reduced Gait Speed Using 5-Time Sit-to-Stand Test in Healthy Older Adults.

OBJECTIVES: To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n = 465) and men (n = 94). METHODS: 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS: The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed <0.8 m/s was 14.15 seconds; for gait speed <1.0 m/s, it was 12.67 seconds. For men, the cutoff scores for 5TSTS to identify gait speed <0.8 m/s was 14.67 seconds, and for gait speed <1.0 m/s, it was 13.63 seconds. CONCLUSION AND IMPLICATIONS: The 5TSTS is clinically useful and can be an alternative assessment for discriminating community-dwelling older adults with reduced gait speed, when the gait evaluation is not feasible. The study also suggests different cutoff values for 5TSTS considering the gait speeds <0.8 and <1.0 m/s for older women and men, respectively.

Usual and dual-task gait adaptations under visual stimulation in older adults at different ages.

BACKGROUND: During the walk along the streets, older adults are exposed to various visual stimuli that can affect their gait in a harmful or beneficial way. AIMS: To evaluate gait strategies during different situations with and without visual stimulation in older adults to identify the influence of the visual stimulus on these gait parameters. METHODS: A total of 200 older adults were divided into 4 groups according to age range between 60 and 102 years. Gait was evaluated in the following situations: (1) habitual gait (HG); (2) gait with the visual stimulation (GVS) provided by a pedestrian traffic light, and (3) GVS associated with a cognitive task (GVS-C). The GAITRite Platinum equipment was used to assess gait variables. RESULTS: Comparison of GVS and HG revealed that the visual stimulus influences the gait parameters and promotes a gait speed increase. However, to increase their gait speed, older adults aged 60-89 years used strategies of increased step length and cadence, whereas subjects older than 90 years used only strategies of increased cadence. In addition, comparison of GVS and GVS-C revealed a decrease in gait speed in all age ranges when the cognitive task was added, although this reduction was more pronounced in subjects older than 70 years. CONCLUSION: Visual stimulus influences the gait parameters in older adults and the strategy used is different depending on their age, a fact that shows that traffic light may be an interesting strategy to improve the gait performance during physical therapy.

Hip muscle strength, dynamic balance and functional capacity of community-dwelling older adults aged 60 and older: A cross-sectional study.

The objective of the present study was to evaluate the association of hip muscle strength, dynamic balance and functional capacity in the older adults aged 60 to 79 years and older adults aged 80 years and older. A total of 191 community-dwelling older adults participated in this study. Isometric muscle strength was quantified as the peak torque (PT), measured using an isokinetic dynamometer. Functional capacity was determined by the forward step test (ST) and the dynamic balance by the tandem gait (TG) test. The hip flexor, extensor, abductor and adductor PT in the older adults aged 60 to 79 years had a positive influence on the execution of the step test (p < 0.05). The peak adductor torque did not show a significant association with tandem gait (p = 0.649). In older adults aged 80 years and older, the peak adductor torque was the only one that showed an association with the performance of the ST (p = 0.001) and TG (p = 0.024) tests. The hip adductors may have a higher contribution in adults aged 80 years and older during the execution of clinical tests. These findings are relevant to clinical practice as they can help in the development of appropriate physical exercise programs targeting older adults of different age groups.

Effect of different residential settings on gait kinematic parameters in older adults with cognitive impairment.

OBJECTIVE: To compare the parameters of gait kinematics of older adults with cognitive impairment who live in community dwellings or those living or spending most of the time in non-family environment settings. METHODS: The sample was composed of 33 older adults of both sexes with cognitive impairment. Participants were separated into three groups: a community-dwelling older adult group comprised of 11 subjects; a semi-institutionalized older adult group comprised of 10 older adults attended in a geriatric daycare institution; and an institutionalized older adult group comprised of 12 older adults living in long-term institutions. Gait kinematics were recorded by pressure sensors (footswitches). Fifty gait cycles at self-selected pace were analyzed to obtain: gait speed, stride length, stance, swing, and stride time. The variability of these parameters was also analyzed. RESULTS: MANCOVA identified the main effect of groups (p < 0.001). Gait speed of older adults living in long-term institutions and older adults attended in geriatric daycare institutions was slower than community-living older adults (p < 0.001 and p = 0.04, respectively). Swing and stride time variability was higher in older adults living in long-term institutions (p = 0.003 and p = 0.001) and in older adults attended in geriatric daycare institutions (p = 0.02 and p = 0.001) than in community-dwelling older adults. CONCLUSION: The most important finding was that older adults with cognitive impairment who need non-family residential setting care had higher gait kinematics abnormalities, which may increase the risk of falls, compared to those who live in the community.

Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls (p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.

What is the best clinical assessment tool for identification of adults aged ≥80 years at high risk of falls?

OBJECTIVES: To assess the Balance Evaluation Systems Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) test and gait speed to determine which is the most appropriate test for identification of adults aged ≥80 years at higher risk of falls, and to investigate the clinical usefulness of the combination of such tests by cumulative post-test probability (PoTP) for predicting the risk of falls. DESIGN: Longitudinal prospective study. PARTICIPANTS: Ninety-eight older adults (aged 80-102 years). INTERVENTIONS: Older adults were submitted to the clinical tests and followed-up in order to record the occurrence of falls. The capacity of the clinical tests to detect which older adults are at higher risk of falls was measured using the receiver operating characteristic curve, followed by calculation of PoTP for predicting the risk of falls. RESULTS: The BESTest and the Mini-BESTest demonstrated the best PoTP for predicting the risk of falls for a positive test (70%), followed by the TUG test (66%) and gait speed (63%). When performed in combination, a positive result on the TUG test, gait speed and Mini-BESTest increased the probability of older adults falling within the next 6months from 50% to 89%; a negative result on these three tests decreased the probability of older adults falling within the next 6months from 50% to 3%. CONCLUSION: The combination of TUG test, gait speed and Mini-BESTest provided the best approach. If all three tests are positive, there is an 89% chance of identifying an older person at risk of falling. If all three tests are negative, there would only be a 3% chance of obtaining a false-negative result.

The effect of unilateral muscle fatigue of hip abductor muscles on balance and functional capacity in community-dwelling older women.

BACKGROUND: Hip abductor muscles are important for the maintenance of postural stability, mainly on the mediolateral direction and unipodal support conditions. The objective of the present study was to evaluate the effect of unilateral induced fatigue of hip abductor muscles on balance and functional capacity of older women. METHODS: The study included physically independent women aged 60-75 years. We assessed static balance with the single limb stance test (SLS) and evaluated functional capacity with the maximum gait speed (MGS) and step test (ST). We ran the protocol of hip abductor muscle fatigue with a Biodex isokinetic dynamometer. Assessment of balance and functional capacity happened before and after the muscle fatigue protocol. We applied the t-test for repeated measures to determine whether unilateral hip abductor muscle fatigue influences the performance in the tests (SLS, MGS and ST). RESULTS: The protocol of hip abductor muscle fatigue negatively affected all three evaluated tasks: SLS (p = 0.000), ST (p = 0.000) and MGS (p = 0.000). However, the single limb stance test was the most task affected (effect size = 0.51, pre- and post-fatigue difference = 28.1 %). CONCLUSION: After the unilateral muscle fatigue of hip abductors, we observed the worst performance on clinical tests, mainly regarding the SLS test, which shows the involvement of hip abductors during usual motor tasks. However, the small magnitude of the limitation of functional tests (MGS and ST) suggests the presence of postural compensations.

Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women.

OBJECTIVE: The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. METHODS: In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. RESULTS: Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. CONCLUSION: The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. IMPACT: Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

Risk factors for future falls among community-dwelling older adults without a fall in the previous year: A prospective one-year longitudinal study.

