scholarly journals Balance Strategy Exercise versus Lower Limb-ROM Exercise for Reducing the Risk of Falls among Older People

2021 ◽  
Vol 11 (1) ◽  
pp. 114-123
Author(s):  
Zakia Azkia ◽  
Rahmi Setiyani ◽  
Lita Heni Kusumawardani
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Range Of Motion ◽  
Lower Limb ◽  
Institutional Care ◽  
Control Group ◽  
Timed Up And Go ◽  
Term Care ◽  
Risk Of Falls ◽  
Balance Strategy

Background: Falls are a significant health problem and the most common cause of injuries in older people. Different types of exercise have been recommended to prevent falls, including balance exercise and range of motion. However, there is a lack of evidence to compare the effect of the two exercises.Purpose: This study aimed to compare the effect of Balance Strategy Exercise (BSE) and Lower Limb-Range of Motion (ROM) exercise on reducing the risk of falls among older people living in long-term care facilities. Methods: This was a quasi-experimental study using a pre-post design without a control group. A total of 30 older adults from two nursing homes who met the inclusion and exclusion criteria participated in the study. A cluster randomization technique was used to assign the older people into either BSE or Lower-Limb ROM groups evenly. Treatment was given for 30 minutes per session, three sessions per week for three weeks. The risk of falls was measured using the Timed Up and Go (TUG) test. The paired t-test, Wilcoxon and Mann-Whitney U-test were used to analyze the data. Results: Results showed significant differences in the TUG scores before and after the intervention within both the BSE (p=0.001) and the Lower Limb-ROM group (p=0.001). However, the Lower Limb-ROM group demonstrated a significantly higher reduction in TUG score than the BSE group after the intervention (p=0.008).Conclusion: Lower Limb-ROM exercise is better to reduce the risk of falls among older people living in institutional care than BSE. This exercise can be applied as part of a fall prevention program in nursing homes.

scholarly journals Enriched gardens improve cognition and independence of nursing home residents with dementia: a pilot controlled trial

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Etienne Bourdon ◽  
Joël Belmin
Keyword(s):  
Nursing Homes ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Nursing Home Residents ◽  
Control Group ◽  
Timed Up And Go ◽  
Staff Members ◽  
Risk Of Falls ◽  
Walking Balance ◽  
And Control

Abstract Background Dementia is a major issue worldwide, and considerable efforts were made to design therapeutic mediation tools and evaluate their benefits on the health of patients. Methods Design: Multi-center cluster-controlled pilot trial. Settings and participants: Four nursing homes that offered separated access to one conventional sensory garden (CSG) and one enriched garden (EG). The participants were residents with dementia, independent for walking and with no severe dementia or behavioural troubles. Eligible residents were divided into three groups according to the proximity of their room: close to the CSG or EG gardens for the first two groups and further from the gardens for the third (control) group. Interventions: We asked staff members to frequently invite residents to visit the EG or the CSG depending on their group allocation. No invitation to gardens was made to the control group. We installed 12 enrichment modules in the EG that stimulated cognitive, independence and walking/balance functions. Measures: Cognitive function (MMSE), independence for activities of daily living (ADL) and risk of falls (unipodal stance and timed up and go – (TUG)) were assessed at baseline and after 6 months. Results The 120 participants were 81·0 ± 3·5 years old and comprised of 83 women. Their MMSE score was 17·5 ± 2·9. Patients’ characteristics were not significantly different between the three groups. Among the participants invited to visit the EG group, 6-month changes in MMSE showed improvement compared to other groups (+ 0·93 ± 0·65 vs −0·25 ± 0·71 and −0·24 ± 0·73 in the EG vs CSG and control groups, respectively, P < 0·0001). Changes in ADL, TUG and unipodal stance were significantly improved in the group visiting the EG as compared to other groups, which indicates better functioning. Conclusions EGs offer a new approach to therapeutic mediation for residents of nursing homes with dementia.

scholarly journals Enriched gardens improve cognition and independence of nursing home residents with dementia: a controlled trial

2021 ◽  
Author(s):  
Etienne Bourdon ◽  
Joel Belmin
Keyword(s):  
Nursing Homes ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Easy Access ◽  
Control Group ◽  
Timed Up And Go ◽  
Staff Members ◽  
Risk Of Falls ◽  
Walking Balance ◽  
And Control

