ABSTRACT
This multicenter, preliminary, randomized controlled trial investigated the effect of a tailored fall-prevention program using home floor plans for discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 72) at five acute-care hospitals. The control group received standard care (exercise to prevent recurrent falls), whereas the intervention group received a tailored fall-prevention program in addition to usual care. A physical therapist conducted the tailored education program using each patient's home floor plans before discharge. A follow-up survey of falls and near-falls at home was performed using a monthly fall calendar for the 1-month period after discharge. Data on 81.5% of participants remained for the final analyses. No falls occurred in the intervention group; however, 4.3% of those in the control group experienced a fall. Near-falls were reported by 3.7% and 26.9% of the participants in the intervention and control groups, respectively. The proportion of participants who did not experience near-falls in the 1st month after discharge was lower in the intervention than in the control group (p = 0.018). In conclusion, the tailored fall-prevention program using home floor plans in multiple acute-care hospitals was effective in reducing falls and near-falls in discharged orthopedic patients.
Subject(s)
Exercise Therapy , Exercise , Aged , HumansABSTRACT
A boy aged 4 years and 2 months died of an unknown neurological disease, which had insidiously occurred around the age of one year. The case slowly developed sleeping tendency, spastic tetraplegia, optic nerve atrophy and flexion contracture but no epileptic seizures. There was neither consanguinity nor familial history of neurological disorders. The proband had intrauterine exposure to X-ray at the seventh fetal month. Laboratory examinations including antiviral antibodies and lysosomal enzymes provided no evidence for known brain disorders. Neuropathological examination revealed widespread multicystic destruction predominantly in the centrum semiovale. The subcortical arcuate fibers were spared. The commissural fibers as well as long tract fibers were also symmetrically affected. There was neither inflammatory reaction, calcification, Rosenthal fibers nor globoid cells. Axons were comparatively preserved. Tissue debris was not metachromatic in acid cresyl violet stain. Chemical analysis demonstrated no changes in fatty acid profiles. These clinicopathological features partly mimic leukoencephalopathy with vanishing white matter (van der Knaap), except for the lack of familial history and cerebellar signs, and the more extensive neuropathological lesions. Although the influence of intrauterine X-ray irradiation could not be neglected completely, reports of several similar cases in the literature suggests that this case had a new variant of child-onset multicystic leukoencephalopathy or leukodystrophy.