Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: a 7-year series.

OBJECTIVE: To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. METHODS: In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. RESULTS: Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25-76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P < 0.001) and recorded lower functional independence measure--motor scores at admission (z = 3.61, P < 0.001) and discharge (z = 4.52, P < 0.001). More non-vascular amputees worked before amputation (43% vs 11%; P < 0.001), were prescribed a prosthesis by discharge (73% vs 52%; P < 0.001) and had a shorter length of stay (7 days, 95% confidence interval: -3 to 17), although this was not statistically significant. CONCLUSIONS: Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees.

Effects of balance strategy training in myasthenia gravis: a case study series.

INTRODUCTION: Studies of exercise in patients with myasthenia gravis (MG) are sparse. Balance strategy training (BST) multimodal exercise has proven efficacy in adults for enhancing balance and functional mobility. This prospective study aims to determine if BST improves functional ability and balance in people with MG. METHODS: Seven individuals with MG participated in a 16-session workstation intervention. Repeated measures (pre/post-intervention and 4-week follow-up) consisting of quantitative myasthenia gravis score (QMG), 6-minute walk test (6MWT), timed up and go (TUG) with dual task (TUG(manual) and TUG(cognitive)), and standing stability on foam with eyes closed (foamEC) were assessed. RESULTS: Most measurements showed sustained improvement at follow-up. QMG, TUG(cognitive), and foam EC achieved clinically significant improvements (>15%). No adverse effects were reported. CONCLUSIONS: BST was effective in improving balance and QMG scores in subjects with MG. A multimodal BST approach is thus suggested to target different aspects of balance and functional mobility.

Enhancing functional balance and mobility among older people living in long-term care facilities.

This study of long-term care residents investigated whether a balance strategy training program (BSTP) developed for older people living in the community is effective in improving functional mobility and reducing falls when adapted to resident functional abilities. The BSTP was delivered twice weekly over 12 weeks. Outcome measures compared pre- and postintervention measured Timed Up and Go, Functional Reach, timed 5 sit-to-stand movements, and number of falls in 12 weeks before intervention with 12-week follow-up period. Forty-seven residents participated, 26 of whom were cognitively impaired. There was a significant improvement in all functional balance and mobility measures, but this was clinically significant only in 5 sit-to-stand time. There was no reduction in falls, although this outcome was confounded by all fallers being acutely ill at the time of falling. These results suggest participation in a BSTP by residents of long-term care improves resident functional mobility and balance.

The state of physical environments in Australian residential aged care facilities.

OBJECTIVE: This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). DESIGN: Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. SETTING: Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. CONCLUSIONS: Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs.

A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery. DESIGN: Pragmatic randomized controlled trial with blinded 6-month follow-up. SETTING: Acute-care private hospital. PARTICIPANTS: People (n=65) undergoing primary hip or knee arthroplasty (average age, 69.6+/-8.2y; 30 men). INTERVENTIONS: Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy. MAIN OUTCOME MEASURES: Strength, gait speed, and functional ability at day 14. RESULTS: At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (P=.001) or water exercise (P=.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention. CONCLUSIONS: A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.

Clinimetric evaluation of the physical mobility scale supports clinicians and researchers in residential aged care.

OBJECTIVE: To investigate the interrater agreement and the internal construct validity of the Physical Mobility Scale, a tool routinely used to assess mobility of people living in residential aged care. DESIGN: Prospective, multicenter, external validation study. SETTING: Nine residential aged care facilities in Australia. PARTICIPANTS: Residents (N=186). Phase 1 cohort (99 residents; mean age, 85.22+/-5.1y); phase 2 cohort (87 residents; mean age, 81.59+/-10.69y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Kappa statistics, minimal detectable change (MDC(90)) scores, and Bland-Altman plots were used to assess interrater agreement. Scale unidimensionality, item hierarchy, and person separation were examined with Rasch analysis for both cohorts. RESULTS: Agreement between raters on 6 of the 9 Physical Mobility Scale items was high (kappa>.60). The MDC(90) value was 4.39 points, and no systematic differences in scores between raters were found. The Physical Mobility Scale showed a unidimensional structure demonstrated by fit to the Rasch model in both cohorts (phase 1: chi(2)=23.90, P=.16, person separation index=0.96; phase 2: chi(2)=22.00, P=.23, person separation index=0.96). Standing balance was the most difficult item in both cohorts (phase 1: logit=2.48, SE, 0.16; phase 2: logit=2.53, SE, 0.15). The person-item threshold map indicated no floor or ceiling effects in either cohort. CONCLUSIONS: The Physical Mobility Scale demonstrated good interrater agreement and internal construct validity with good fit to the Rasch model in both cohorts. The comparative results across the 2 cohorts indicate generality of the findings. The Physical Mobility Scale total raw scores can be converted to Rasch transformed scores, providing an interval measure of mobility. The Physical Mobility Scale may be suited to a range of clinical and research applications in residential aged care.

