Postural stability, risk of falls and fear of falling in elderly with diabetic neuropathy who do therapeutic exercises

This study aimed to analyze postural stability, the risk of falls and fear of falling in elderly with diabetic neuropathy (DNP) that perform therapeutic exercises. The authors conducted the screening of elderly patients with DNP using the instruments Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS). The 50 selected patients were divided into two groups: 24 of G1 (who were performing therapeutic exercises) and 26 of G2 (the control group). To assess postural stability, risk of falls and fear of falling among groups used the pressure platform, the Berg Balance Scale (BBS) and the Falls Efficacy Scale (FES-I). There was no significant difference in the outcome of BBS scales (p=0.16) and FES-I (p=0.15) between the G1 and G2; by the pressure platform, we found differences between G1 and G2 in parameters path length (PL) and stability medio-lateral (ML), with both eyes closed (EC). Elderly people with DNP who perform therapeutic exercise have better stability and ML and PL with EC that sedentary elderly; however, there was no association with therapeutic exercise, risk of falls and fear of falling.

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Effect of workshops for coaches on the motor ability of balance in children practicing sports in late childhood

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00388-9 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

D. Wilczyńska ◽

A. Łysak-Radomska ◽

M. Podczarska-Głowacka ◽

K. Krasowska ◽

E. Perzanowska ◽

...

Keyword(s):

Vestibular System ◽

Postural Stability ◽

Motor Coordination ◽

Stability Index ◽

Control Group ◽

Eyes Closed ◽

Significant Difference ◽

And Control ◽

Experimental Group ◽

Balance Stability

Abstract Background The coach attitude impacts the whole mind and body system of a child athlete from emotional and motivational aspects to motor skills like motor coordination. It translates into the ability to control and stabilize posture. The vestibular system plays an important role in this regulation. This system, next to the visual system and mechanoreceptors, is responsible for balance and control during posture transition. Moreover, the vestibular system is influenced by emotional factors. Therefore the authors of this study focused on the changes in the balance stability of children practicing sport after the implementation of the psychological workshops for coaches. Methods Fifty-nine children at the age of 9–12 practicing soccer, art gymnastic and sport gymnastic were divided into two groups. The experimental group consisted of 31 participants and 28 in the control group. Experimental group children were under the influence of the 3 coaches who attended three workshops over 12 weeks period. Control group children were coached by 5 coaches who attended no workshops. Postural stability tests were performed on children before and after the workshops. Results The statistically significant changes were observed in selected parameters of children’s balance stability after the experiment. The significant difference between the experimental and control group in Overall Stability Index (OSI) (p < 0.0002), Anterior–Posterior Stability Index (AP) (p < 0.01), Medial–Lateral Stability Index (ML) (p < 0.01) with eyes open were observed after the experiment. The results show a significant deterioration in control group contrary to the experimental group where the improvement trend was observed. Moreover, the difference between the groups was observed in OSI parameter (p < 0.005) with eyes closed after the experiment. Conclusion The results obtained by the authors of the current study may support the thesis that educating coaches allows for better results in postural stability of child’s athletes. Nevertheless, this thesis requires further research, with particular emphasis on the age and gender of young athletes.

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Quantification of Trunk Postural Stability Using Convex Polyhedron of the Time-Series Accelerometer Data

Journal of Healthcare Engineering ◽

10.1155/2016/1621562 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Roman Melecky ◽

Vladimir Socha ◽

Patrik Kutilek ◽

Lenka Hanakova ◽

Peter Takac ◽

...

Keyword(s):

Postural Stability ◽

Convex Polyhedron ◽

Human Movement ◽

Control Group ◽

Accelerometer Data ◽

Eyes Closed ◽

Significant Difference ◽

Eyes Open ◽

Novel Method ◽

Well Correlation

Techniques to quantify postural stability usually rely on the evaluation of only two variables, that is, two coordinates of COP. However, by using three variables, that is, three components of acceleration vector, it is possible to describe human movement more precisely. For this purpose, a single three-axis accelerometer was used, making it possible to evaluate 3D movement by use of a novel method, convex polyhedron (CP), together with a traditional method, based on area of the confidence ellipse (ACE). Ten patients (Pts) with cerebellar ataxia and eleven healthy individuals of control group (CG) participated in the study. The results show a significant increase of volume of the CP (CPV) in Pts or CG standing on foam surface with eyes open (EO) and eyes closed (EC) after the EC phase. Significant difference between Pts and CG was found in all cases as well. Correlation coefficient indicates strong correlation between the CPV and ACE in most cases of patient examinations, thus confirming the possibility of quantification of postural instability by the introduced method of CPV.

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The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179351 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9351

Author(s):

Juntip Namsawang ◽

Pornpimol Muanjai ◽

Nongnuch Luangpon ◽

Sirirat Kiatkulanusorn

Keyword(s):

Electrical Stimulation ◽

Fear Of Falling ◽

The Elderly ◽

Limited Range ◽

Community Dwelling ◽

Control Group ◽

Muscle Strengthening ◽

Limited Range Of Motion ◽

Significant Difference ◽

Risk Of Falls

Introduction: Intrinsic foot muscle weakness is a crucial cause of balance deficit in the elderly, which leads to a limited range of motion from the fear of falling and subsequently decreases the quality of life. Muscle strengthening via transcutaneous electrical stimulation (TENS) is an effective intervention; however, its effects on elderly people have rarely been reported. This study was conducted to investigate the effects of TENS on navicular height, balance, and fear of falling. Method: In this study, forty-eight participants aged 65–75 years were included and were randomly divided into two groups: the TENS and control groups. Before and after 4 weeks of training, navicular height, balance, and fear of falling were measured. Result: After 4 weeks of training, navicular height significantly increased in both groups (p < 0.05); however, the increase was higher in the TENS group (p = 0.035). The TENS group had a better improvement in balance in all four directions—front, back, left, and right (p < 0.05). However, postural balance improvements in the control group were observed in three directions only—front, back, and left (p < 0.05)—without any significant difference between the two groups. Furthermore, the TENS group decreased the scale of fear of falling after 4 weeks of training (p = 0.039). Conclusion: In summary, the results of this study can be used as part of the muscle strengthening via ES for decreasing the risk of falls or fear of falling in the elderly.

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Postural stability assessment in flatfoot subjects trough lyapunov exponent analysis

European Journal of Public Health ◽

10.1093/eurpub/ckab120.113 ◽

2021 ◽

Vol 31 (Supplement_2) ◽

Author(s):

Joel Marouvo ◽

Maria António Castro ◽

Nelson Azevedo ◽

Filipa Sousa ◽

Orlando Fernandes

Keyword(s):

Lyapunov Exponent ◽

Postural Stability ◽

Center Of Pressure ◽

Chaotic Behavior ◽

Weight Bearing ◽

Control Group ◽

Posture Analysis ◽

Eyes Closed ◽

Significant Difference ◽

Pressure Feedback

Abstract Background Flatfoot subjects presents an increase plantar foot area related to a plantar pressure feedback impairment. The Lyapunov Exponent is considered a nonlinear parameter used to characterize a signal chaotic behavior measuring the information rate loss from time series, i.e., for the Center of Pressure data. This exponent is used to quantify and measure the capability and resistance of subjects to several perturbations. The study purpose was to investigate the postural stability differences among foot posture condition through the Lyapunov Exponent analysis. Methods The sample of the observation descriptive study consisted of 31 participants (23.26 yo ± 4.43 SD) comprising a total of 62 feet, where 15 integrated into the experimental group with bilateral flatfoot condition and the remaining 16 in the control group with the bilateral neutral foot condition. Subjects were screened, before posture analysis, using the Navicular Drop Test and Resting Calcaneal Stance Position test, to characterize each group. All participants were subjected to a bipedal weight-bearing stance posture stability analysis a force platform, both in eyes-open and closed condition. The Lyapunov Exponent was calculated using the Matlab-R2020b (MathWorks Inc., USA) software. Results Regarding the Center of Pressure outcomes, only the Lyapunov Exponent value upon the Antero-Posterior component regarding groups in the eyes closed condition (diff = 3.09°, p = .016) presented a significant result. Conclusion Flatfoot subjects present a significant difference compared to neutral foot participants, in bipedal weight-bearing stance, in the eyes closed condition regarding the Lyapunov Exponent. This relates to increase variability and decrease stability regarding the Antero-Posterior component.

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Treatment of vertebral fractures due to osteoporosis

Osteologie/Osteology ◽

10.1055/s-0037-1622038 ◽

2015 ◽

Vol 24 (01) ◽

pp. 7-10 ◽

Cited By ~ 3

Author(s):

M. Pfeifer ◽

M. Sinaki

Keyword(s):

Exercise Program ◽

Therapeutic Exercise ◽

Training Support ◽

Axial Stability ◽

Extensor Muscles ◽

Therapeutic Exercises ◽

Increase Risk ◽

Risk Of Falls ◽

Risk Of Fall

SummaryThe objective of exercise in the treatment of osteoporosis is to improve axial stability through strengthening of back extensor muscles. Therefore, a back extension exercise program specific to one’s musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. A significant reduction in back pain, kyphosis, and risk of falls and an improvement in the level of physical activity have been achieved through the SPEED (Spinal Proprioceptive Extension Exercise Dynamic) program. In addition, the application of a “Posture Training Support” (PTS) using a backpack may decrease kyphosis and pain related not only to compression fractures but also reduce iliocostal friction. Therapeutic exercise should address osteo - porosis-related deformities of axial posture, which can increase risk of fall and fracture. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized.

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A systematic review and meta-analysis on efficacy of exercise on posture and balance in patients suffering from Diabetic Neuropathy

Current Diabetes Reviews ◽

10.2174/1573399816666200703190437 ◽

2020 ◽

Vol 16 ◽

Author(s):

Neerja Thukral ◽

Jaspreet Kaur ◽

Manoj Malik

Keyword(s):

Diabetes Mellitus ◽

Diabetic Neuropathy ◽

Meta Analysis ◽

Berg Balance Scale ◽

Risk Of Bias ◽

Core Stability ◽

Balance Scale ◽

Eyes Closed ◽

Significant Difference ◽

Eyes Open

Background: Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% of patients suffering from diabetes. There is involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability. Objective: To assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus. Method: Mean changes in Timed Up and Go test(TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias. Included studies had low risk of bias. Sixteen RCT’s were included for the meta-analysis. Result: Results of meta-analysis showed that there was statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I 2 = 84%, p < 0.00001) in experimental group as compared to control group. There was statistically significant difference in Berg Balance Scale scores and heterogeneity of I 2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I 2 = 100%, p =0.01 and eyes closed, heteogeneity I 2 = 0%, p =0.01). Sensitivity analysis causes change in heterogeneity. Conclusion: It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training etc. have a significant effect in improving balance and posture in diabetic neuropathy.

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Rocker outsole shoe is not a threat to postural stability in patients with diabetic neuropathy

Prosthetics and Orthotics International ◽

10.1177/0309364614543549 ◽

2014 ◽

Vol 40 (2) ◽

pp. 224-230 ◽

Cited By ~ 5

Author(s):

Banafshe Ghomian ◽

Mojtaba Kamyab ◽

Hassan Jafari ◽

Mohammadebrahim Khamseh ◽

Aoife Healy

Keyword(s):

Diabetic Neuropathy ◽

Response Latency ◽

Postural Stability ◽

Response Strength ◽

Diabetic Patients ◽

Foot Ulceration ◽

Objective Evidence ◽

Significant Difference ◽

Quasi Experimental ◽

Force Displacement

Background: Rocker outsole shoes are commonly prescribed to patients with diabetic neuropathy to offload a particular area of the foot sole, thereby decreasing the risk of foot ulceration. Contrary to this, some evidence has reported a postural destabilising effect of these shoes in healthy adults. Objective: To explore the postural stability of patients with diabetic neuropathy who wear a rocker outsole shoe. Study design: Quasi-experimental. Method: In total, 17 patients with diabetic neuropathy (aged 49.29 ± 7.48 years; 7 female, 10 males) participated in this study. A Motor Control Test measuring centre of force displacement, response strength scale and response latency in medium and large perturbations was conducted using the EquiTest system to evaluate postural stability while wearing a baseline shoe (without a rocker outsole) or a rocker outsole shoe (with a toe-only rocker sole). Results: No significant difference was observed between the shoe conditions in centre of force displacement and response latency of the participants (p > 0.05). The results indicated a significant increase in the response strength scale of participants by the rocker outsole, for medium forward and backward and large forward perturbations ( p = 0.014, p = 0.001 and p = 0.027, respectively). Conclusion: When the immediate effect is a concern, the rocker outsole shoe did not negatively affect postural stability in patients with diabetic neuropathy. Clinical relevance This article will provide objective evidence about the effect of rocker outsole on postural balance in diabetic patients. In prescription of rocker outsole to prevent plantar ulceration of diabetic foot, immediate postural destabilising is not a concern.

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Assessment of muscle mass, risk of falls and fear of falling in elderly people with diabetic neuropathy

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.004.ao04 ◽

2015 ◽

Vol 28 (4) ◽

pp. 677-683 ◽

Cited By ~ 1

Author(s):

Hudson Azevedo Pinheiro ◽

Karla Helena Coelho Vilaça ◽

Gustavo de Azevedo Carvalho

Keyword(s):

Diabetic Neuropathy ◽

Lean Body Mass ◽

Muscle Mass ◽

Body Mass ◽

Fear Of Falling ◽

Berg Balance Scale ◽

Elderly Adults ◽

Risk Of Falling ◽

Risk Of Falls ◽

History Of

Abstract Objective : To assess muscle mass, risk of falls and fear of falling in elderly adults with diabetic neuropathy (DNP). Methods : 50 elderly patients with diabetes mellitus (DM) and diabetic neuropathy (NPD) participated in this study. Risk of falling was assessed using the Berg Balance Scale (BBS). Fear of falling was assessed by means of the Falls Efficacy Scale-International (FES-I). Muscle mass was assessed by tetrapolar bioimpedance analysis (BIA) and Janssen's equation. Subjects were divided into two groups: one with a history of falls in the six months before study enrollment (G1) and the other without history of falls (G2). Results : There were statistically significant differences between G1 and G2 regarding lean body mass (p < 0.05), risk of falls as measured by the BBS (p < 0.01), and fear of falling as measured by the FES-I (p < 0.01). In addition, there was a significant correlation between the BBS and BIA (r = 0.45 and p < 0.01), showing that the greater the lean body mass, the lower the risk of falling. Conclusions : We found an association between lean mass, risk of falls and fear of falling in elderly adults with DNP and a history of falls from own height.

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Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6273 ◽

2021 ◽

Vol 67 (4) ◽

pp. 409-415

Author(s):

Köksal Sarıhan ◽

Hülya Uzkeser ◽

Akın Erdal

Keyword(s):

Social Isolation ◽

Fall Risk ◽

Nottingham Health Profile ◽

Risk Index ◽

Control Group ◽

Healthy Individuals ◽

Increased Risk ◽

Study Results ◽

Significant Difference ◽

Risk Of Falls

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

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The Relationship Between Postural Stability, Anthropometry Measurements, Body Composition, and Sport Experience in Judokas with Visual Impairment

Asian Journal of Sports Medicine ◽

10.5812/asjsm.103030 ◽

2020 ◽

Vol 11 (3) ◽

Author(s):

Bruno Ferreira Jeronymo ◽

Pablo Rodrigo de Oliveira Silva ◽

Míriam Mainenti ◽

Lilian Ramiro Felicio ◽

Arthur de Sá Ferreira ◽

...

Keyword(s):

Body Composition ◽

Confidence Interval ◽

Visual Impairment ◽

Postural Stability ◽

Anthropometric Measurements ◽

Cross Sectional ◽

Bootstrap Analysis ◽

Eyes Closed ◽

Significant Difference ◽

Stability Area

Background: Postural stability is quite mandatory when practicing high-performance sports. Investigations of postural stability and related variables in judokas with visual impairment can lead to new training plans targeting the improvement of postural stability and ultimately to enhanced performance. Objectives: To investigate postural stability and its relationship with anthropometric measurements, body composition, and experience in judokas with visual impairment. Methods: Seventeen judokas (70.6% men) with visual impairment participated in this cross-sectional study. The athletes were grouped based on the functional classification of partial (B2/B3, n = 10) and total visual impairment (B1, n = 7). Postural stability was assessed using the elliptical area of the 95% confidence interval (Area) and the average displacement velocity (Vavg) while remaining in a bipedal stance with eyes closed and blindfolded. Body mass, height, circumferences, skinfold thickness and diameters were measured and used to estimate body composition. Between-group comparisons were evaluated using the Mann-Whitney test. Bivariate correlations were determined with Spearman’s correlation coefficient with bootstrap analysis and 95% confidence interval (95% CI) from 500 resamplings. Results: No significant difference was observed between the B1 and B2/B3 groups in relation to postural stability (Area; P = 1.00; Vavg; P = 0.85). Postural stability (Area but not Vavg) correlated positively and moderately (P < 0.05) with anthropometric measurements and negatively with judo experience (practice time). Conclusions: The postural stability of judokas was unrelated to the degree of visual impairment. Postural instability was correlated with anthropometric measurements, mainly body fat and height, and judo experience.

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