Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22.760
Filtrar
1.
Medicine (Baltimore) ; 99(28): e21228, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664177

RESUMO

BACKGROUND: Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD: A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS: Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION: Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Jogos de Vídeo , Idoso , Estudos de Viabilidade , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(29): e21040, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702844

RESUMO

BACKGROUND: Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS: This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS: This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER: CRD42020169549.


Assuntos
Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Tai Ji , Extremidade Superior/fisiopatologia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
3.
Geriatr Gerontol Int ; 20(7): 691-696, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32483917

RESUMO

AIM: In Japan, nursing care is advised for patients with locomotive syndrome (LS) because of musculoskeletal disorders. Balance tests have indicated an association between LS risk and sway size related to center of pressure (COP) movement. Here, the power spectrum represents the energy contained in each frequency of COP sway. Although balance tests are often performed during health checkups, no studies have investigated the relationship between the power spectrum and LS. This study investigated this relationship. METHODS: In total, 605 recipients of health checkups were evaluated for LS using the 25-item Geriatric Locomotive Function Scale. Power spectrums were calculated by applying fast Fourier transform to COP sway time-series data. These were classified into three sections (0.02-0.2 Hz [low-frequency band; LFB], 0.2-2 Hz [mid-frequency band], and 2-10 Hz [high-frequency band; HFB]). Power spectrums were evaluated in left-right and front-back directions. RESULTS: LS was associated with significantly lower ratios for both the HFB (P = 0.001) in the left-right direction and LFB (P = 0.007) in the front-back direction. In addition, men had significantly lower HFB ratios in the left-right direction (P = 0.032) and LFB ratios in the front-back (P = 0.013), whereas women had significantly lower HFB ratios in the left-right direction (P = 0.007). CONCLUSIONS: LS was associated with significantly lower ratios for both the HFB in the left-right direction and LFB in the front-back direction. This understanding of the power spectral characteristics of LS may be useful in the context of pathology and therapeutic intervention. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Locomoção/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Análise de Fourier , Avaliação Geriátrica , Humanos , Japão , Masculino , Pessoa de Meia-Idade
4.
Medicine (Baltimore) ; 99(19): e20154, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384503

RESUMO

To investigate the effect of multi-disciplinary teamwork on balance performance of Parkinson's disease (PD).Sixteen primary Parkinson's disease patients (8 male, 8 female) treated with bilateral subthalamic nucleus deep brain stimulation (STN-DBS) were included in the study. The median age of patients was 60.5 years; all patients were in the Hoehn&Yahr (H&Y) 3 stage; the median PD duration of the disease was 9 years. For each patient, multi-disciplinary teamwork treatment including DBS, medication, physical therapy and psychotherapy proceeded. levodopa equivalent daily dose (LEDD, mg/day), life quality (PDQ-39), Motor disability (MDS-UPDRSIII) and balance performance (MDS-UPDRS 3.12, Berg Balance Scale BBS, Limits of Stability LoS) were assessed in different time and status respectively: preoperation (Med-off, Med-on), postoperation (Stim-Off/Med-Off, Stim-On/Med-Off, Stim-On/Med-On), 6 months postoperation (Stim-On/ Med-Off, Stim-On/Med-On) and 12 months postoperation (Stim-On/Med-Off, Stim-On/Med-On).The LEDD, life quality (PDQ-39) continued to improve during the follow-up, statistical difference were found in both 6 months postoperation and 12 months postoperation compared with preoperation. The Motor disability (MDS-UPDRSIII), balance performance (MDS-UPDRS 3.12, BBS) and the LoS (target acquisition percentage, trunk swing angle standard deviation, time) showed significant improvement in Stim-On/med-Off 6 months postoperation and 12 months postoperation separately compared with Med-Off preoperation.Multi-disciplinary teamwork for PD patients with STN-DBS could improve balance performance.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Modalidades de Fisioterapia , Equilíbrio Postural/fisiologia , Idoso , Antiparkinsonianos/uso terapêutico , Terapia Combinada , Avaliação da Deficiência , Pessoas com Deficiência , Feminino , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Equipe de Assistência ao Paciente , Psicoterapia/métodos , Qualidade de Vida , Núcleo Subtalâmico/patologia
5.
PLoS One ; 15(5): e0233045, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32401819

