Effects of modified long stick exercise on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis.

BACKGROUND: Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control. OBJECTIVE: This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis. METHODS: Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE programme 30-40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise. RESULTS: The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p< 0.05). CONCLUSION: The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis.

The 7th cervical vertebra wall distance (C7WD) identifies balance control, functional mobility and the risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis.

BACKGROUND: Thoracic hyperkyphosis is common in the elderly, especially in women, and results in impaired balance control, impaired functional mobility and an increased risk of multiple falls. The 7th cervical vertebra wall distance (C7WD) is a practical method for evaluating thoracic hyperkyphosis. OBJECTIVE: This study calculated C7WD cut-off scores that may identify impaired balance control, impaired functional mobility and an increased risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. This study also explored the correlation between C7WD, balance control and functional mobility. METHODS: Sixty participants were assessed for thoracic hyperkyphosis using the C7WD, balance control using the functional reach test (FRT), functional mobility using the timed up-and-go test (TUG) and a history of falls using their personal information. RESULTS: The data indicated that a C7WD of at least 7.95 cm, 8.1 cm and 8.8 cm had a good to excellent capability of identifying impaired balance control, impaired functional mobility and an increased risk of multiple falls, respectively. The C7WD results were significant and correlated with balance control (rs=-0.68) and functional mobility (rs= 0.41). CONCLUSIONS: The C7WD may be utilised as a screening tool for these three impairments in this population.

Knee Extensor Muscle Strength to Measure the Ability of Five Times Sit to Stand Independently in Patients with Incomplete Spinal Cord Injury.

Background: Patients with incomplete spinal cord injury (iSCI) and lower extremity muscle weakness often fall while standing up from a chair. The sit-to-stand (STS) task primarily uses the strength of the knee extensor muscles. The five times sit-to-stand test (FTSST) is often applied to determine lower limb function and the results are related to lower extremity muscle strength. This study explored the cut-off point for knee extensor muscle strength in patients with iSCI to independently determine their FTSST results and the correlation between knee extensor muscle strength and FTSST results. Methods: Forty-four participants were assessed for knee extensor muscle strength using a hand-held dynamometer (HHD) and the FTSST. Results: The data indicated that knee extensor muscle strength ≥ 53.06 Newton was the best independent predictor of the FTSST results (sensitivity 72.7%, specificity 72.7%). Moreover, knee extensor muscle strength was significant and correlated with the FTSST results (r = -0.45, P = 0.035). Conclusion: The findings offer a cut-off point for the knee extensor muscle strength measured while standing up from a chair that may help medical professionals set rehabilitation goals for patients with iSCI.

Agreement between clinical measures to classify foot posture in asymptomatic adults.

BACKGROUND: Various clinical measures of static foot posture have been developed and used. However, consensus among clinical measures to classify foot posture remains to be established. Therefore, this study aimed to determine the level of agreement as a reliability component between two common clinical methods in asymptomatic adults: the normalised navicular height truncated (NNHt) and the Foot Posture Index-6 (FPI-6). METHODS: The NNHt and FPI-6 were conducted on 102 asymptomatic adults. The measurement sequence was randomly arranged for each participant. Weighted Kappa (Kw) was used to determine the agreement between the methods. RESULTS: Both the NNHt and FPI-6 achieved similar foot posture distributions: approximately 40-50% of the participants had a normal foot, approximately 40% had a pronated foot and approximately 10-20% had a supinated foot. The agreement between the methods to classify foot posture was excellent (Kw = 0.84). CONCLUSIONS: The present study found excellent agreement between two commonly used clinical measures. This finding highlights the NNHt and FPI-6 consensus for foot posture classification in asymptomatic adults.

Effects of Play in an Upright Position on Intra-Individual Variability of Gross Motor and Language Development in Institutionalized Infants.