Evidence from a cohort of able bodied adults to support the need for driver training for motorized scooters before community participation.

OBJECTIVE: This study sought to utilize the implementation of a new competency test in order to define skills required to safely drive a motorized scooter. This test endeavours to reduce the number of driving and pedestrian related accidents, by determining an acceptable level of driver skill and awareness. METHODS: Healthy subjects, who might at some time use a motorized scooter for mobility, were recruited from the local community. Each undertook a driver competency test including basic driving skills, traffic and multiple tasks. Ten subjects repeated the test three times to determine practice effect on proficiency. RESULTS: Thirty-three of the 50 participating subjects (mean age 34 years) failed at least one test item. Basic skills of reversing, weave and zigzag, and all traffic and performing multiple simultaneous tasks produced failures. CONCLUSION: Driving skills for motorized scooters need to be taught and learned with assessment for competency recommended before unrestricted community driving is allowed. PRACTICE IMPLICATIONS: Basic driving skills including weaving, steering in reverse and traffic and multiple tasking need to be taught and tested for all new users of this equipment.

Age-related changes in strength and somatosensation during midlife: rationale for targeted preventive intervention programs.

Age-related changes in strength and somatosensation have a negative impact on balance with advanced age. Knowledge of the decades of life when strength and somatosensation show initial and subsequent reductions could inform balance assessment and targeted preventive intervention. We report a cross-sectional study investigating strength and somatosensation of 316 healthy women aged 20-80 years. Demographics, health profile, and activity level were recorded. Strength of quadriceps, hip abductors and adductors, and lower limb somatosensation (tactile acuity, vibration threshold, and joint position error) were measured. Significant age-related changes in strength and somatosensory function were identified, even when demographic variables of activity level, weight, number of reported conditions, medications used, and history of falls were included as covariates. Tested muscles achieved peak force in women in their 40s and then trending reductions presented for those in their 50s and 60s, with significant reductions by the 70s. Tactile acuity, vibration sensitivity, and joint position sense for a non-weight-bearing toe-matching task were significantly reduced by the 40s or 50s, with further reductions by either the 60s or 70s. For the weight-bearing replication task, joint position error was significantly increased by the 60s. A main effect of activity level and body weight was identified for strength measures, and weight also had a main effect for most of the somatosensory modalities. These findings can inform health professionals to use knowledge of early and any subsequent reductions in muscle strength and somatosensation, along with effects of demographics, to develop targeted, innovative programs across the mid-life, a preclinical change period for balance, to promote healthier aging.

Normal values of balance tests in women aged 20-80.

OBJECTIVES: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. DESIGN: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. SETTING: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. PARTICIPANTS: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. MEASUREMENTS: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. RESULTS: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. CONCLUSION: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk.

The seating dilemma in aged care.

Choosing the most appropriate easy chair for elderly clients is often difficult. The demands that need to be fulfilled by the chair chosen need to be identified and considered in order of priority. Benefits of good seating are identified, as are consequences of poor seating. Some guidelines are provided for choosing specific chair characteristics. There is discussion of the thought provoking points raised.

Predictors of discharge destination in a geriatric population after undergoing rehabilitation.