RESUMO

OBJECTIVE: The Falls Risk for Older People in the Community assessment (FROP-Com) was originally developed using 13 risk factors to identify the fall risks of community-dwelling older people. To suit the practical use in busy clinical settings, a brief version adopting 3 most fall predictive risk factors from the original FROP-Com, including the number of falls in the past 12 months, assistance required to perform domestic activities of daily living and observation of balance, was developed for screening purpose (FROP-Com screen). The objectives of this study were to investigate the inter-rater and test-retest reliability, concurrent and convergent validity, and minimum detectable change of the FROP-Com screen in community-dwelling people with stroke. PARTICIPANTS: Community-dwelling people with stroke (n = 48) were recruited from a local self-help group, and community-dwelling older people (n = 40) were recruited as control subjects. RESULTS: The FROP-Com screen exhibited moderate inter-rater (Intraclass correlation coefficient [ICC]2,1 = 0.79, 95% confidence interval [CI]: 0.65-0.87) and test-retest reliability (ICC3,1 = 0.70, 95% CI: 0.46-0.83) and weak associations with two balance measures, the Berg Balance Scale (BBS) (rho = -0.38, p = 0.008) and the Timed "Up & Go" (TUG) test (rho = 0.35, p = 0.016). The screen also exhibited a moderate association with the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) (ABC-C; rho = -0.65, p<0.001), a measure of subjective balance confidence. CONCLUSIONS: The FROP-Com screen is a reliable clinical tool with convergent validity paralleled with subjective balance confidence measure that can be used in fall risk screening of community-dwelling people with stroke. However, one individual item, the observation of balance, will require additional refinement to improve the potential measurement error.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Acidente Vascular Cerebral/psicologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Psicometria , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações
6.
PLoS One ; 15(5): e0232513, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407415

RESUMO

BACKGROUND: The unipodal stance task is a clinical task that quantifies postural stability and alignment of the lower limb joints, while weight bearing on one leg. As persons with knee osteoarthritis (KOA) have poor postural and knee joint stability, objective assessment of this task might be useful. OBJECTIVE: To investigate the discriminant validity of three-dimensional joint kinematics and centre of mass displacement (COM) between healthy controls and persons with knee KOA, during unipodal stance using inertial sensors. Additionally, the reliability, agreement and construct validity are assessed to determine the reproducibility and accuracy of the discriminating parameters. METHODS: Twenty healthy controls and 19 persons with unilateral severe KOA were included. Five repetitions of the unipodal stance task were simultaneously recorded by an inertial sensor system and a camera-based system (gold standard). Statistical significant differences in kinematic waveforms between healthy controls and persons with severe knee KOA were determined using one-dimensional statistical parametric mapping (SPM1D). RESULTS: Persons with severe knee KOA had more lateral trunk lean towards the contralateral leg, more hip flexion throughout the performance of the unipodal stance task, more pelvic obliquity and COM displacement towards the contralateral side. However, for the latter two parameters the minimum detectable change was greater than the difference between healthy controls and persons with severe knee KOA. The construct validity was good (coefficient of multiple correlation 0.75, 0.83 respectively) and the root mean squared error (RMSE) was low (RMSE <1.5°) for the discriminant parameters. CONCLUSION: Inertial sensor based movement analysis can discriminate between healthy controls and persons with severe knee KOA for lateral trunk lean and hip flexion, but unfortunately not for the knee angles. Further research is required to improve the reproducibility and accuracy of the inertial sensor measurements before they can be used to assess differences in tasks with a small range of motion.


Assuntos
Articulação do Joelho/fisiologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Imageamento Tridimensional , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular/fisiologia , Tecnologia de Sensoriamento Remoto , Reprodutibilidade dos Testes
7.
Medicine (Baltimore) ; 99(16): e19835, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312005