(1) Objective: To investigate the effects of play in an upright position on intra-individual variability and to examine the relationship between the variability of gross motor and language development in institutionalized infants aged six to ten months. (2) Methods: Thirty infants were conveniently enrolled in either the experimental or control groups. The Alberta Infant Motor Scale (AIMS) and the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) Infant/Toddler Checklist were tested pre and post each monthly intervention for three months. Sixteen infants in the experimental group received an additional program of 45 min play in an upright position three times a week for a 3-month period. (3) Results: There were significant between-group differences in intra-individual variability of the AIMS percentiles (p-value = 0.042). In addition, there was a significant difference in the intra-individual variability of the language percentile between groups (p-value = 0.009). The intra-individual variability of gross motor development was significantly correlated (rs = 0.541; p = 0.03) with language development. (4) Conclusions: Play in an upright position could be applied to improve intra-individual variability in gross motor and language development percentiles in institutionalized infants.

Intra-Individual Variability in Gross Motor Development in Healthy Full-Term Infants Aged 0-13 Months and Associated Factors during Child Rearing.

The gross motor development of a typically developing infant is a dynamic process, the intra-individual variability of which can be investigated through longitudinal assessments. Changes in gross motor development vary, according to the interaction of multiple sub-systems within the child, environment, task setting, and experience or practice of movement. At present, studies on environmental factors that influence gross motor development in full-term infants over time are limited. The main aim of this study was to investigate environmental factors affecting intra-individual variability from birth to 13 months. The gross motor development of 41 full-term infants was longitudinally assessed every month from the age of 15 days using the Alberta Infant Motor Scale. Parents were interviewed monthly about environmental factors during childcare. Infants showed fluctuations in the percentile of gross motor development, and no systematic pattern was detected. The total mean range of gross motor percentile was 65.95 (SD = 15.74; SEM = 2.28). The percentiles of gross motor skills over the 14 assessments ranged from 36 to 93 percentile points. Factors that were significantly associated with the gross motor development percentile were the use of a baby walker (Coef. = -8.83, p ≤ 0.0001) and a baby hammock (Coef. = 7.33, p = 0.04). The use of baby hammocks could increase the gross motor percentile by 7.33 points. Although the usage of a baby walker is common practice in childcare, it may cause a decrease in the gross motor percentile by 8.83 points according to this study. In conclusion, healthy full-term infants exhibited a natural variability in gross motor development. Placing infants in a baby walker during the first year of age should be approached with caution due to the risk of delayed gross motor development.

Validity and reliability of the block method for measuring thoracic hyperkyphosis.

OBJECTIVE: This study aimed to investigate the concurrent validity of the block method as compared with the gold standard (Cobb's method). An additional aim was to examine the intra- and inter-rater reliability of expert and novice assessors using the block method. METHODS: In a cross-sectional study, we enrolled 62 participants with hyperkyphosis aged ≥10 years, with hyperkyphosis defined as one or more blocks. The participants were stratified by age (<60 years and ≥60 years). To determine concurrent validity, and kyphosis was assessed in all the participants using the block method and Cobb's method. Finally, 15 participants were included in a reliability study. To determine intra- and inter-rater reliability, each participant was assessed twice, 7 days apart, by one expert and one novice using the block method. RESULTS: The concurrent validity of the block method and gold standard method showed moderate correlation (rs = 0.53, P < .001). However, after stratifying the participants by age (<60 years and ≥60 years), there was small to moderate correlation (rs = 0.42, P = .006, and rs = 0.64, P = .002, respectively). The intra- and inter-rater reliability of the expert and novice assessors was excellent (ICC3,1 = 0.82-0.97, P < .001). CONCLUSIONS: The findings showed small correlation in those <60 and moderate correlation in those ≥60 years, and reported excellent reliability. The block method can be used by novices with strong reliability. This method is a practical technique for early screening hyperkyphosis in the elderly.

The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury.