BACKGROUND AND PURPOSE: Patients undertaking inpatient rehabilitation comprise a diverse group, including patients with stroke and other neurological conditions, patients who have fallen with or without a resulting fracture, and patients with joint replacements, general debility, or various cardiopulmonary conditions. It is not clear whether diagnosis has an impact on discharge destination in a heterogeneous patient group. The purpose of this study was to determine whether diagnostic category matters or whether it is rehabilitation length of stay (LOS), ability on the 10-Meter Walk Test (10MWT), or Balance Outcome Measure for Elder Rehabilitation (BOOMER) at discharge that predicts discharge destination in elderly patients undergoing rehabilitation who had previously lived at home. METHODS: A retrospective audit was undertaken at a single rehabilitation facility in South East Queensland, Australia, that serviced 4 local short-term care hospitals. Participants were admitted consecutively to the facility between June 2010 and March 2012 who met inclusion criteria. These included a primary diagnosis category of orthopedic conditions, debility, stroke, and other neurological conditions according to the Australasian Rehabilitation Outcomes Centre and older than 60 years (n = 248). Interventions while being a rehabilitation inpatient comprised usual care physiotherapy individually tailored and incorporating elements of balance, strengthening, and functional exercise. Main outcome measures were discharge to residential aged care facility (RACF) versus home, differences between diagnostic categories in terms of discharge destination, LOS, and performance on outcome measures. Prediction of discharge destination by LOS, 10MWT, and BOOMER performance at discharge was explored. RESULTS: A total of 28 patients (12.3%) were discharged to RACF. Diagnosis was not correlated with discharge destination (Pearson χ2 = 1.26, P = .74). The variables rehabilitation LOS, an inability to perform the 10MWT at discharge, and discharge BOOMER score of less than 4 can predict discharge destination with 86.4% accuracy (P = .002). This model had a sensitivity of 71.4% (discharge to RACF) and specificity of 93.3% (discharge home). DISCUSSION: To return home after rehabilitation, patients need to be able to walk at least 10 m and undertake tasks such as moving from sitting to standing, turning around, as well as managing steps. The study revealed that a standardized suite of measures of functional ability and balance may not be appropriate for patients in all diagnostic categories undergoing rehabilitation. Therefore, just as intervention needs to be tailored for the individual patient, the measure of their progress also should be unique.

Impact of inaccessible spaces on community participation of people with mobility limitations in Zambia.

BACKGROUND: The study investigated the perspective of people with mobility limitations (PWML) in Zambia, firstly of their accessibility to public buildings and spaces, and secondly of how their capacity to participate in a preferred lifestyle has been affected. OBJECTIVES: Firstly to provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia. Secondly to establish how the Zambian disability context shape the experiences of participation by PWML. METHOD: A qualitative design was used to gather data from 75 PWML in five of the nine provinces of Zambia. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family's participation experiences. The nominal group technique was utilised to rank inaccessible buildings and facilities which posed barriers to opportunities in life areas and how this interfered with the whole family's lifestyle. RESULTS: Inaccessibility of education institutions, workplaces and spaces have contributed to reduced participation with negative implications for personal, family, social and economic aspects of the lives of participants. Government buildings, service buildings, and transportation were universally identified as most important but least accessible. CONCLUSION: Zambians with mobility limitations have been disadvantaged in accessing services and facilities provided to the public, depriving them and their dependants of full and equitable life participation because of reduced economic capacity. This study will assist in informing government of the need to improve environmental access to enable equal rights for all citizens.

In vivo trial results of a novel ultrasonic cough stimulator.

The aims of these double-blind in-vivo trials of a prototype ultrasonic cough stimulator (CoughStim™) were to establish (1) whether ultrasound (US) stimulation can be safely used to stimulate a cough, (2) the most efficient US frequency and power parameters to reliably stimulate a cough, (3) whether single- or dual-sided stimulation is more effective, and (4) whether a cough can be stimulated in adults unable to cough on demand. Fifteen nondisabled volunteers (18-59 yr) and seven volunteers unable to cough on demand (85-102 yr) were recruited. Stimulation was applied to the neck unilaterally at eight frequencies and two power levels and bilaterally at two frequencies and three power levels. Vital signs were monitored during testing with no adverse responses. CoughStim stimulated a cough in all nondisabled subjects, 80% of subjects at 0.58 MHz and 9 W unilaterally and 75% of subjects at 0.58 MHz and 6 W bilaterally. Of the subjects unable to cough, 71 percent responded to bilateral stimuli (0.54 MHz and 6 W) with a strong cough. The CoughStim regularly and safely produced a moderately strong cough response in subjects with or without ability to cough and produced this effect without causing undue discomfort.