RESUMO

RATIONALE: Pusher syndrome is a disorder of postural control. It is associated with unilateral lesions on central vestibular system. In the current study, we attempted to identify and investigate neural connectivity of the parieto-insular vestibular cortex in a patient with pusher syndrome, using diffusion tensor imaging. PATIENT CONCERNS: A 60-year-old male patient had left hemiplegia due to an infarction on right premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobe. The patient had severe motor weakness in left upper and lower limb, left side neglect and significant pusher syndrome. DIAGNOSIS: Patient was diagnosed with left hemiplegia due to an infarction in the right middle cerebral artery territory at the neurology department of a university hospital. INTERVENTIONS: One patient and 5 control subjects of similar age participated. Diffusion tensor imaging data were acquired at 4-month and 12-month after the initial injury. OUTCOMES: Fractional anisotropy, mean diffusivity, and tract volume (TV) were measured. TV values in both affected and unaffected hemispheres of the patient were significantly decreased at 4-month compared to those of control subjects. In the unaffected hemisphere of the patient, TV value showed significant increase at 12-month compared to that at 4-month. Although the TV value at 12-month of the affected hemisphere was out of reference range, TV was considerably increased compared to that at 4-month. Mean values for fractional anisotropy or mean diffusivity in 2 hemispheres did not show significant difference compared to those of control subjects regardless of month. LESSONS: Restoration of an injured projection pathway between the vestibular nuclei and parieto-insular vestibular cortex with recovery of pusher syndrome was found in a patient with stroke.


Assuntos
Imagem de Tensor de Difusão/métodos , Hemiplegia/diagnóstico , Sistema Nervoso/diagnóstico por imagem , Equilíbrio Postural/fisiologia , Anisotropia , Infarto Encefálico , Córtex Cerebral/fisiopatologia , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Hemiplegia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/patologia , Córtex Motor/diagnóstico por imagem , Córtex Motor/patologia , Sistema Nervoso/fisiopatologia , Lobo Occipital/diagnóstico por imagem , Lobo Occipital/patologia , Lobo Parietal/fisiopatologia , Córtex Somatossensorial/fisiopatologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
8.
Medicine (Baltimore) ; 99(17): e19862, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332647

RESUMO

Recovery of postural control and proprioception in patients affected by chronic ankle instability (CAI) and operated on capsulo-ligaments reconstructive surgery lacks of objective assessment. The aim of this study was to evaluate long-term post-surgical postural and proprioceptive control through the DPPS device in a cohort of patients operated on ligaments reconstruction through the modified Brostrom procedure at a minimum follow up of 12 months.Eleven patients with post-traumatic lateral CAI, operated of external capsulo-ligamentous complex repair according to Brostrom technique at a minimum follow-up of 1 year were enrolled. Physical examination and American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score. Proprioceptive and postural stability was assessed by DPPS - Delos Postural Proprioceptive System, linked to a computer with a specific software and including a flat table, an electronic unstable proprioceptive board, a Delos Vertical Controller, a monitor and a horizontal bar fitted with an infra-red sensor for hand support.Patients were 5 males and 6 females, mean age of 38.4 ±â€Š12 years. Mean BMI of the patients was 26.8 ±â€Š4.4. Mean follow up was 13.4 ±â€Š2.1. The mean value of (AOFAS) clinical score was 90.3/100. Mean Static Stability Index (SSI) with open eyes was 87.7% (±7.6) in the operated leg and 90.4% (±6.1) in the contra-lateral. SSI with closed eyes was 64.5% (±11.2) in the operated leg and 61.6% (±16.8) in the contra-lateral. Mean Dynamic Stability Index (DSI) without restrictions was 56.2% (±14.6) in the operated leg and 56.8% (±10.6) in the contra-lateral. DSI with restricted upper limbs, had a mean value of 56.3% (±11.4) in the operated leg and 58.1% (±11.9) in the contra-lateral.Re-tensioning capsular-ligamentous surgery of the external compartment for CAI allow to recovery proprioceptive and postural control on the operated side, comparable with data from the contralateral limb and from the healthy population of the same age and sex.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Equilíbrio Postural , Propriocepção , Adulto , Artroscopia , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
9.
PLoS One ; 15(4): e0231556, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348321

RESUMO

INTRODUCTION: Mobility significantly depends on the ankle muscles' strength which is particularly relevant for the performance of daily activities. Few tools are available, to assess ankle strength with all of the measurement properties tested. The purpose of this study is to test the responsiveness of Calf-Raise Senior Test (CRS) in a sample of elderly participants undergoing a 24-week community exercise program. METHODS: 82 older adults participated in an exercise program and were assessed with CRS Test and 30-second chair stand test (CS) at baseline and at follow-up. Effect size (ES), standardized response mean (SRM) and minimal detectable change (MDC) measures were calculated for the CRS and CS tests scores. ROC curves analysis was used to define a cut-off representing the minimally important difference of Calf-Raise Senior test. RESULTS: Results revealed a small (ES = 0.42) to moderate (SRM = 0.51) responsiveness in plantar-flexion strength and power across time, which was lower than that of CS test (ES = 0.64, SRM = 0.67). The responsiveness of CRS test was more evident in groups of subjects with lower initial scores. A minimal important difference (MID) of 3.5 repetitions and a minimal detectable change (MDC) of 4.6 was found for the CRS. CONCLUSION: Calf-Raise Senior Test is a useful field test to assess elderly ankle function, with moderate responsiveness properties. The cutoff scores of MDC and MID presented in this study can be useful in determining the success of interventions aiming at improving mobility in senior participants.


