Age-Related Vestibular Dysfunction; Vestibulo-Ocular Reflex, Dynamic Visual Acuity, Dizziness and Falls: A Review

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.

Effect of Executive Dysfunction on Posture Control and Gait after Stroke

Objective. The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods. In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results. The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry ( P < 0.05). However, there was no significant correlation between SCWT-C and stride ( P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry ( P < 0.05). There was no significant correlation between SCWT-T and stride ( P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry ( P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry ( P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride ( P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry ( P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride ( P > 0.05). Conclusions. ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients’ executive function to accelerate the recovery of postural control.

A Review of the Significance of Vision in the Remediation of Balance Control and Associated Falls Avoidance

Background: Loss of balance and falls are the primary cause of accidental death in persons over 65 years of age. This review examines the role of visual functions in the maintenance of a balanced posture and associated fall avoidance, including how visual functions interact with proprioceptive, tactile, vestibular and cognitive factors under a range of environmental circumstances and conditions. Methods: Reference to relevant articles from a wide range of sources were used to examine how vision functions are usually integrated with other senses in avoiding falls. Results: Under most conditions vision can make an important contribution to posture control and fall avoidance although such contributions have not always been recognized in the past. However, successful balance training has been shown to be associated with multi-component programs. Conclusions: Given the complexity of posture control and the multiple changes (physiological- and disease-related) which occur with age, as well as the capacity for different professional groups to contribute more or less dissimilar fall prevention strategies, it is not surprising that there appears to be great potential for improved interdisciplinary coordination of remedial interventions which reduce the risk of fall-related injuries and death. Similarly, overcoming age- or frailty-related difficulties in standing from a seated position can be best handled by interdisciplinary approaches.

ANALYSIS OF DIGITAL HEALTHCARE NEEDS FOR PEOPLE WITH SEVERE DISABILITIES CENTERING DAILY LIVING ACTIVITIES

People with severe disabilities require support in performing activities of daily living (ADL), from personal care to technological support. For people with disabilities, digital healthcare is effective in improving their ability to perform ADLs. This study aimed to identify factors associated with the digital healthcare needs of people with severe disabilities in ADL. Qualitative data were collected from in-depth individual interviews and focus group interviews from 16 participants. Transcripts of interviews were then analyzed, and the essential factors were identified. Twenty-eight difficulty factors related to ADL were defined according to the type of disability. Factors requiring digital healthcare were specified in accordance with the qualitative analysis performed on the interview results. Appropriate tasks were established according to disability, such as posture control and emergency management for individuals with cervical spinal injury; communication and posture control in adults with cerebral palsy; communication and toileting monitoring for parents of children with disabilities; and emergency management, breathing exercise, and oxygen saturation management for individuals with muscular dystrophy. All factors identified in the study conform to the International Classification of Functioning, Disability, and Health (ICF) codes. This study will contribute toward understanding the needs of people with severe disability in terms of digital healthcare.