BACKGROUND: Data relating to weight-bearing or lower limb loading ability (LLLA) have been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration. AIM: To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals. DESIGN: Cross-sectional study. SETTING: Tertiary rehabilitation centers and communities. POPULATION: Ninety ambulatory participants with SCI. METHODS: Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months. RESULTS: Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94-95% of the bodyweight had moderate diagnostic properties to indicate the independence and safety of these individuals (sensitivity =68-77%, specificity =66-81%, and AUC=0.73-0.80). CONCLUSIONS: The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings. CLINICAL REHABILITATION IMPACT: The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and home-based settings, specifically for ambulatory individuals with SCI.

Gross motor development of Thai healthy full-term infants aged from birth to 14 months using the Alberta Infant Motor Scale: Inter individual variability.

BACKGROUND: The gross motor percentiles of the Alberta Infants Motor Scale (AIMS) have been commonly referenced in research. Cross-cultural assessment of gross motor development during the first year of life is suggested as diverse child-rearing practices can cause inter-variability. The main aim of this study was to develop an AIMS percentile curve for typically developing home-raised infants in the northeastern part of Thailand. The AIMS scores of these infants were also compared with the standard Canadian norms. METHODS: The gross motor development of 574 full-term infants aged 15 days to 14 months was assessed using the Thai version of the AIMS. Percentile curves of their gross motor ability were developed. The Thai infants' mean AIMS scores were compared with the Canadian norm using the one-sample t-test. RESULTS: The percentile curve of gross motor development of healthy Thai infants showed that mean AIMS scores increased with age. Large inter-variability was present from the 7th to 10th months. The mean AIMS scores of Thai infants were significantly lower than the standard Canadian means during the first three months (P < 0.05), but significantly higher in three age groups: 7-<8 months, 11-<12 months, and 13-14 months. CONCLUSION: The developed percentile curve of gross motor development is applicable for infants from the same demographic and environmental context. According to the study, infants from diverse cultures display a natural inter-variability in gross motor development between the 7th and 10th months.

Thai dance exercises benefited functional mobility and fall rates among community-dwelling older individuals.

BACKGROUND: With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals. OBJECTIVE: To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals. METHODS: Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes/day, 3 days/week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months. RESULTS: Participants improved their functional mobility significantly after 3- and 6-week training ( p < 0.01 ) . The number of faller individuals obviously decreased from 35% ( n = 21 ) prior to training to only 8% ( n = 5 ) after training ( p < 0.01 ) . CONCLUSION: The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Effects of Exercises on a Hard, Soft, and Sand Surface on Functional Outcomes of Community-Dwelling Older Individuals: A Randomized Controlled Trial.

This single-blind, randomized controlled trial compared the effects of Thai dance exercise training on hard, soft, and sand surfaces on the functional outcomes of 120 community-dwelling older adults (40 subjects/group). The subjects were involved in a Thai dance exercise program on each surface, according to their groups, for 50 min/day, 3 days/week, for 6 weeks. The functional outcomes were assessed prior to training, at Week 3, and Week 6 after training. Subjects showed a significant improvement in all functional tests at 3 and 6 weeks after training, particularly in those who were trained on a sand surface and a soft surface (7-30% improvement, p < .05). The improvement was especially demonstrated in the complex and demanding motor activities after exercise on a soft and sand surface. Aside from attempting to modify training programs on a hard surface, the current findings suggest an alternative and cost-effective program to promote the levels of independence and safety that can be applied easily in clinical, home-based, and community settings.

Reliability of novice and experienced physiotherapists using the normalized navicular height truncated and the foot posture index-6 for classifying static foot posture in adults.