INTRODUCTION: One of the main risk factor for falls is a history of falls itself. Henceforth, preventing a fall is an important strategy for the prevention of new ones. The objective of the present study was to determine whether personal self-perception questions and functional tests might represent risk factors for a fall during the year following a year without any falls among independent community-dwelling older adults, considering a period of 12 prospective months. METHODS: A total of 101 community-dwelling older adults without a fall in the previous year underwent an initial evaluation (sample characterization, self-perception questionnaire and functional tests) and monthly monitoring of prospective fall episodes by telephone contact. We determined the association between the occurrence of prospective falls (dependent variable) and personal questions and functional tests (independent variables) with multiple binary logistic regression adjusted for confounding variables. RESULTS: Only age (p = 0.005) and self-perception of general health (p = 0.019) showed association with the occurrence of prospective falls. CONCLUSION: Our results showed that the only factors bearing an association with the occurrence of prospective falls were age and general health self-perception, which demonstrates the importance of administrating self-perception measures in clinical practice or in epidemiological studies for the prevention of a fall during the year following a year without any falls in older adults.

Association between the trunk muscle function performance and the presence of vertebral fracture in older women with low bone mass.

BACKGROUND: Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). AIMS: The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. METHODS: This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD <- 1.0 DP. Multidimensional evaluations were performed: appendicular skeletal muscle mass index (ASMI) was determined by the total body DEXA; the radiographic evaluations measured the degree of thoracic kyphosis and classification of VF. The trunk muscle function parameters, such as peak torque (PT), rate of torque development (RTD) and torque steadiness (TS) were evaluated by isokinetic dynamometer. The trunk muscle endurance was evaluated by the timed loaded standing test. The adjusted multivariate logistic regression model and multivariate linear regression were performed to verify the association between the variables studied. RESULTS: The results showed that the trunk muscle function parameter with greater association with the presence of VF is TS extensors (OR = 1.70; p < 0.001). The other two significant muscle parameters were: RTD30 flexors (OR = 0.31; p = 0.033) and PT extensors (OR = 0.13; p = 0.009). No statistical association was found between the presence of VF and the ASMI and trunk muscle endurance. No correlation between trunk muscle function and fall history was observed. There was a weak correlation between ASMI and extensor PT (R2 = 0.21; p = 0.027) and extensor RTD30 (R2 = 0.21; p = 0.026). CONCLUSIONS: This study demonstrated that deficit in trunk muscle function has shown a strong association with the presence of VF, highlighting issues heretofore unexplored regarding the association between VF with muscle power and motor control.

Use of the BESTest and the Mini-BESTest for Fall Risk Prediction in Community-Dwelling Older Adults Between 60 and 102 Years of Age.

BACKGROUND AND PURPOSE: Reference values for the Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) need to be established to predict falls in older adults during every stage of aging. The purpose of this study was to determine the cutoff scores for the BESTest and the Mini-BESTest for community-dwelling older adults in order to predict fall risk. METHODS: A total of 264 older adults, of both sexes, between the ages of 60 and 102 years, were divided into 4 groups according to age range. After evaluation, participants received telephone follow-up for 6 months to record the number of fall episodes. To define the reference values of the tests in relation to fall risk prediction, a receiver operating characteristic curve was drawn to identify the area under the curve and the sensitivity and specificity of the tests. Statistical analyses were done using SPSS (Version 16.0-SPSS Inc) with a significance level of 5% (P ≤ .05). RESULTS: The cutoff scores to identify older adults with fall risk according to the BESTest and the Mini-BESTest in the different age groups were 99 and 25 points, respectively, for people 60 to 69 years of age, 92 and 23 points for the age group of 70 to 79 years, 85 and 22 points for people 80 to 89 years of age, and 74 and 17 points for people 90 years of age or older. CONCLUSION: The BESTest and the Mini-BESTest are good tools for predicting fall risk in the 6 months following an initial evaluation in community-dwelling Brazilian older adults. The study also determined that cutoff values vary for different age groups.

The ability of gait kinematic parameters to predict falls in older adults with cognitive impairments living in long term institutions.

BACKGROUND: Cognitive impairments reduce adaptive responses and may increase the risk of falls. OBJECTIVES: To compare gait kinematics in older adults with cognitive impairments living in long term institutions and to identify the ability of gait kinematics to predict falls in older adults with cognitive impairments living in long term institutions. METHODS: Data of 23 older adults with cognitive impairments living in long term institutions were considered for this study. Fifty gait cycles were recorded during walking at a self-selected pace using footswitches sensors. The variables considered for the analysis were: speed; stride length; stance, swing and stride time; and the variability of these parameters. Fall status was recorded for a 6 month-period. FINDINGS: MANOVA found group effect (p = 0.025) for gait kinematics comparisons. Variability of stance (p = 0.01) and swing (p = 0.012) and stride time (p < 0.001) were higher in older fallers. Speed of older fallers was 31.8% slower than those of the non-fallers (p < 0.001). The kinematic variables that were able to predict falls were: stride time variability (p < 0.001), threshold of 0.4 s, sensitivity of 50% and specificity of 100%; and gait speed (p < 0.001), threshold of 0.65 m·s-1, sensibility and specificity of 50%. INTERPRETATION: Older adults living in an assisted living facility with a history of falls demonstrate increased kinematic variability while walking. However, the ability of gait kinematic parameters to predict falls was found to be weak. The results suggested that gait kinematic parameters are weak predictors of falls in older adults with cognitive impairments living in long term institutions.

Balance Evaluation of Prefrail and Frail Community-Dwelling Older Adults.

BACKGROUND AND PURPOSE: With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform. METHODS: Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed. RESULTS: Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP. CONCLUSION: The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.

Contribution of hip abductor-adductor muscles on static and dynamic balance of community-dwelling older adults.

BACKGROUND: The previous studies have investigated causes of and risk factors for falls and impairment of functional capability in older adults. However, the biomechanical factors involved in functional performance and postural control, and the contribution of hip muscles, are still unknown. AIMS: The aim of the present study was to verify the association between the muscle function of hip abductors and adductors and static and dynamic balance, in a narrow base of support, in community-dwelling older adults. METHODS: Eighty-one older adults, including both women and men, were evaluated. Tandem gait and single-leg stance were used to assess static and dynamic balance, and an isokinetic dynamometer was used to analyze muscle function (peak torque and rate of torque development according to body weight). Data were analyzed by a multivariate linear regression test without adjustment and with adjustment using two models: adjustment I (sex) and adjustment II (age). RESULTS: There was a statistically significant association between peak torque of abductor in single-leg stance and tandem gait speed. The PT of hip adductors contributed to static balance performance, in a narrow base of support from the unadjusted data and from the adjusted data by sex. CONCLUSION: The findings of the present study are relevant, because if deficits in balance and functionality in older adults can be linked to a decline in maximum muscle strength of hip abductors, this parameter can be treated to maintain independence in older adults for as long as possible.

Exercise on balance and function for knee osteoarthritis: A randomized controlled trial.

OBJECTIVES: To assess balance and function of symptomatic and asymptomatic subjects with knee osteoarthritis (OA) and investigate the influence of physical exercise. DESIGN: Subjects were divided into three groups: Group 1 (n = 15), symptomatic knee OA; Group 2 (n = 11), asymptomatic knee OA; and Group 3 (n = 16), knee OA and no intervention. History of falls, the WOMAC questionnaire, balance and functionality were assessed. RESULTS: After intervention, there was a significant difference in the total WOMAC score and in the pain and function domains only in Group 1. After intervention, Group 2 showed significant differences in decreased time on the Step Up/Over test and postural sway increased. CONCLUSION: After the intervention, the symptomatic group reported improvement in pain and function on the WOMAC, while the asymptomatic group showed improvement in performance in the Step Up/Over test. There were no new episodes of falls in groups 1 and 2.

Factors associated with low levels of physical activity among elderly residents in a small urban area in the interior of the Brazilian Amazon.

The aim of the present study was to investigate levels of physical activity and risk factors for inactivity in older adults living in an urban area in the interior of the Amazonas state, Brazil. Data were collected between 2013 and 2015 from 274 individuals 60 years of age or older who resided in the interior of the Brazilian Amazon. Sociodemographic, general health, functional capacity and physical performance were associated with self-referred physical activity level. A multivariate analysis, after adjustment, showed that being a man, having a body mass index above 27kg/m2, never having lived in riverside communities and having less than three associated chronic diseases were independent risk factors for low levels of physical activity among elderly residing in the interior of the Brazilian Amazon. Few studies have been conducted about the characteristics that are singular to this population. Our results suggest that the physical activity level and, consequently, the aging process of the elderly is influenced by where they have resided throughout their lives. Additionally, the results showed particular risk factors associated with low physical activity level among older adults residing in the interior of the state of Amazonas.

POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA.

OBJECTIVE: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . METHODS: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . RESULTS: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . CONCLUSION: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

OBJETIVO: O objetivo deste estudo foi avaliar a independência funcional e o controle de tronco durante tarefas de alcance máximo em indivíduos com lesão medular, que foram divididos em grupo sedentário (SSI, n = 10) e grupo fisicamente ativo (PASI, n=10). MÉTODOS: Foi realizada anamnese, identificação do nível e tipo de lesão (de acordo com o protocolo da ASIA - American Spinal Injury Association), e aplicou-se o questionário de Medida de Independência Funcional (MIF). Para a tarefa de alcance anterior e lateral os indivíduos foram instruídos a fazer o alcance máximo. Para comparação das médias dos dados foram aplicados o teste t não pareado e teste de Mann-Whitney, e as diferenças foram consideradas significativas quando p < 0,05. RESULTADOS: O grupo PASI teve melhor desempenho na realização de atividades de autocuidado (PASI: 40,8 ± 0,42 pontos, SSI 38,0 ± 3,58 pontos, p = 0,01), controle de esfíncter (PASI: 10,5 ± 1,84 pontos, SSI 8,2 ± 3,04 pontos, p = 0,02), transferências (PASI: 20,7 ± 0,48 pontos, SSI 16,9 ± 4,27 pontos, p = 0,04) e MIF total (PASI: 104,0 ± 2,30 pontos, SSI 105,1 ± 8,56 pontos, p = 0,01). No alcance máximo, o grupo PASI teve maior alcance médio em todas as direções avaliadas (p < 0,05) . CONCLUSÃO: A prática de exercício físico contínuo aumentou a independência funcional motora e o controle de tronco em indivíduos com lesão medular completa. Nível de Evidência II, Estudo Prospectivo Comparativo.

Immediate effects of an anchor system on the stability limit of individuals with chronic dizziness of peripheral vestibular origin.

INTRODUCTION: The symptoms associated with chronic peripheral vestibulopathy exert a negative impact on the independence and quality of life of these individuals, and many individuals continue to suffer from these symptoms even after conventional vestibular rehabilitation. OBJECTIVE: To evaluate the acute effect of an anchor system for balance evaluation of patients with chronic dizziness who failed to respond to traditional vestibular rehabilitation. METHODS: Subjects over 50 years of age, presenting with chronic dizziness and postural instability of peripheral vestibular origin, participated in the study. The limit of stability was evaluated in three positions using the Balance Master® system: Position 1, standing with the arms along the body; Position 2, standing with the elbows bent at 90° (simulating holding the anchors); and Position 3, with the elbows bent at 90° holding the anchors. The variables of movement latency, endpoint excursion and directional control of movement were evaluated. RESULTS: Using the anchor system, significant reduction of time in the response at the beginning of the movement compared to Position 1 (p<0.05); increased endpoint excursion in the left lateral direction compared to Position 1 (p<0.05); and more directional control of movement in the anterior and posterior directions (p<0.05) compared to the other positions, were found. CONCLUSION: While using the system anchor, individuals with chronic peripheral vestibulopathy showed an immediate improvement in the stability limit in relation to the movement latency, endpoint excursion, and directional control of movement variables, suggesting that the haptic information aids postural control.