Assuntos
Tornozelo , Teste de Esforço , Terapia por Exercício , Idoso , Tornozelo/fisiologia , Exercício Físico , Teste de Esforço/métodos , Terapia por Exercício/métodos , Feminino , Seguimentos , Avaliação Geriátrica/métodos , Humanos , Vida Independente , Masculino , Força Muscular , Aceitação pelo Paciente de Cuidados de Saúde , Resistência Física , Equilíbrio Postural , Estudos Prospectivos , Reprodutibilidade dos Testes , Seguridade Social
11.
Clin Ter ; 171(3): e240-e244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32323713

RESUMO

Postural instability and increased risk of falls are relevant problems in patients with fragility vertebral fractures (VFs). The inter-relationship between flexed posture (FP), VFs and altered balance control is complex and only partially elucidated. The purpose of the study is to identify key factors of balance impairment in osteoporotic patients with VFs. In particular, we focused on the role of FP, number and severity of VFs and their relationships with clinical and static balance instrumental measures. Secondary aim of the study is to investigate possible correlations of stabilometric parameters with clinical and functional outcome measures. The results showed no significant correlations between static balance parameters and FP, number and severity of VFs. Stabilometry measures weakly correlate with age, 20 meters Walking Test and Barthel Index. Further studies are required to improve our understanding of the mechanisms underlying balance impairment in patients with VFs with the aim of identifying early clinical and instrumental markers of poor balance and fall's risk.


Assuntos
Fraturas da Coluna Vertebral/fisiopatologia , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Estudos Retrospectivos , Medição de Risco , Fraturas da Coluna Vertebral/complicações
12.
PLoS One ; 15(4): e0231334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275736

RESUMO

Subthreshold stochastic vestibular stimulation (SVS) is thought to enhance vestibular sensitivity and improve balance. However, it is unclear how SVS affects standing and walking when balance is challenged, particularly when the eyes are open. It is also unclear how different methods to determine stimulation intensity influence the effects. We aimed to determine (1) whether SVS affects stability when balance is challenged during eyes-open standing and overground walking tasks, and (2) how the effects differ based on whether optimal stimulation amplitude is derived from sinusoidal or cutaneous threshold techniques. Thirteen healthy adults performed balance-unchallenged and balance-challenged standing and walking tasks with SVS (0-30 Hz zero-mean, white noise electrical stimulus) or sham stimulation. For the balance-challenged condition, participants had inflatable rubber hemispheres attached to the bottom of their shoes to reduce the control provided by moving the center of pressure under their base of support. In different blocks of trials, we set SVS intensity to either 50% of participants' sinusoidal (motion) threshold or 80% of participants' cutaneous threshold. SVS reduced medial-lateral trunk velocity root mean square in the balance-challenged (p < 0.05) but not in the balance-unchallenged condition during standing. Regardless of condition, SVS decreased step-width variability and marginally increased gait speed when walking with the eyes open (p < 0.05). SVS intensity had minimal effect on the standing and walking measures. Taken together, our results provide insight into the effectiveness of SVS at improving balance-challenged, eyes-open standing and walking performance in healthy adults.


Assuntos
Marcha , Equilíbrio Postural , Vestíbulo do Labirinto/fisiologia , Adulto , Feminino , Humanos , Masculino , Modelos Neurológicos , Postura , Limiar Sensorial , Processos Estocásticos , Potenciais Evocados Miogênicos Vestibulares
13.
PLoS One ; 15(4): e0231491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275692

RESUMO

PURPOSE: To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS: A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home. RESULTS: FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model. CONCLUSIONS: A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.