[Purpose] To investigate the reliability of novice and experienced physiotherapists using the normalized navicular height truncated and the foot posture index-6 for classifying foot posture in healthy adults. [Participants and Methods] Thirty asymptomatic adults participated in this study. After brief training, inter-rater reliability was performed by an expert and inexperienced rater (the novice physiotherapist). On the same day, both raters independently performed the normalized navicular height truncated and the foot posture index-6. For intra-rater reliability, the inexperienced rater repeated data collection on the 8th day after the first assessment. Intraclass correlation coefficients (ICCs) and Cohen's Weighted Kappa (Kw ) were used for continuous and categorical data, respectively. [Results] The normalized navicular height truncated and the Rasch-converted foot posture index-6 scores demonstrated an excellent inter- and intra-rater reliability (ICCs=0.98-0.99). For classifying foot posture, the normalized navicular height truncated and the total foot posture index-6 scores represented more than 90% inter- and intra-rater agreement with Kw values ranging from 0.92-0.94, while each item of foot posture index-6 demonstrated inter- and intra-rater agreement ranging from substantial to almost perfect (Kw =0.71-0.94). [Conclusion] The normalized navicular height truncated and the foot posture index-6 are simple and reliable methods that can be used by the inexperienced rater.

Various surfaces challenge gait characteristics of ambulatory patients with spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To assess the influence of various surfaces on the gait characteristics of ambulatory participants with incomplete spinal cord injury (SCI) as compared to data from able-bodied participants. SETTING: A tertiary rehabilitation center and communities. METHODS: Seventy participants (35 ambulatory individuals with incomplete SCI and 35 able-bodied individuals with gender- and age-matched) were assessed for their spatiotemporal gait variables while walking over a 10-m walkway of different surfaces (including hard, artificial grass, soft, and pebble surfaces) at a self-selected and fastest speed. The findings were analyzed using the method of manual digitization. The data among the surfaces were compared using Kruskal-Wallis test and Mann-Whitney U test, with a level of statistical significance at P < 0.05. RESULTS: Participants with incomplete SCI could safely walk over every surface without any adverse events. Their average stride length, cadence, and walking speed, but not percent step length symmetry, were significantly decreased while walking on the artificial grass, soft, and particularly pebble surfaces as compared to those found on a hard surface. These changes were found particularly in those with SCI, resulting in a walking speed decreased from 0.11 to 0.35 m/s, whereas the reduction of walking speed of able-bodied participants ranged from 0.04 to 0.20 m/s. CONCLUSIONS: The spatiotemporal characteristics of ambulatory participants with SCI were dramatically affected by the surfaces as compared to the data found in able-bodied participants. The findings have potential clinical implications for the incorporation of various surfaces to promote the functional outcomes and safety for ambulatory individuals with SCI.

Increased Lower Limb Loading During Sit-to-Stand is Important for the Potential for Walking Progression in Ambulatory Individuals with Spinal Cord Injury.

BACKGROUND: Decreased rehabilitation time may increase the need for walking devices at the time of discharge to promote levels of independence among ambulatory individuals with spinal cord injury (SCI). However, using walking devices could create adverse effects on patients. This study explores the proportion of walking devices used, potential for walking progression, and associated factors among ambulatory individuals with SCI. METHODS: Fifty-seven participants were assessed for their demographics and functional ability relating to the requirement for walking devices, including the Timed Up and Go Test (TUGT) and lower limb loading during sit-to-stand (LLL-STS). RESULTS: Thirty-five participants (61%) used a walking device, particularly a standard walker, for daily walking. More than half of them (n = 23, 66%) had potential of walking progression (i.e., safely walk with a less-support device than the usual one). The ability of walking progression was significantly associated with a mild severity of injury, increased lower-limb muscle strength, decreased time to complete the TUGT, and, in particular, increased LLL-STS. CONCLUSION: A large proportion of ambulatory individuals with SCI have the potential for walking progression, which may increase their level of independence and minimise the appearance of disability. Strategies to promote LLL-STS are important for this progression.

Failures in dual-task obstacle crossing could predict risk of future fall in independent ambulatory individuals with spinal cord injury.

OBJECTIVE:: To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury. DESIGN:: Six-month prospective study. SETTING:: A rehabilitation center and community hospitals. SUBJECTS:: Independent ambulatory individuals with spinal cord injury. MAIN OUTCOME MEASURES:: Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total. RESULTS:: A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity ( n = 71, 79%) and walked with a walking device ( n = 54, 60%) completed in the study. More than one-third of the subjects ( n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P < 0.002, power = 1.000). CONCLUSION:: Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

Ability of sit-to-stand with hands reflects neurological and functional impairments in ambulatory individuals with spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To explore the need of upper limb contribution during sit-to-stand (STS) in ambulatory participants with spinal cord injury (SCI) and compare the lower limb loading during the sit-to-stand (LLL-STS) in those with SCI who performed the task with or without hands as compared to able-bodied individuals. In addition, the study assessed the correlation between the LLL-STS, and sensorimotor scores and functional ability in ambulatory participants with SCI. SETTING: A tertiary rehabilitation center and community hospitals, Thailand. METHODS: Forty-three participants with SCI who could perform STS with or without hands, and 10 able-bodied individuals were interviewed and assessed for their demographics, STS, and LLL-STS ability. Moreover, participants with SCI were assessed for SCI characteristics, sensorimotor scores, and functional ability relating to independent walking. RESULTS: More than half of participants with SCI (58%) performed STS using hands. Their LLL-STS, sensorimotor, and functional ability were significantly lower than those with SCI who performed the task without hands. The LLL-STS of participants with SCI, particularly amount, was significantly associated with their sensorimotor scores and functional ability (P < 0.05). CONCLUSIONS: The findings indicated that those with marked lower limb muscle weakness and sensory impairments used their hands during STS. As such, the use of the hands during STS can be used as an indicator of neurological and functional impairments in ambulatory individuals with SCI.

Effects of dual- and complex-task on walking ability of ambulatory individuals with spinal cord injury.

BACKGROUND: Attempting to perform dual- and complex-tasks obviously reduces the walking ability of individuals with impaired cognitive functions. However, there is no clear evidence describing the effects of dual- and complex-tasks on the walking ability of ambulatory individuals with a spinal cord injury (SCI) who have intact cognitive functions, but suffer from various degrees of sensorimotor deterioration. AIM: To primarily investigate the effects of dual- and complex-task on the walking ability of ambulatory subjects with SCI as compared to healthy individuals. In addition, the study secondarily compared the effects in subgroups of subjects with SCI, including different age groups, lesion severity and level of ability. DESIGN: Cross-sectional design. SETTING: A major tertiary referral and community hospitals in Thailand. POPULATION: Thirty-seven ambulatory individuals with SCI and 13 healthy subjects. METHODS: All subjects were evaluated for outcomes while they walked under four conditions, including single-task overground walking (ST-OG), dual-task overground walking (DT-OG) using a color word Stroop task, single-task obstacle crossing (ST-OC) and dual-task obstacle crossing (DT-OC). The outcomes were compared among the conditions and between the groups of subjects in terms of walking time, obstacle crossing ability and percent of Stroop task errors. RESULTS: With the increasing complexity of the tasks, both SCI and healthy subjects walked significantly slower (P<0.001 for those with SCI and P<0.05 for healthy subjects), but not when compared between the ST-OC and DT-OG conditions (P>0.05). Subjects also showed a greater percentage of cognitive task errors when they encountered a dual- and complex-task, particularly those with SCI who were over 50 years old, had mild lesion severity or walked with a walking device (P<0.001). CONCLUSIONS: The incorporation of dual- and complex-task challenged cognitive-motor interference of ambulatory individuals with SCI. CLINICAL REHABILITATION IMPACT: The application of such tasks may benefit rehabilitation outcomes in a real-world situation for patients, especially for those who are older than 50, have mild lesion severity or use a walking device.

Importance of independent sit-to-stand ability in ambulatory patients with spinal cord injury.