Participation-based environment accessibility assessment tool (P-BEAAT) in the Zambian context.

PURPOSE: The purpose of this study was to describe the preliminary development and validation of a potential measure for assessing the accessibility of the built environment in Zambia. It was designed to identify environmental features that present barriers to participation for people with mobility limitations (PWML) using mobility devices such as wheelchairs or crutches. METHOD: The Participation-Based Environment Accessibility Assessment Tool (P-BEAAT) was developed through focus group discussions and personal interviews with 88 PWML from five provinces of Zambia regarding the accessibility of their built environment. The content validity of the P-BEAAT checklist was accomplished through three phases of development with data gathered from 11 focus groups and nine personal interviews. RESULTS: Participants described accessibility barriers which affect their participation in daily life. This information generated the P-BEAAT with 66 items describing eight environmental features with potential for identifying environmental barriers. The P-BEAAT has shown good homogeneity with Cronbach's α score of 0.91. CONCLUSION: The P-BEAAT was constructed grounded in the reality of people's experiences in Zambia for use in assessing environmental features important in the participation of daily life of PWML pertinent to developing countries. Further clinimetric testing of the properties of the P-BEAAT to establish reliability should be conducted next.

Instrumented measurement of balance and postural control in individuals with lower limb amputation: a critical review.

Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks and outcome measures utilized in studies investigating static and dynamic balance using instrumented measurement devices in individuals with a LLA. A systematic search was conducted on multiple databases using keyword or subject headings appropriate to the respective database. Articles investigating static or dynamic balance in adults with LLA by means of instrumented measures were considered for the review. A total of 21 articles were included in the review. The static balance ability of individuals with an LLA has been investigated thoroughly, but their dynamic balance attributes remain relatively unexplored. Although the individual studies do provide valuable information on balance ability in the LLA, the heterogeneity in study designs and measures did not allow an overall analysis of the tasks and the outcome measures used. On the basis of these findings, this review provides an insight into the measurement of balance in amputees to inform novice researchers and clinicians working with individuals with an LLA.

Mobility has a non-linear association with falls risk among people in residential aged care: an observational study.

QUESTIONS: What is the association between mobility and falls risk for people living in residential aged care? Can the Physical Mobility Scale discriminate between residents at risk of falling and those not at risk? DESIGN: Prospective longitudinal observational study. SETTING: Six residential aged care facilities in Australia. PARTICIPANTS: Eighty-seven high- and low-level care permanent residents. OUTCOME MEASURES: The primary outcome measure was the number of falls in the six months after the initial mobility assessment. Mobility of all participants was assessed using the Physical Mobility Scale, which includes nine mobility items assessed on a 0-5 scale yielding a total score out of 45. RESULTS: During the six-month study period, 131 falls were reported. Residents with mild mobility impairment (Physical Mobility Scale total score 28-36) had the highest fall risk (hazard ratio = 1.98, 95% CI 1.30 to 3.03). Residents with fully dependent mobility (Physical Mobility Scale total score 0-9) had the lowest risk for falls (HR=0.05, 95% CI 0.01 to 0.32). CONCLUSION: Aged care residents with mild mobility impairment are at increased risk of falls and are an appropriate target for falls prevention strategies. Although improving the mobility of residents with moderate to severe mobility impairment may enhance their independence and reduce their burden on staff, paradoxically this may also increase their risk of falls. When these residents improve enough to progress into a higher category of mobility, physiotherapists should be aware that this may increase the risk of falls and should consider instituting appropriate falls prevention strategies.

Sitting position affects participative interaction of immobile aged care residents: a pilot study.