Assuntos
Equilíbrio Postural/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Acidentes por Quedas/prevenção & controle , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/fisiologia , Estudos Transversais , Avaliação da Deficiência , Pessoas com Deficiência , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autoeficácia , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada/fisiologia
14.
Clinics (Sao Paulo) ; 75: e1409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267394

RESUMO

OBJECTIVE: This study aimed to evaluate if posturography can be considered a recurrent fall predictor in elderly individuals. METHODS: This was a cross-sectional study. A total of 124 subjects aged 60 to 88 years were evaluated and divided into two groups-the recurrent fallers (89) and single fallers (35) groups. Patients' sociodemographic characteristics were assessed, and clinical testing was performed. The functional test assessment instruments used were timed up and go test (TUGT), Berg Balance Scale (BBS), five times sit-to-stand test, and Falls Efficacy Scale (to measure fear of falling). Static posturography was performed in a force platform in the following three different situations-eyes open (EO), eyes closed (EC), and EO dual task. RESULTS: There were significant differences between the single and recurrent fallers groups regarding the fear of falling, the Geriatric Depression Scale score, the mean speed calculated from the total displacement of the center point of pressure (COP) in all directions with EO, and the root mean square of the displacement from the COP in the mediolateral axis with EC. Based on the hierarchical logistic regression model, none of the studied posturographic variables was capable of significantly increasing the power of differentiation between the recurrent and single fallers groups. Only TUGT with a cognitive distractor (p<0.05) and the BBS (p<0.01) presented with significant independent predictive power. CONCLUSION: TUGT with a cognitive distractor and the BBS were considered recurrent fall predictors in elderly fallers.


Assuntos
Acidentes por Quedas , Vida Independente , Equilíbrio Postural/fisiologia , Postura/fisiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Sensibilidade e Especificidade , Estudos de Tempo e Movimento
15.
Medicine (Baltimore) ; 99(17): e19775, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332619

RESUMO

Patients with chronic ankle instability (CAI) have postural-control deficits during center-of-pressure excursions than do healthy individuals. While an external analysis of center-of-pressure excursions in CAI has been performed, a quantitative analysis of center-of-gravity movements, to detect the balance deficits associated with CAI, has yet to be performed. Therefore, the aim of the study is to quantify the balance deficits in patients with unilateral CAI.Forty-four patients with unilateral CAI (24 men; age, 31.7 ±â€Š5.5 years) and 26 uninjured volunteers (12 men; age, 28.6 ±â€Š5.9 years) underwent Neurocom Balance Manager assessments of dynamic and static balance responses in limits of stability, unilateral stance, and forward lunge tests.In the limits of stability test, there were no significant group differences in the forward direction; however, reaction times were longer in the CAI group than in the control group in the backward (P = .037, effect size [ES] = 0.49) and rightward directions (P = .032, ES  = 0.47). Furthermore, the CAI group showed more excursions in the rightward (P = .046, ES = 0.50) and leftward directions (P = .002, ES = 0.80), and less directional control in the leftward direction (P = .036, ES = 0.59). In the unilateral stance test, the center of gravity sway velocity was faster in the CAI group than in the control group, whether eyes were opened or closed (P < .05). There were no significant group differences in forward lunge-test outcomes.Patients with CAI have poor static and dynamic balance performance compared to that in healthy counterparts. Thus, balance retraining should be an essential component of rehabilitation programs for patients with CAI.


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/classificação , Equilíbrio Postural/fisiologia , Adulto , Articulação do Tornozelo/anormalidades , China , Feminino , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Entorses e Distensões/classificação , Entorses e Distensões/complicações , Entorses e Distensões/fisiopatologia , Estatísticas não Paramétricas
16.
PLoS One ; 15(4): e0225358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310944

