Split-Belt Training but Not Cerebellar Anodal tDCS Improves Stability Control and Reduces Risk of Fall in Patients with Multiple Sclerosis

The objective of this study was to examine the therapeutic potential of multiple sessions of training on a split-belt treadmill (SBT) combined with cerebellar anodal transcranial direct current stimulation (tDCS) on gait and balance in People with Multiple Sclerosis (PwMS). Twenty-two PwMS received six sessions of anodal (PwMSreal, n = 12) or sham (PwMSsham, n = 10) tDCS to the cerebellum prior to performing the locomotor adaptation task on the SBT. To evaluate the effect of the intervention, functional gait assessment (FGA) scores and distance walked in 2 min (2MWT) were measured at the baseline (T0), day 6 (T5), and at the 4-week follow up (T6). Locomotor performance and changes of motor outcomes were similar in PwMSreal and PwMSsham independently from tDCS mode applied to the cerebellum (anodal vs. sham, on FGA, p = 0.23; and 2MWT, p = 0.49). When the data were pooled across the groups to investigate the effects of multiple sessions of SBT training alone, significant improvement of gait and balance was found on T5 and T6, respectively, relative to baseline (FGA, p < 0.001 for both time points). The FGA change at T6 was significantly higher than at T5 (p = 0.01) underlining a long-lasting improvement. An improvement of the distance walked during the 2MWT was also observed on T5 and T6 relative to T0 (p = 0.002). Multiple sessions of SBT training resulted in a lasting improvement of gait stability and endurance, thus potentially reducing the risk of fall as measured by FGA and 2MWT. Application of cerebellar tDCS during SBT walking had no additional effect on locomotor outcomes.

Single center, observational study to analyze correlation between vitamin D-3 deficiency and age in patients with orthopedic disorders

<p><strong>Background:</strong> Vitamin D deficiency has been strongly associated with various health outcomes, including all-cause mortality. Chronic vitamin D deficiency in adults and in old age results in osteomalacia, osteoporosis, muscle weakness, and increased risk of fall and long bone fractures. <strong></strong></p><p><strong>Methods:</strong> We examined records of 1029 such patients and to analyze association of vitamin d-3 levels and categories of age groups (1-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years). We categorized mild, moderate and severe cases age wise.</p><p><strong>Results: </strong>During the study period records for 1029 patients were evaluated, of which 347 (33.72%) male and 682 (66.27) were female the mean age with standard deviation for male was 38.25±15.64 years and for female was 41.43±15.23 years. Vitamin D deficiency (&lt;20 ng/ml) was present in 623 patients (61%), 189 patients (18%) had vitamin D level 20-30 ng/ml and 217 patients (21%) had sufficient levels of vitamin D.</p><p><strong>Conclusions:</strong> Our study concludes that although there is high prevalence of vitamin D-3 deficiency across all age groups among orthopedic patients, age group 31-40 years, was found to be more affected.</p><p><strong> </strong></p>

The risk of fall-related hospitalisations at entry into permanent residential aged care

Background Entering permanent residential aged care (PRAC) is a vulnerable time for individuals. While falls risk assessment tools exist, these have not leveraged routinely collected and integrated information from the Australian aged and health care sectors. Our study examined individual, system, medication, and health care related factors at PRAC entry that are predictors of fall-related hospitalisations and developed a risk assessment tool using integrated aged and health care data. Methods A retrospective cohort study was conducted on N = 32,316 individuals ≥65 years old who entered a PRAC facility (01/01/2009-31/12/2016). Fall-related hospitalisations within 90 or 365 days were the outcomes of interest. Individual, system, medication, and health care-related factors were examined as predictors. Risk prediction models were developed using elastic nets penalised regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination. Results 64.2% (N = 20,757) of the cohort were women and the median age was 85 years old (interquartile range 80-89). After PRAC entry, 3.7% (N = 1209) had a fall-related hospitalisation within 90 days and 9.8% (N = 3156) within 365 days. Twenty variables contributed to fall-related hospitalisation prediction within 90 days and the strongest predictors included fracture history (sub-distribution hazard ratio (sHR) = 1.87, 95% confidence interval (CI) 1.63-2.15), falls history (sHR = 1.41, 95%CI 1.21-2.15), and dementia (sHR = 1.39, 95%CI 1.22-1.57). Twenty-seven predictors of fall-related hospitalisation within 365 days were identified, the strongest predictors included dementia (sHR = 1.36, 95%CI 1.24-1.50), history of falls (sHR = 1.30, 95%CI 1.20-1.42) and fractures (sHR = 1.28, 95%CI 1.15-1.41). The risk prediction models had an AUC of 0.71 (95%CI 0.68-0.74) for fall-related hospitalisations within 90 days and 0.64 (95%CI 0.62-0.67) for within 365 days. Conclusion Routinely collected aged and health care data, when integrated at a clear point of action such as entry into PRAC, can identify residents at risk of fall-related hospitalisations, providing an opportunity for better targeting risk mitigation strategies.

Fall-related Injuries in Older Adults and Medications Prescribed within 30 Days Prior to the Injury

Fall-related injuries in older adults have serious consequences both for individuals and the public health care system. The purpose of this study was to identify medication classes prescribed within 30 days prior to the injury that were associated with fall-related injuries in older adults. This population-based, case-control study used secondary administrative health care data in Ontario, Canada. The cases were older adults, aged 66 years and older, who visited an emergency department for a fall-related injury. Controls were extracted from the Registered Person Database, and matched by same age, sex and residence area. Medication classes prescribed to both groups were recorded and logistic regression was conducted to examine the association between medications and fall-related injury. The case group included 255,270 older adults who experienced a fall-related injury over the five-year period (2010-2014). After adjustment for sex, age group, residence area, income level and number of medications prescribed, psychotropic medications (i.e., opioids, anti-epileptics, anti-Parkinson’s drugs, and antidepressants), drugs for treatment of constipation, infection and benign prostatic hyperplasia, antithrombotic agents, statins and bronchodilators were identified to be related to increased risk of fall-related injuries. In addition to medications already on the list of fall-risk increasing drugs or FRIDs, this study uncovered that drugs for benign prostatic hyperplasia, cephalosporins, biphosphates and bronchodilators increased the risk of fall-related injury in older adults. Well-designed prospective cohort studies considering prescription indication and drug-drug interactions are needed to provide more convincing evidence on medications that may be associated with increased risks of fall-related injury in older adults.

Reliability of Sit to Stand Test in Fall Identification in Knee Osteoarthritis- A Literature Review

Osteoarthritis is the second most prevalent degenerative illness as well as the most frequent joint condition in India. It is one of the most common degenerative disorder of the articular cartilage and surface of weightbearing joints causing disability in elderly patients. Gait, stair-climbing, unipedal stance, and the sitting-to-standing (STS) task have all been shown to be altered in research. Most of the research article had proved that sit to stand test, we can use to physiotherapy department to identify the risk of fall in knee OA patients. Most of the patients had severe knee pain and reduced lower limb muscle strength so, during the test patient may take a long time to complete the test and there is a loss of balance. Due to pain and reduced endurance and loss of balance, the patient may not be capable of completing the test. So, the test is reliable to determine the risk of a fall in knee OA patient.

Effects of neuromuscular electrical stimulation and core muscle strengthening on trunk instability following stroke

Background: Postural instability leads to balance dysfunction in stroke subjects, which always increase the risk of fall. This study aimed to compare the effect of neuromuscular electrical stimulation and core muscle strengthening on trunk balance following stroke.Methods: Forty five stroke subjects were participated and assigned randomly into three groups; all groups received standard rehabilitation program; and core group received additional core strengthening, neuromuscular electrical stimulation (NMES) group received added electrical stimulation over paraspinal region and combination group received core muscle strengthening and NMES along with standard rehabilitation protocol. After four weeks of the interventions, primary and secondary outcome measures are evaluated. Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale (TIS) and Barthel Index (BI) were evaluated before and after the intervention.Results: All the three (core MS, NMES and combination) groups showed significant improvement after the intervention (BBS 10.07, 15.54 and 18.27, PASS 6.54, 13.06 and 14.00, TIS 0.25, 0.25 and 0.51, BI 16.40, 29.93 and 36.53). The combination group (NMES and core muscle strengthening) showed better improvement than other two groups. TIS and BI total score showed positive (0.849) correlation.Conclusions: Addition of NMES along with core muscle strengthening for stroke rehabilitation will improve trunk stability, balance and ADLs.

The influence of physical activity on balance, risk and fear of fall in the elderly / A influência da atividade física no equilíbrio, risco e medo de queda em idosos

The purpose is to evaluate possible relationships between the level of structured physical exercise and the risk of falls in the elderly. The volunteers were elderly of both genders aged from 60 to 70 years old, sorted into 3 groups, which were: Structured Exercise Group (SEG); Sufficiently Active Group (SAG); Insufficiently Active Group (IAG). For data collecting, validated tools were used, being the International Physical Activity Questionnaire (IPAQ), Falls Efficacy Scale International (FES-I-BRASIL) and Test Up and Go (TUG) for the level of physical activity, risk of fall, and mobility, respectively. In addition, perimetry of the abdomen, waist, and hip were collected, in addition to body mass and height. It was found that the level of physical activity is directly related to the fear of falls and that the exercises structured by a professional and Physical Education further reduce this fear.

Age-Related Vestibular Dysfunction with Motion Sensitive Vertigo and Risk of Fall in Adults

Background: This ageing is physiological process associated with vestibular dysfunction. The incidence of vestibular problems increases with age and can lead to drops, dropping risk, lack of confidence, pain and depression. Vestibular disorder is commonly characterized by vertigo or body discomfort (look and aggravation of postural stability) (a sense of spinning movement). In older adults with a fall history, peripheral vestibular disorders are among the most frequently known and widespread vestibular dysfunctions. Aim: To associate vestibular dysfunction and motion sensitive vertigo and risk of fall in adults. Methodology: Cross sectional study with convenient non- random sampling. For tests has been applied for screening vestibular dysfunction. If a participant shows 2 tests positive have vestibular dysfunction. SPSS 21 is used for data analysis. Results: Highly significant results between association of age with motion sensitive and age with fall efficacy scale P value is less than 5. Results are also significant between MSQ and FES-1. Conclusion: After conducting this research it has been concluded. That age-related vestibular dysfunction significantly associated with motion sensitive vertigo and risk of fall. As with the age people are more concerned about fall Keywords: vestibular dysfunction, vertigo, risk of fall in adults