BACKGROUND: Sit-to-stand (STS) is an important and basic activity for daily living. However, a few studies have reported information relating to STS ability in ambulatory patients with spinal cord injury (SCI). AIM: To investigate factors associated with the ability of independent sit-to-stand (iSTS) among ambulatory patients with SCI. DESIGN: Cross-sectional cohort study. SETTING: Inpatient tertiary rehabilitation center and communities. POPULATION: Ambulatory patients with SCI. METHODS: Sixty-nine independent ambulatory individuals with SCI who walked with or without a walking device were cross-sectionally interviewed and assessed for their demographics, SCI characteristics, iSTS ability (pass or fail), types of walking device used, balance ability, and lower limb support capability during STS. RESULTS: Forty-six subjects (67%) successfully performed iSTS ability (pass). The ability of iSTS was significantly associated with lower extremity muscle strength, lower limb support ability, balance control, and ability of walking with a single cane and without a walking device (P<0.01). CONCLUSIONS: The ability of iSTS is important for ambulatory patients with SCI as it related to ability of walking with minimal use of the upper extremities. Other significant associated factors provided important clue to promote ability of iSTS. CLINICAL REHABILITATION IMPACT: The findings imply the use of iSTS ability as a simple and practical screening or monitoring tool for the ability of walking at least with a single cane. The improvement of lower extremity muscle strength, lower limb support ability, and balance control could improve iSTS ability of these individuals.

Functional ability and health status of community-dwelling late age elderly people with and without a history of falls.

BACKGROUND: Obvious functional deterioration is demonstrated in elderly people aged 75 years and older. However, there is only little objective evidence relating to falls in these individuals. OBJECTIVE: This cross-sectional study compared functional abilities and health status in the elderly age at least 75 years with no fall, single fall (1 fall), and multiple falls (≥2 falls) during the past 6 months. Furthermore, the study describes fall information of the participants. METHODS: Ninety participants (30 individuals/group) were interviewed for their health status and fall history within the past 6 months. Then they were objectively assessed in terms of their functional ability to conduct daily activities independently. RESULTS: The findings indicated that the functional abilities of participants with multiple falls were significantly poorer, with the number of those requiring a walking device significantly greater than that in the other groups. These individuals reported loss of balance as a major factor for falls, whereas individuals with a single fall reported an environmental hazard as a common cause of falls. CONCLUSION: Although the cross-sectional findings may be unable to clearly confirm the causal relationship of the outcomes, the data support the influence of intrinsic impairments and can be used to promote functional ability and minimise fall risk in these individuals.

Discriminative ability of the three functional tests in independent ambulatory patients with spinal cord injury who walked with and without ambulatory assistive devices.

BACKGROUND/OBJECTIVES: Many persons with spinal cord injury (SCI) require an ambulatory assistive device (AAD). An effective monitoring method enables the use of an appropriate AAD and promotes levels of independence for patients. This study investigated the discriminative ability of the three-functional tools relating to walking ability, including the 10-meter walk test (10MWT), the five times sit-to-stand test (FTSST), and the timed up and go test (TUGT), in independent ambulatory persons with SCI who walked with walker, crutches, cane, and non-AAD. METHODS: Eighty-five persons with SCI who could perform sit-to-stand and walk independently at least 50 m were cross-sectionally assessed for their functional ability using the 10MWT, FTSST, and TUGT. RESULTS: The findings for persons not using AADs were significantly better than the other groups for every test (P < 0.001). In addition, persons who walked with cane were significantly different from those who used walkers (P < 0.001) but there were no significant differences between persons who used walker and crutches for every test (P > 0.05). CONCLUSION: The findings supported the discriminative validity of the tools, allowing them to indicate functional changes in persons with SCI who walk with different AADs. However, the non-significant differences between subjects who used a walker and crutches may relate to the method of subject arrangement and inclusion criteria that recruit subjects with rather good walking capability and lower limb function. The findings may also suggest the use of the sit-to-stand maneuver as a simple screening tool for walking advancement of walker users, pending further investigation.