RESUMO

Cognitive impairment is prevalent but still poorly diagnosed in hemodialysis adults, mainly because of the impracticality of current tools. This study examined whether remotely monitoring mobility performance can help identifying digital measures of cognitive impairment in hemodialysis patients. Sixty-nine diabetes mellitus hemodialysis patients (age = 64.1±8.1years, body mass index = 31.7±7.6kg/m2) were recruited. According to the Mini-Mental State Exam, 44 (64%) were determined as cognitive-intact, and 25 (36%) as cognitive-impaired. Mobility performance, including cumulated posture duration (sitting, lying, standing, and walking), daily walking performance (step and unbroken walking bout), as well as postural-transition (daily number and average duration), were measured using a validated pendant-sensor for a continuous period of 24-hour during a non-dialysis day. Motor capacity was quantified by assessing standing balance and gait performance under single-task and dual-task conditions. No between-group difference was observed for the motor capacity. However, the mobility performance was different between groups. The cognitive-impaired group spent significantly higher percentage of time in sitting and lying (Cohens effect size d = 0.78, p = 0.005) but took significantly less daily steps (d = 0.69, p = 0.015) than the cognitive-intact group. The largest effect of reduction in number of postural-transition was observed in walk-to-sit transition (d = 0.65, p = 0.020). Regression models based on demographics, addition of daily walking performance, and addition of other mobility performance metrics, led to area-under-curves of 0.76, 0.78, and 0.93, respectively, for discriminating cognitive-impaired cases. This study suggests that mobility performance metrics could be served as potential digital biomarkers of cognitive impairment among hemodialysis patients. It also highlights the additional value of measuring cumulated posture duration and postural-transition to improve the detection of cognitive impairment. Future studies need to examine potential benefits of mobility performance metrics for early diagnosis of cognitive impairment/dementia and timely intervention.


Assuntos
Disfunção Cognitiva/diagnóstico , Idoso , Técnicas Biossensoriais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Postura , Diálise Renal , Caminhada , Dispositivos Eletrônicos Vestíveis
17.
Medicine (Baltimore) ; 99(16): e19641, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311935

RESUMO

BACKGROUND: We conducted this meta-analysis to analyze the effectiveness of balance training in improving postoperative rehabilitation outcomes in hip fracture surgery patients. METHODS: The Cochrane Library, Web of Science, Embase, and PubMed electronic databases were searched from their inception to December 2018. We selected prospective clinical control analyses and high-quality randomized controlled trials (RCTs) following the inclusion standards. We used Stata 12.0 to perform the meta-analysis. Where possible, the standard mean difference (SMD) with the 95% confidence interval (CI) was determined using a random effects model. RESULTS: Ten RCTs involving 955 hips (balance training = 487, control = 468) published between 2002 and 2019 were assessed for eligibility of inclusion in the meta-analysis. Balance training was shown to remarkably improve the aspects of quality of life associated with physical health (standard mean difference [SMD], 2.20; 95% CI, 1.63-2.78, P = .000), a fast gait speed (SMD, 1.01; 95% CI, 0.25-1.77, P = .009), and balance (SMD = 0.26, 95% CI: [0.12, 0.41], P = .000). Moreover, the balance training group showed increases in independence in activities of daily living (ADLs), performance task scores, and health-related quality of life (HRQoL) scores compared with the control group (P < .05). CONCLUSION: According to the present meta-analysis, balance training improves one's independence in activities of daily living, performance tasks, lower limb strength, gait, and total physical function compared with no balance training. More high-quality RCTs with large sample sizes are required for the identification of the best balance training program after hip fracture.


Assuntos
Atividades Cotidianas , Fraturas do Quadril/reabilitação , Modalidades de Fisioterapia , Equilíbrio Postural , Terapia por Exercício , Humanos , Desempenho Físico Funcional , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Velocidade de Caminhada
18.
Medicine (Baltimore) ; 99(15): e19621, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282709

RESUMO

Although lumbopelvic stability exercise improves lumbopelvic motor control function in patients with chronic low back pain (CLBP), the difference in lumbopelvic motor control function between the patients with CLBP and the healthy controls is unclear. The purpose of this study was to compare lumbopelvic motor control function between patients with CLBP and healthy controls and to determine the prevalence of CLBP according to core stability function.For this study, 278 participants were recruited, including patients with CLBP (n = 137) and healthy controls (n = 141). The participants performed a core stability function test and were classified to either the low or high core stability function group according to their core stability function for CLBP prevalence analysis.Lumbopelvic motor control was significantly higher in the healthy controls than in patients with CLBP. Of the patients in the low lumbopelvic motor control function group, 65.9% had CLBP, whereas 36.8% of the patients in the high lumbopelvic motor control function group had CLBP. Lumbopelvic motor control function demonstrated a significant difference between the patients with CLBP and the healthy controls. The lumbopelvic motor control function test was demonstrated to be an effective diagnostic tool for distinguishing CLBP. This information can be applied in assessments and interventions for CLBP in clinical settings.


Assuntos
Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Músculo Esquelético/fisiopatologia , Equilíbrio Postural , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
PLoS One ; 15(3): e0228768, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150553

RESUMO

OBJECTIVES: To identify predictive factors for falls in patients with bilateral vestibulopathy (BV). Specific variables contributing to the general work-up of a vestibular patient were compared between BV patients experiencing falls and those who did not. DESIGN: Prospective multi-centric cohort study. SETTING: Department of Otorhinolaryngology & Head and Neck Surgery at two tertiary referral centers: Antwerp University Hospital and Maastricht University Medical Center. PARTICIPANTS: In total, 119 BV patients were included. BV diagnosis was defined in accordance with the diagnostic BV criteria, established by the Bárány Society in 2017. MAIN OUTCOME MEASURES: Patients were divided into fallers and non-fallers, depending on the experience of one or more falls in the preceding 12 months. Residual vestibular function on caloric testing, rotatory chair testing, video head impulse test (vHIT) and cervical vestibular evoked myogenic potentials (cVEMP) was evaluated as a predictive factor for falls. Furthermore, hearing function (speech perception in noise (SPIN)), sound localization performance, etiology, disease duration, sport practice, scores on the Dizziness Handicap Inventory (DHI) and the Oscillopsia Severity Questionnaire (OSQ) were compared between fallers and non-fallers. RESULTS: Forty-five (39%) patients reported falls. In a sub-analysis in the patients recruited at UZA (n = 69), 20% experienced three or more falls and three patients (4%) suffered from severe fall-related injuries. The DHI score and the OSQ score were significantly higher in fallers. Residual vestibular function, SPIN, sound localization performance, etiology, disease duration, age and sport practice did not differ between fallers and non-fallers. CONCLUSIONS: Falls and (severe) fall-related injuries are frequent among BV patients. A DHI score > 47 and an OSQ score > 27.5 might be indicative for BV patients at risk for falls, with a sensitivity of 70% and specificity of 60%. Residual vestibular function captured by single vestibular tests (vHIT, calorics, rotatory chair, cVEMP) or by overall vestibular function defined as the number of impaired vestibular sensors are not suitable to distinguish fallers and non-fallers in a BV population.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Audiometria da Fala/métodos , Vestibulopatia Bilateral/diagnóstico , Testes Calóricos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Vestibulopatia Bilateral/complicações , Vestibulopatia Bilateral/fisiopatologia , Estudos de Coortes , Feminino , Teste do Impulso da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Centros de Atenção Terciária , Potenciais Evocados Miogênicos Vestibulares , Adulto Jovem
20.
PLoS One ; 15(3): e0230202, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155225

RESUMO

People with multiple sclerosis (PwMS) who exhibit minimal to no disability are still over twice as likely to fall as the general population and many of these falls occur during walking. There is a need for more effective ways to detect preclinical walking balance deficits in PwMS. Therefore, the purpose of this study was to investigate the effects of optical flow perturbations applied using virtual reality on walking balance in PwMS compared to age-matched controls. We hypothesized that susceptibility to perturbations-especially those in the mediolateral direction-would be larger in PwMS compared to controls. Fourteen PwMS and fourteen age-matched controls walked on a treadmill while viewing a virtual hallway with and without optical flow perturbations in the mediolateral or anterior-posterior directions. We quantified foot placement kinematics, gait variability, lateral margin of stability and, in a separate session, performance on the standing sensory organization test (SOT). We found only modest differences between groups during normal, unperturbed walking. These differences were larger and more pervasive in the presence of mediolateral perturbations, evidenced by higher variability in step width, sacrum position, and margin of stability at heel-strike in PwMS than controls. PwMS also performed worse than controls on the SOT, and there was a modest correlation between step width variability during perturbed gait and SOT visual score. In conclusion, mediolateral optical flow perturbations revealed differences in walking balance in PwMS that went undetected during normal, unperturbed walking. Targeting this difference may be a promising approach to more effectively detect preclinical walking balance deficits in PwMS.


Assuntos
Teste de Esforço/métodos , Esclerose Múltipla/fisiopatologia , Fluxo Óptico/fisiologia , Equilíbrio Postural/fisiologia , Acidentes por Quedas/prevenção & controle , Adulto , Fenômenos Biomecânicos/fisiologia , Feminino , Pé/fisiologia , Marcha/fisiologia , Humanos , Extremidade Inferior/fisiologia , Masculino , Esclerose Múltipla/diagnóstico por imagem , Realidade Virtual , Caminhada/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA