Multi-sensory training and wrist fractures: a randomized, controlled trial.

BACKGROUND: Asymmetric vestibular function, decreased plantar sensation, postural control and functional ability have been associated with fall-related wrist fractures. OBJECTIVE: To investigate whether multi-sensory training (MST) improves postural control, vestibular function, foot sensation and functional ability among people with fall-related wrist fractures compared to wrist stabilization training (WT). METHODS: This was an assessor-blinded, randomized controlled trial. Ninety-eight participants, age 50-75 years, were randomized to MST or WT. Pre- and post-training measurements: Head Shake Test (HST), Video-Head Impulse Test (vHIT), Semmes-Weinstein Monofilaments (SWF), Biothesiometer (BT), Sensory Organization Test (SOT), 10-m Walk Test (10MWT), Five Times Sit to Stand Test (FTSTS), Activities-Specific Balance Confidence (ABC) and Dizziness Handicap Inventory Scales (DHI). The training period was 12 weeks, with six supervised sessions by a physical therapist and daily home exercises for both groups. RESULTS: There were significant endpoint differences in SOT (p = 0.01) between the two groups, in favor of the MST group, but no changes were seen in other outcome variables. Subgroup analysis with participants below normal baseline SOT composite scores indicated that the MST was more effective in improving 10MWT fast (p = 0.04), FTSTS (p = 0.04), SWF (p = 0.04) and SOT scores (p = 0.04) than the WT. CONCLUSIONS: MST improves postural control among people with a fall-related wrist fracture. The results further suggest that the program is more effective for those with SOT balance scores below age-related norms.

Sensory impairments and wrist fractures: A case-control study.

OBJECTIVES: To investigate vestibular function, foot sensation, postural control and functional abilities, and to evaluate whether these variables are associated with fall-related wrist fracture. METHODS: A case-control study was conducted with 98 subjects, age range 50-75 years, who had sustained a fall-related wrist fracture. Forty-eight sex-, age- and physical activity-matched individuals, with no previous history of wrist fracture, served as controls. Measurements included: head-shake test (HST), tuning fork, biothesiometer, Semmes-Weinstein monofilaments (MF), Sensory Organization Test (SOT), Five-Times-Sit-to-Stand Test (FTSTS), 10-m walk test (10MWT), Activities-specific Balance Confidence (ABC), and the Dizziness Handicap Inventory (DHI) scales. Logistic regression models were used to determine associations of variables with a fall-related wrist fracture. RESULTS: Vestibular asymmetry was apparent in 82% of wrist fracture subjects and 63% of controls (p = 0.012). Plantar pressure sensation (p <0.001), SOT composite scores (p< 0.001), 10MWT (p <0.001), FTSTS (p <0.001), ABC (p <0.001) and DHI (p <0.005) were significantly poorer among cases than controls. A positive HST (odds ratio (OR) 5.424; p = 0.008) and monofilament sensation (OR 3.886; p = 0.014) showed the strongest associations with having a fall-related wrist fracture. CONCLUSION: Asymmetrical vestibular function and reduced plantar pressure sensation are associated with fall-related wrist fractures among the ageing population. These factors are potential targets for future interventions.

Older patients with distal forearm fracture. A challenge to future fall and fracture prevention.

BACKGROUND AND AIMS: Falls and fractures in older people are a common health problem. Patients with distal forearm fracture are at risk of sustaining new fractures. The aim of this work was to describe the characteristics of this patient group. METHODS: Sixty women and six men, mean age 68 years (50-86), with a recent fall-related distal forearm fracture, filled in a questionnaire about medical history, previous falls and fractures. Handgrip strength on the non-fractured side, one-leg standing, walking tests, and test of vibration sensation were measured and a video-nystagmoscopy was performed. RESULTS: One-third of the subjects had fallen during the last year, and one-third had had previous fall-related fractures during the last 10 years. Half of the patients took medication and were examined for chronic ailments regularly. Handgrip strength, balance and walking capacity declined with age and were similar to reference values. In three patients, the vibration sensation value was above the threshold value. Fifty patients (76%) had nystagmus, but no relationship between fall direction, physical performance and nystagmus was found. CONCLUSIONS: Although apparently healthy, many patients exhibited risk factors for new falls and fractures. Our recommendation is that these patients should be screened for fall and fracture risk and be targeted for preventive measures, besides fracture treatment. Physical therapists must play a major role in increasing and maintaining general physical functions in this patient group.