A Comparison between Effects of Neurofeedback and Balance Exercise on Balance of Healthy Older Adults.

BACKGROUND: Balance ability is a crucial component of independent daily activities among the older adultss. Balance impairment is one of the major risk factors for falls and related complications. OBJECTIVE: The present study aims to investigate and compare the effect of neurofeedback training and balance training on balance and fall risk among older adults. MATERIAL AND METHODS: In this randomized controlled trial, a total of 48 older adults aged more than 65 years were recruited and randomly assigned into two groups, neurofeedback group (n=24) and balance exercise group (n=24). Prior to the intervention, the static balance, dynamic balance, and fall risk were measured using Biodex D balance system and Fullerton Advanced Balance scale. Subjects in neurofeedback group received neurofeedback training for 12 sessions of 30-min, every other day. Moreover, subjects in balance exercise group received balance training for four weeks in 12 sessions (45-minute) every other day. After the intervention, balance measurements were repeated in both groups. The significance level was set at p<0.05. RESULTS: Static balance and dynamic balance were shown to significantly improve, after the interventions (p<0.001). Furthermore, fall risk was significantly reduced, after the trial (p<0.001). In addition, the therapeutic effect of neurofeedback training was not less significant than exercises on balance in the older adults (p<0.001). CONCLUSION: The findings suggest that both neurofeedback training and balance training improved balance ability among the older adults. Results also show the therapeutic effect of neurofeedback training on balance in older people. However, further research is required to accurately investigate the long-term effects of these two treatment methods among the older adults.

Prática de Tai Chi Chuan como método de intervenção preventiva em idosos com risco de quedas: revisão narrativa / The Practice of Tai Chi Chuan as a preventive intervention method for the elderly at risk of falls: a narrative review

A população ao longo dos anos está envelhecendo de forma expressiva e, no Brasil, de acordo com a Organização Mundial de Sáude, um percentual entre 28% a 35% dos idosos acima de 65 anos sofrem queda anualmente, de 32% a 42% dos acima dos 70 anos e um percentual acima de 50% em idades superiores aos 80 anos. Diante de diversas evidências científicas, exercícios físicos resultam na redução das complicações relacionadas às quedas, além de ser um componente determinante na minimização dos efeitos do processo fisiológico. O Tai Chi Chuan (TCC), que é uma prática da medicina tradicional chinesa, presente no Sistema Único de Saúde que, através de movimentos flexíveis e lentos, contribui na maior coordenação entre a consciência e a respiração, promovendo a harmonização das energias "yin e yang", além de proporcionar as liberações das tensões corporais de seus praticantes, sendo considerada uma meditação ativa promotora de saúde e de saúde preventiva. Objetivo: do presente estudo é identificar a redução de quedas na população idosa com uso da prática deTai Chi Chuan. Metodologia: A presente pesquisa é uma revisão narrativa, na qual foram identificados estudos a partir das bases de dados "Pubmed" e "Bireme". Foram considerados somente os artigos de ensaios clínicos randomizados que utilizaram o TCC como intervenção em indivíduos idosos com idade ≥ 60 anos para prevenção de quedas e melhoria do equilíbrio. Após a análise dos critérios de inclusão predeterminados, 10 artigos foram selecionados. Destes, foram selecionados para participarem da revisão narrativa 5 artigos. Os 5 artigos excluídos apresentaram o TCC com outras finalidades e/ou grupo específico de idosos com determinadas patologias e comorbidades e duplicidade de títulos. Resultados e Discussão: Observa-se que a média idade de 77 anos, sendo 436 (65%) mulheres, 617 ( 92% ) brancos , 31 (4,6%) eram afro-americanos, 485 (72,4%) relataram 1 quedas nos últimos 6 meses, ter mais de 3 condições crônicas e 67 (10%) uso de 4 ou mais medicamentos. Mesmo com ocorrência de quedas houve após 6 meses uma taxa de incidência (IRR) significativamente menor no TCC de 31% em comparação com exercícios muldimodal e 58% comparados com alongamentos (braço controle). Sendo, o estilo Yang mais utilizados nos estudos, com eficácia de intervenção, acima de 12 semanas. Conclusão: Percebe-se que a prática do TCC promove ganhos funcionais em relação a aptidão física como equilíbrio, capacidade aeróbica, flexibilidade e na função cardiorrespiratória.

The population has been aging significantly over the years and, in Brazil, according to the World Health Organization, a percentage of between 28% and 35% of elderly people over 65 suffer a fall annually, 32% to 42% of over 70 years old and a percentage above 50% in ages over 80 years old. Given diverse scientific evidence, physical exercise results in the reduction of complications related to falls, in addition to being a determining component in minimizing the effects of the physiological process. Tai Chi Chuan (TCC), which is a practice of traditional Chinese medicine, present in the Unified Health System which, through flexible and slow movements, contributes to greater coordination between consciousness and breathing, promoting the harmonization of "yin" energies. and yang", in addition to providing release of bodily tension for its practitioners, being considered an active meditation that promotes health and preventive health. Objective: of the present study is to identify the reduction of falls in the elderly population using the practice of Tai Chi Chuan. Methodology: This research is a narrative review, in which studies were identified from the "Pubmed" and "Bireme" databases. Only articles from randomized clinical trials that used CBT as an intervention in elderly individuals aged ≥ 60 years to prevent falls and improve balance were considered. After analyzing the predetermined inclusion criteria, 10 articles were selected. Of these, 5 articles were selected to participate in the narrative review. The 5 articles excluded presented the TCC for other purposes and/or a specific group of elderly people with certain pathologies and comorbidities and duplication of titles. Results and Discussion: It is observed that the average age is 77 years, of which 436 (65%) women, 617 (92%) white, 31 (4.6%) were African American, 485 (72.4%) reported 1 falls in the last 6 months, having more than 3 chronic conditions and 67 (10%) using 4 or more medications. Even with the occurrence of falls, after 6 months there was a rate of significantly lower incidence (IRR) in TCC of 31% compared to multimodal exercises and 58% compared to stretching (control arm). The Yang style is most used in studies, with intervention effectiveness lasting more than 12 weeks. Conclusion: It is clear that the practice of TCC promotes functional gains in relation to physical fitness such as balance, aerobic capacity, flexibility and function cardiorespiratory.

Comparação da aptidão física de mulheres adultas e idosas de acordo com o histórico de quedas e a prática regular de diferentes modalidades de exercícios físicos / Comparison of the physical fitness of older adult women according to the history of falls and the regular practice of different physical exercises

RESUMO: Objetivos:Comparar a aptidão física de mulheres de acordo com o histórico de quedas e a prática regular de diferentes modalidades de exercícios físicos (treinamento combinado: musculação e resistência aeróbia; treinamento funcional: multicomponente; e treinamento multimodal: duas ou mais modalidades). Métodos: Estudo transversalcom 44 mulheres (idade entre 50 e 80 anos). Foram coletados dados sociodemográficos e sobre o histórico de quedas no último ano, além da avaliação antropométrica e testes motores (flexibilidade, força de membros superiores e inferiores, capacidade aeróbia e agilidade e equilíbrio dinâmico) para avaliar a aptidão física. Na análise estatística, foram realizados o Teste t para amostras independentes e a ANCOVA utilizando idade, índice de massa corporal e tempo de exercício físico como covariáveis. Resultados: As participantes que tiveram ocorrência de quedas no último ano apresentaram piores resultados nos testes de flexibilidade (sentar e alcançar e mãos nas costas), força de membros superiores (flexão de cotovelo) e de membros inferiores (sentar e levantar), bem como capacidade aeróbia (teste de caminhada de seis minutos). Em relação às diferentes modalidades de exercícios físicos, não foi possível observar diferença estatística para nenhuma das variáveis estudadas. Entretanto, resultados satisfatórios de acordo com os valores normativos foram observados nos três grupos. Conclusões: O grupo com histórico de quedas apresentou piores resultados na aptidão física. Em relação às diferentes modalidades de treinamento, não houve diferença entre os grupos para nenhuma variável analisada. Entretanto, observa-se que estas modalidades são importantes para a manutenção de bons níveis de aptidão física no contexto do envelhecimento

ABSTRACT: Objectives: Comparing women's physical fitness according to the history of falls and regular practice of different physical exercises (combined training: strength and aerobic training; functional training: multicomponent; and multimodal training: two or more styles). Methods: A cross-sectional study was conducted with 44 women (aged between 50 and 80 years old). Sociodemographic data and history of falls in the last year were collected, in addition to anthropometric assessment and motor tests (flexibility, upper and lower limb strength, aerobic capacityand agility, and dynamic balance) to assess physical fitness. In the statistical analysis, independent samples t-test and ANCOVA using age, body mass index, and time of physical exercise as covariates were performed. Results: The participants who had falls in the last year presented worse outcomes in the flexibility tests (sit and reach and hands-on-the back), strength tests of upper limbs (elbow flexion), and lower limbs (sit and stand up), as well as aerobic capacity (six-minute walking test). Regarding the different modalities of exercises, it was not possibleto observe statistical differences for any of the variables studied. However, satisfactory results according to the normative values were observed in the three groups. Conclusions: The group with a history of falls had worse outcomes in physical fitness. Regarding the different modalities of training, there was no difference between the groups for any variable analyzed. However, it seems that these modalities are essential to maintain satisfactorylevels of physical fitness in the context of aging.

Qualitative approach on the cognition and experience of fall prevention among the geriatric ward staff / 中国实用护理杂志

Objective To understand the cognition and experience of fall prevention amongthe geriatric ward staff. Methods The methods of qualitativeresearch conducted focus groups interviews of the geriatric ward staff. The interview data of focus groups were collated and analyzed using Colaizzi's seven-step analysis method. Results A total of 5 themes had been raised: the recognition of the uniqueness of elderly patients; the overestimation of self-competence; the lack of family support; the significance of environment facilities;the problem of cooperation and communication. Conclusions In the prevention of falls in elderly patients, We should identify related promote and hinder factors. And the special needs of elderly patients should be taken into consideration. The prevention strategy of falls prevention is formulated to reduce the incidence of falls.

Nuclear magnetic resonance therapy (MBST) in the treatment of osteoporosis. Case report study.

Despite various pharmacological treatments, the problem of osteoporosis is not yet solved nor decreased. Drug's adverse event and fractures after long termed pharmacotherapy indicate a need for new treatment modalities. Nuclear magnetic resonance therapy could be a supplement to exercise and an alternative or supplement to pharmacotherapy. Number of clinical studies showed increase of BMD after nuclear magnetic resonance therapy and here presented case reports of eleven well-documented cases in which patients experienced severe trauma, having a huge hematoma around the hip but did not suffer any fracture, encourage this expectation. This case report study additionally presents case reports based on the follow-up of the incidence of fractures in a group of 450 patients (males n = 55, females n = 395) with a mean age of 68.4 years. All patients had been treated with MBST - therapeutic nuclear magnetic resonance, standard cycles of 10 days subsequently and followed during a five-year period. The data indicates that NMRT might reduce a risk of fractures in osteoporotic patients.

O evento queda em idosos hospitalizados / The event falls in hospitalized elderly

Resumo: Trata-se de estudo quantitativo com delineamento transversal, cujo objetivo foi identificar os cuidados necessários à prevenção de quedas em idosos internados nas unidades de Clínica Médica e Cirurgia Geral de um hospital de ensino. A amostra de 127 idosos foi constituída no período amostral de quatro meses, compreendendo abril a julho de 2013. O recrutamento dos idosos, de ambos os sexos, foi realizado por conveniência. Para a coleta dos dados utilizou-se de entrevista semiestruturada e check list para análise da estrutura física, baseado na Associação Brasileira de Normas Técnicas. Os dados foram organizados no programa Excel 2007 sob dupla conferência. Para análise, foram empregados estatística descritiva, teste Exato de Fisher e t-Student utilizando o softwer SPSS v.20.0. Valores de p< 0,05 indicaram significância estatística. Os resultados apontam maior incidência de internamento do gênero masculino (58,3%), com destaque para a Unidade de Clínica Médica (59,8%), faixa etária de 60-69 anos de 51,2%. Dos idosos internados 81,9% utilizavam medicação de uso contínuo e 87,4% faziam uso de alguma tecnologia assistiva, 63,4% afirmaram ter sofrido queda nos últimos 12 meses e 7% sofreram queda durante o período de internação. O número de reinternações correspondeu a 42,5% nos últimos 12 meses e 45,8% alegam que existe risco de cair dentro do hospital. Das nove quedas ocorridas, seis delas não tiveram consequências físicas e três apresentaram resultados moderados a graves, sendo uma com fratura de fêmur. Somente quatro dessas quedas foram notificadas, demonstrando que há subnotificações. Quanto aos fatores intrínsecos apresentaram significância estatística para o risco de quedas no ambiente hospitalar, a associação entre a ocorrência de queda nos últimos 12 meses e quedas durante o período de internação (p = 0,008), presença de tontura ou desequilíbrio (p = 0,026). Quanto aos fatores extrínsecos a acessibilidade e a estrutura física interna da instituição possui boa infraestrutura, com destaque negativo para as instalações sanitárias, que não estão de acordo com a legislação e oferecem risco para ocorrência de quedas. Conclui-se que o ambiente hospitalar é propício a quedas. Os cuidados necessários para a segurança do idoso são competências das equipes: de enfermagem, da interdisciplinar e de infraestrutura. Destacam-se como cuidados prioritários específicos da enfermagem as orientações para a equipe, paciente e familiar, a implementação da Sistematização da Assistência de Enfermagem e do protocolo de prevenção de quedas e realização de notificações.

Abstract: This is a quantitative cross-sectional study, which aimed to identifying the necessary care of falls in elderly patients hospitalized in Medical Units and General Surgery in a teaching hospital. A sample of 127 elderly people was formed in the sample period of four months, comprising from April to July 2013. The recruitment of elderly people of both sexes was held for convenience. To collect the data we used semi-structured interviews and checklists for analysis of the physical structure based on the Brazilian Association of Technical Standards. Data were organized in Excel 2007 doubleconference. For analysis, descriptive statistics, Fisher's exact test and Student t using SPSS v.20.0 softwer were employed. P values < 0.05 were considered statistically significant. The results indicate a higher incidence of hospitalization were male (58.3 %), highlighting the Unit of Clinical Medicine (59.8 %), aged 60-69 years of 51.2 %. 81.9 % of elderly inpatients continued use of medication used and 87.4 % were using some assistive technology , 63.4 % said they had been dropped in the last 12 months and 7 % suffered falls during hospitalization. The number of readmissions accounted for 42.5 % in the last 12 months and 45.8 % claim that there is risk of falling within the hospital. Nine falls occurred, six of them had no physical consequences and three had moderate to severe outcomes, one with a fractured femur. Only four of these falls were reported, demonstrating that there is underreporting. As for intrinsic factors showed statistical significance for the risk of falls in the hospital setting, the association between the occurrence of falls in the past 12 months and declines during the period of hospitalization (p = 0.008), presence of dizziness or imbalance (p = 0.026). As for extrinsic factors accessibility and internal physical structure of the institution has good infrastructure, especially negative for sanitary facilities, which are not in accordance with the law and offer risk for falls. It is concluded that the hospital environment is conducive to falling. Necessary for the safety of elderly care skills of the teams are: nursing, interdisciplinary and infrastructure. Stand out as specific priority nursing care guidelines for staff, patient and family, the implementation of the Nursing Care System and protocol for the prevention of falls and making notifications.