Abstract Background: Dementia is a major issue worldwide, and considerable efforts were made to design therapeutic mediation tools and evaluate their benefits on the health of patients. Methods:Design: Multi-center cluster-controlled trial. Settings and participants: Four nursing homes that offered separated access to one conventional sensory garden (CSG) and one enriched garden (EG). The participants were residents with dementia, independent for walking and with no severe dementia or behavioural troubles. Eligible residents were distributed into three groups based on the proximity of their rooms to the CSG or EG for the first two groups respectively, and without easy access to either garden for the third (control) group. Interventions: We asked staff members to frequently invite residents to visit the EG or the CSG depending on their group allocation. No invitation to gardens was made to the controls. We installed 12 enrichment modules in the EG that stimulated cognitive and walking/balance functions.Measures: Cognitive function (MMSE), independence for activities of daily living (ADL) and risk of falls (unipodal stance and Timed up and go – (TUG)) were assessed at baseline and after six months.Results: The 120 participants were 81·0 +/- 3·5 years old and comprised of 83 women. Their MMSE score was 17·5 +/- 2·9. Patients characteristics were not significantly different between the three groups. Among the participants invited to visit the EG group, six months changes in MMSE showed improved compared to other groups (+ 0·93 +/- 0·65 vs -0·25 +/- 0·71 and -0·24 +/- 0·73 in the EG vs CSG and control groups, respectively, P < 0·0001). Changes in ADL, TUG and unipodal stance were significantly improved in the group visiting the EG as compared to other groups, which indicates better functioning. Conclusions: EGs offer a new approach to therapeutic mediation for residents of nursing homes with dementia.

scholarly journals Lower-Limb Joint Coordination Pattern in Obese Subjects

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Alberto Ranavolo ◽  
Lorenzo M. Donini ◽  
Silvia Mari ◽  
Mariano Serrao ◽  
Alessio Silvetti ◽  
...  
Keyword(s):  
Lower Limb ◽  
Control Group ◽  
Coordination Pattern ◽  
Obese People ◽  
Joint Coordination ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Coupling Parameters ◽  
Obese Subjects ◽  
Time Distance

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern.

scholarly journals Effect of Cognitive Function on Balance and Posture Control after Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Hui-xian Yu ◽  
Zhao-xia Wang ◽  
Chang-bin Liu ◽  
Pei Dai ◽  
Yue Lan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Berg Balance Scale ◽  
Posture Control ◽  
Control Group ◽  
Cognitive Resources ◽  
Balance Function ◽  
Timed Up And Go ◽  
Risk Of Falls ◽  
Group 16 ◽  
Hemiplegic Gait

Hemiplegic gait is the most common sequela of stroke. Patients with hemiplegic gait are at a risk of falling because of poor balance. The theory of cognitive-motor networks paved the way for a new field of research. However, the mechanism of the relationship of cognition with gait or posture control networks is unclear because of the dynamic characteristics of walking and changing postures. To explore differences in the balance function and fall risk between patients with and without cognitive impairment after stroke, we utilized the Berg balance scale, Timed “Up and Go” test, and 10 m walking test. Patients were divided into two groups: the observation group (16 patients, female 6 and male 10), comprising patients with cognitive impairment after stroke, and the control group (16 patients, female 7 and male 9), comprising patients without cognitive impairment after stroke. We found that patients with cognitive impairment had worse balance function and a higher risk of falls. They needed a longer time to turn around or sit down. Our findings indicated that posture control in turning around and sitting down required more cognitive resources in daily life.

scholarly journals Effectiveness of Virtual Reality and Visual Feedback on Balance and Leg Function in Children with Cerebral Palsy

2019 ◽  
Vol 1 (18) ◽  
Author(s):  
Arūnė Dūdaitė ◽  
Vilma Juodžbalienė
Keyword(s):  
Virtual Reality ◽  
Cerebral Palsy ◽  
Postural Control ◽  
Range Of Motion ◽  
Visual Feedback ◽  
Lower Limb ◽  
Dynamic Balance ◽  
Control Group ◽  
Children With Cerebral Palsy ◽  
Stretching Exercises

Research background. Virtual reality and visual feedback improve motor performance, motor function and balance, so we want to fnd if it affects the function of legs and balance of children with spastic hemiplegia. Research aim was to establish if the use of virtual reality and visual feedback with traditional physiotherapy improve the function of legs and balance of children with cerebral palsy. Methods. Nine children with cerebral palsy participated in the research. Participants were randomly divided into two groups – virtual reality group (n = 6) and control (n = 3). Virtual reality group practised exergaming and stretching exercises for 10 weeks, twice a week. Control group practiced conventional physiotherapy and stretching exercises for 6 weeks, twice a week. We measured the range of motion of the lower limb, spasticity of the lower limb using Modifed Ashworth’o Scale, static, dynamic balance, trunk coordination using Trunk Impairment Scale at the start and the end of the research, and balance using Pediatric Balance Scale. Results. Virtual reality and visual feedback reduced the spasticity of the lower limb, improved balance and postural control for children with cerebral palsy, but it did not improve the range of motion of the lower limb of children with cerebral palsy. Conclusions. Virtual reality and visual feedback did not improve the range of motion of the lower limb of children with cerebral palsy. Virtual reality and visual feedback reduced spasticity of the lower limb, improved balance and postural control for children with cerebral palsy.Keywords. Cerebral palsy, virtual reality, visual feedback, postural control, muscle architecture.

Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations

2008 ◽  
Vol 32 (1) ◽  
pp. 111-126 ◽  
Author(s):  
Lexyne L. McNealy ◽  
Steven A. Gard
Keyword(s):  
Power Generation ◽  
Range Of Motion ◽  
Ankle Joint ◽  
Lower Limb ◽  
Stance Phase ◽  
Sagittal Plane ◽  
The Body ◽  
Control Group ◽  
Initial Contact ◽  
Ankle Motion

In able-bodied individuals, the ankle joint functions to provide shock absorption, aid in foot clearance during the swing phase, and provides a rocker mechanism during stance phase to facilitate forward progression of the body. Prosthetic ankles currently used by persons with lower limb amputations provide considerably less function than their anatomical counterparts. However, increased ankle motion in the sagittal plane may improve the gait of persons with lower limb amputations while providing a more versatile prosthesis. The primary aim of this study was to examine and quantify temporal-spatial, kinematic, and kinetic changes in the gait of four male subjects with bilateral trans-femoral amputations who walked with and without prosthetic ankle units. Two prosthesis configurations were examined: (i) Baseline with only two Seattle LightFoot2 prosthetic feet, and (ii) with the addition of Endolite Multiflex Ankle units. Data from the gait analyses were compared between prosthetic configurations and with a control group of able-bodied subjects. The amputee subjects' freely-selected walking speeds, 0.74 ± 0.19 m/s for the Baseline condition and 0.81 ± 0.15 m/s with the ankle units, were much less than that of the control subjects (1.35 ± 0.10 m/s). The amputee subjects demonstrated no difference in walking speed, step length, cadence, or ankle, knee, and hip joint moments and powers between the two prosthesis configurations. Sagittal plane ankle range of motion, however, increased by 3–8° with the addition of the prosthetic ankle units. Compared to the control group, following initial contact the amputee subjects passively increased the rate of energy storage or dissipation at the prosthetic ankle joint, actively increased the power generation at the hip, and increased the extension moment at the hip while wearing the prosthetic ankle configuration. The amputee subjects increased the power generation at their hips, possibly as compensation for the reduced rate of energy return at their prosthetic ankles. Results from subject questionnaires administered following the gait analyses revealed that the prosthetic ankle units provided more comfort during gait and did not increase the perceived effort to walk. The subjects also indicated that they preferred walking with the prosthetic ankle units compared to the Baseline configuration. The results of the study showed that the prosthetic ankle units improved sagittal plane ankle range of motion and increased the comfort and functionality of the amputee subjects’ prostheses by restoring a significant portion of the ankle rocker mechanism during stance phase. Therefore, prosthetic ankle mechanisms should be considered a worthwhile option when prostheses are prescribed for persons with trans-femoral amputations.

scholarly journals Effects of training with nintendo wii on balance and mobility in institutionalized elderly

2020 ◽  
pp. 1-6
Author(s):  
Lara Alves Moreira ◽  
Lívia Marcondes Faber ◽  
Marcos Eduardo Scheicher
Keyword(s):  
The Elderly ◽  
Functional Mobility ◽  
Static Balance ◽  
Nintendo Wii ◽  
Timed Up And Go ◽  
Term Care ◽  
Institutionalized Elderly ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Pre Treatment

Background: One of the consequences of the institutionalization of the elderly is the increased risk of falls. Games of video games have shown ability to improve balance in the elderly population, but there is no data on their use in institutionalized elderly. Objective: To evaluate the effects of training with Nintendo Wii on static balance and functional mobility in elderly living in Long-Term Care Facilities for Elderly. Methods: Participated in the research 10 institutionalized elderly, who underwent training with Nintendo Wii for eight weeks, twice a week. Functional mobility was assessed by the Timed Up and Go (TUG) test and the static balance by a force platform. Results: Significant improvement in TUG was observed (17.65 ± 4.38s pre-treatment and 15.30 ± 3.70s p= 0.03). There was no significant improvement in the static equilibrium variables, but there was a tendency for improvement. Conclusion: The results demonstrated that the intervention with Nintendo Wii significantly improved the functional mobility, but with no improvement in the static balance in the institutionalized elderly.

Effects of mental practice strategies associated to physiotherapy on gait and risk of falls in Parkinson’s disease: a pilot study of a randomized clinical trial

2020 ◽  
Vol 30 (Supplement_2) ◽  
Author(s):  
T Silva ◽  
L Silva ◽  
K Silva ◽  
S Silva ◽  
D Silva ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pilot Study ◽  
Gait Speed ◽  
Mental Practice ◽  
Control Group ◽  
Timed Up And Go ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Degenerative Disorder

Abstract Introduction Parkinson’s Disease (PD) is a degenerative disorder that interferes with the voluntary movements due to dysfunction of the basal ganglia and presenting with motor signals, such as the reduction of gait speed. This contributes to an increased risk of falls. In rehabilitation, mental practice (MP) has been shown to promote plastic modulation of neural circuits and improve motor learning, but the results of research with MP in PD are still ambiguous due to the diversity of intervention strategies. Objectives To compare the effects of MP strategies associated to physiotherapy in gait and risk of falls in PD patients. Methodology We performed a pilot study of a clinical randomized, single blind, trial, conducted in accordance with the consort checklist. Patients with idiopathic PD were included and allocated to four groups: Control group (CG); Group with mental practice guided by images (MPI); Group with mental practice guided by audio (MPA); group with mental practice without a guide (MPWG). The subjects of the experimental groups were submitted to 15 sessions of physiotherapy and mental practice, while the CG received only physiotherapy. The sessions were held 2 times per week, 40 minutes for physiotherapy and approximately 5-10 minutes for the corresponding mental practice protocol. Spatial-temporal parameters of gait were assessed with the 10 meters Walking Test (TC10m), and the risk of falls was evaluated with the Timed Up and Go (TUG) test. Results The MPI group showed significant results for the parameters time (p = 0.027) and speed (p = 0.025) when compared with the results of the CG. No main effects for the group were observed concerning cadence and risk of falls had. Groups MPWG and MPA showed no significant results for the TC10m and TUG when compared with the CG. Conclusion The results of this pilot study suggest that MP guided by images associated to physical therapy was more effective to increase the gait speed than the alternative strategies.

scholarly journals Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Whitney B. Berta ◽  
Adrian Wagg ◽  
Lisa Cranley ◽  
Malcolm B. Doupe ◽  
Liane Ginsburg ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
High Intensity ◽  
Practice Change ◽  
Quality Improvement Intervention ◽  
Control Group ◽  
Evidence Based ◽  
Phase 2 ◽  
Term Care ◽  
Improvement Intervention

Abstract Background Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. Methods/design SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. Discussion This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.

THE USE OF POSTUROGRAPHY IN INVESTIGATING THE RISK OF FALLING IN FRAIL OR PREFRAIL OLDER PEOPLE WITH DIABETES

2019 ◽  
pp. 1-7
Author(s):  
H. Domergue ◽  
L. Rodríguez-Mañas ◽  
O. Laosa Zafra ◽  
K. Hood ◽  
D. Gasq ◽  
...  
Keyword(s):  
Older People ◽  
Walking Speed ◽  
Analysis Data ◽  
Diabetic Patients ◽  
Clinical Test ◽  
Risk Of Falling ◽  
Timed Up And Go ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Risk Patients

Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

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