OBJECTIVES: To determine the effect of sitting position (reclined versus upright) on the levels of participative interaction and spontaneous communication of immobile and totally dependent aged care residents. METHODS: Ten frail, immobile and totally dependent female residents older than 85 years were observed in reclined and upright sitting positions. Scores measuring responsiveness to stimuli in the surrounding environment and spontaneous communication initiation were derived from observations (taken morning and afternoon). RESULTS: There was a significant increase in the responsiveness score in the upright sitting position (P < 0.001) but no effect of sitting position on initiative score. There was no effect of time of day on either responsiveness or initiative score. CONCLUSIONS: An increased level of responsiveness was seen in upright sitting position in immobile and totally dependent aged care residents. The potential for participative interaction with the surrounding environment increases in this position which therefore may improve quality of life.

Measuring fall risk and predicting who will fall: clinimetric properties of four fall risk assessment tools for residential aged care.

BACKGROUND: The purpose of this prospective cohort study was to describe the clinimetric evaluation of four fall risk assessment tools (FRATs) recommended in best practice guidelines for use in residential aged care (RAC). METHODS: Eighty-seven residents, mean age 81.59 years (SD +/-10.69), participated. The Falls Assessment Risk and Management Tool (FARAM), Peninsula Health Fall Risk Assessment Tool (PHFRAT), Queensland Fall Risk Assessment Tool (QFRAT), and Melbourne Fall Risk Assessment Tool (MFRAT) were completed at baseline, and 2 and 4 months, and falls occurring in the 6 months after the baseline assessment were recorded. Interrater agreement (kappa), predictive accuracy (survival analysis and Youden Index), and fit to the Rasch model were examined. Twelve-month fall history formed the predictive accuracy reference. RESULTS: Interrater risk classification agreement was high for the PHFRAT (small ka, Cyrillic = .84) and FARAM (small ka, Cyrillic = .81), and low for the QFRAT (small ka, Cyrillic = .51) and MFRAT (small ka, Cyrillic = .21). Survival analysis identified that 43%-66% of risk factors on each tool had no (p > .10) association with falls. No tool had higher predictive accuracy (Youden index) than the question, "has the resident fallen in past 12 months?" (p > .05). All tools did not exhibit fit to the Rasch model, invalidating summing of risk factor scores to provide an overall risk score. CONCLUSION: The studied tools have poor clinimetric properties, casting doubt about their usefulness for identifying fall risk factors for those most at risk for falling and measuring fall risk in RAC.

Somatosensation, circulation and stance balance in elderly dysvascular transtibial amputees.

OBJECTIVE: To establish the relationship between poor lower limb somatosensory and circulatory status with standing balance, falls history, age and mobility level in dysvascular transtibial amputees (TTAs). DESIGN: Within-subjects evaluation of somatosensation, circulation and stance balance measures in dysvascular transtibial amputees. SETTING: Physiotherapy department of a tertiary metropolitan hospital in Australia. PARTICIPANTS: Twenty-two community-dwelling unilateral dysvascular transtibial amputee volunteers, aged between 54 and 86 recruited from a metropolitan hospital outpatient amputee clinic. MAIN OUTCOME MEASURES: Lower limb vibration sense, light touch sensation and circulatory status were related to centre of pressure excursion during quiet stance, dynamic balance measures of forward and lateral reach distance, and demographic information such as falls history and mobility level. RESULTS: Overall, poor somatosensory status was associated with poor stance balance. There was an association between poor vibration and circulation and increased centre of pressure excursion in quiet stance and reduced reach distance, whereas poor light touch was linked with even weight-bearing in quiet stance. Poor vibration sense was associated with a history of frequent falls. CONCLUSIONS: Compromised lower limb somatosensation and circulation was linked with poor balance and a history of frequent falls in the elderly dysvascular amputee population.

The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial.

BACKGROUND: older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups. OBJECTIVE: to determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls. DESIGN: a randomised controlled trial model. SETTING: Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland. SUBJECTS: 73 males and females over 60 years, living independently in the community and who had fallen in the previous year were recruited. METHODS: all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study. Treatment sessions were once a week for 10 weeks. Subject assessment before and after intervention and at 3 months follow-up included number of falls, co-morbidities, medications, community services and activity level, functional motor ability, clinical and laboratory balance measures and fear of falling. RESULTS: all participants significantly reduced the number of falls (P < 0.000). The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group (P = 0.034). Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group (P < 0.04). The control group only improved in TUG and TUGcog. CONCLUSIONS: the results provide evidence that all participants achieved a significant reduction in falls. Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance.