The Aachen Mobility and Balance Index to measure physiological falls risk: a comparison with the Tinetti POMA Scale.

PURPOSE: The most commonly used mobility assessments for screening risk of falls among older adults are rating scales such as the Tinetti performance oriented mobility assessment (POMA). However, its correlation with falls is not always predictable and disadvantages of the scale include difficulty to assess many of the items on a 3-point scale and poor specificity. The purpose of this study was to describe the ability of the new Aachen Mobility and Balance Index (AMBI) to discriminate between subjects with a fall history and subjects without such events in comparison to the Tinetti POMA Scale. METHODS: For this prospective cohort study, 24 participants in the study group and 10 in the control group were selected from a population of patients in our hospital who had met the stringent inclusion criteria. Both groups completed the Tinetti POMA Scale (gait and balance component) and the AMBI (tandem stance, tandem walk, ten-meter-walk-test, sit-to-stand with five repetitions, 360° turns, timed-up-and-go-test and measurement of the dominant hand grip strength). A history of falls and hospitalization in the past year were evaluated retrospectively. The relationships among the mobility tests were examined with Bland-Altmananalysis. Receiver-operated characteristics curves, sensitivity and specificity were calculated. RESULTS: The study showed a strong negative correlation between the AMBI (17 points max., highest fall risk) and Tinetti POMA Scale (28 points max., lowest fall risk; r = -0.78, p < 0.001) with an excellent discrimination between community-dwelling older people and a younger control group. However, there were no differences in any of the mobility and balance measurements between participants with and without a fall history with equal characteristics in test comparison (AMBI vs. Tinetti POMA Scale: AUC 0.570 vs. 0.598; p = 0.762). The Tinetti POMA Scale (cut-off <20 points) showed a sensitivity of 0.45 and a specificity of 0.69, the AMBI a sensitivity of 0.64 and a specificity of 0.46 (cut-off >5 points). CONCLUSION: The AMBI comprises mobility and balance tasks with increasing difficulty as well as a measurement of the dominant hand-grip strength. Its ability to identify fallers was comparable to the Tinetti POMA Scale. However, both measurement sets showed shortcomings in discrimination between fallers and non-fallers based on a self-reported retrospective falls-status.

Neuralgic amyotrophy of the lumbar area. Case report.

Two cases of a rare peripheral neurological disease (neuralgic amyotrophy of the lower extremity) are presented, with clinical symptoms (severe sciatic pain with motor paresis) that pose differential diagnostic difficulties against a hernia of a lumbar disk. Because of a tendency to heal by itself, the disease has a good prognosis. The diagnosis is based on a process of exclusion of herniated disks, lesions of the lumbar plexus in tumors or after radiation therapy, hematoma of the psoas after coagulation disturbances, birth, or trauma, and nutritive disruptions of the nervous system as in diabetes mellitus. Knowledge of the symptoms of this--in orthopedics--mostly unknown disease and critical interpretation of the clinical and medical-technical data are important to avoid wrong indications for surgery.

[Mobilization of the partially stiff shoulder under anesthesia (ankylosing humeroscapular periarthritis)]. / Narkosemobilisation der Schulterteilsteife (Periarthritis humeroscapularis ankylosans).

"Humeroscapular periarthritis" (HPA) was first described by Duplay in 1872 and is to be understood as a syndrome whose typical symptoms are pain and partial or total stiffness of the shoulder ("ankylosing" HPA). This term includes all regressive and reactive affections occurring in the region of the shoulder joint proper (Refish and van Laack, 1985), and has meanwhile become a synonym for painful shoulder stiffness, a term which covers many different processes which are not covered in detail here. Today, however, thanks to refined clinical and radiological examination methods, it is often possible to detect objectively at least some of the changes and to gain insights into the pathophysiological processes. The goal of treatment of HPA is to restore the function of the shoulder joint and eliminate the pain. To this end, various forms of treatment are fundamentally available: 1) conservative treatment, with medication and physiotherapy; 2) surgical treatment; and 3) mobilization under anesthetic, with which, comparatively speaking, results have been best.

[Experimental studies on the effectiveness of various shin guards in soccer]. / Experimentelle Untersuchungen über die Wirksamkeit verschiedener Schienbeinschoner im Fussballsport.

These experimental studies with protective shin-guards show, whether it is possible to protect soccer players' shins effectively, even to prevent shin-fractures. In simulating different forces, acting on shin-guard protected wooden rollers compared to non-protected ones, it could be shown, that injury-protection can be efficient due to stretching the acting forces over a longer period of time, so that the maximal acting force can be decisively reduced. It could be shown, that the greatest effect was seen on maximal forces of less than about 300 kp (3000 N), and that increasing the acting forces will soon reduce this effect. A comparison with forces which are able to fracture human tibial bones shown, that this effect can sometimes even be great enough to prevent tibial fractures. Shin-guards greatest effect nevertheless lies in preventing the great majority of soft tissue damage.