Effectiveness of Virtual Reality in Balance Training for Fall Prevention in Older Adults: Systematic Review.

OBJECTIVE: The purpose of this study was to determine the effectiveness of virtual reality (VR) in balance training for the prevention of falls in older adults. METHODS: We included studies with experimental designs, cohort studies, and quasi-experimental studies of older adults who underwent balance training associated with the use of VR for the prevention of falls. The comparison of control and intervention groups in the studies reported statistically significant improvements in terms of balance for VR. RESULTS: The effects and benefits from the use of VR were seen by the fourth week of intervention, with significant improvements in balance and lower fall rates, the improvements became greater for groups using VR. CONCLUSIONS: The benefits presented by the studies were related not only to balance but also to fear of falling, reaction time, gait, physical fitness, independence in activities of daily living, muscle strength, and even quality of life.

Colombian Stakeholder Perceptions and Recommendations Regarding Fall Detection Systems for Older Adults.

This study aimed to analyze perceptions and recommendations from stakeholders on the effectiveness of fall detection systems for older adults, aside from any additional technological solutions they may use within their activities of daily living (ADLs). This study performed a mixed-method approach to explore the views and recommendations of stakeholders concerning the implementation of wearable fall detection systems. Semi-structured online interviews and surveys were conducted on 25 Colombian adults classified into four stakeholder groups: older adults, informal caregivers, healthcare professionals, and researchers. A total of 25 individuals were interviewed or surveyed, comprising 12 females (48%) and 13 males (52%). The four groups cited the importance of wearable fall detection systems in ADLs monitoring of older adults. They did not consider them stigmatizing nor discriminatory but some raised potential privacy issues. The groups also communicated that the apparatus could be small, lightweight, and easy to handle with a help message sent to a relative or caregiver. All stakeholders interviewed perceived assistive technology as potentially useful for opportune healthcare, as well as for promoting independent living for the end user and their family members. For this reason, this study assessed the perceptions and recommendations received concerning fall detectors depending on the needs of stakeholders and the settings in which they are used.

Características morfométricas de los discos articulares de la rodilla en imágenes de resonancia magnética de mujeres colombianas / Morphometric features of the knee menisci in magnetic resonance images of Colombian female

RESUMEN: La población femenina de adultos mayores suele presentar daños de los discos o meniscos articulares de la rodilla (DAR) generalmente derivados de procesos degenerativos de cartílago ocurridos en osteoartritis. Conocer patrones morfológicos estándares de los DAR en una población demográfica específica permite tener claridad de las características autóctonas de dicha población. Una forma de caracterizar estos patrones es a través del diseño de Modelos de Elementos Finitos (MEF) que permiten predecir anormalidades clínicas y radiológicas. Hasta el momento es escasa la evidencia sobre las características morfométricas de los DAR en la población colombiana. Por esta razón, el objetivo del presente estudio fue describir la morfometría de DAR en imágenes por resonancia magnética (IRM) de mujeres colombianas saludables. En este estudio se tomaron 25 IRM de la rodilla de mujeres colombianas con normo-peso, sin antecedentes de patología de la rodilla, ni historia de trauma o cirugía de esta, y con edades entre los 18 y 60 años. El análisis del ancho del cuerno posterior del DAR medial (12,73 ± 2,42) comparado con el lateral (8,04 ± 1,52) arrojó diferencia estadísticamente significativa (p<0,05). Por otra parte, el DAR medial presentó un diámetro antero-posterior aumentado (38,52 ± 2,71) en comparación con el del DAR lateral (29,18 ± 2,75) cercano a la significancia estadística (p=0.051). De igual manera, la altura del cuerno anterior se encontró aumentada en el DAR medial (4,42 ± 0,79) en comparación con el lateral (3,66 ± 0,76), con tendencia a la significancia estadística (p=0,063). Anatómicamente se reconoce que los DAR medial y lateral se adaptan a la forma y tamaño de los cóndilos femorales, lo que concuerda con las medidas resultantes de la población estudiada, donde se evidencia un DAR medial más largo (diámetro antero-posterior) y menos alto que el lateral.

SUMMARY: The elderly female population usually presents damage to the articular discs or menisci of the knee (ADK), generally derived from degenerative cartilage processes that occur in osteoarthritis. Knowing the standard morphological patterns of ADKs in a specific demographic population allows clarity of the indigenous characteristics of that population. One way to characterize these patterns is through the design of Finite Element Models (FEM) that would enable predicting clinical and radiological abnormalities. So far, there is little evidence on the morphometric characteristics of ADKs in the Colombian population. Thus, the objective of the present study was to describe the morphometry of ADK in magnetic resonance imaging (MRI) of healthy Colombian women. In this study, 25 MRIs of the knee of Colombian women with normal weight were taken, with no history of knee pathology, trauma, or surgery, and with ages between 18 and 60 years. The analysis of the width of the posterior horn of the medial ADK (12.73 ± 2.42) compared to the lateral (8.04 ± 1.52) showed a statistically significant difference (p <0.05). On the other hand, the medial ADK presented an increased anteroposterior diameter (38.52 ± 2.71) compared to that of the lateral ADK (29.18 ± 2.75) close to statistical significance (p = 0.051). Similarly, the height of the anterior horn was found to be increased in the medial ADK (4.42 ± 0.79) compared to the lateral (3.66 ± 0.76), with a trend towards statistical significance (p = 0.063). Anatomically, it is recognized that the medial and lateral ADK adapt to the shape and size of the femoral condyles, which is in agreement with the results of the studied population where measurements show that medial ADK has a longer (anterior to posterior diameter) and a shorter height than the lateral ADK.

Dynamic analysis of forces in the lumbar spine during bag carrying.

OBJECTIVE: The intervertebral disc supports axial and shear forces generated during tasks such as lifting and carrying weights. The objective of this study was to determine the forces in the lumbar spine of workers carrying a bag on the head, on the shoulder and on the anterior part of the trunk. METHODS: Kinematic measurements were recorded for 10 subjects carrying bags of 10, 20 and 25 kg on each of the three aforementioned positions. A simple dynamic model implemented in a custom program was then developed to determine the lumbar forces using the accelerations and positions obtained from the kinematic analysis. RESULTS: The analyses yielded a maximum compressive force of 2338.4 ± 422 N when a 25-kg bag was carried on the anterior part of the trunk. CONCLUSION: Carrying bags on the anterior part of the trunk generated higher lumbar forces compared to those developed by carrying the bag on the head or on the shoulder. Force levels suggest that this activity represents a moderate risk for the subjects. However, future biomechanical models should be developed to analyze the cumulative effect in the discs when longer periods of time are spent in this activity.

A finite element model of the L4-L5-S1 human spine segment including the heterogeneity and anisotropy of the discs.

With the aim to study disc degeneration and the risk of injury during occupational activities, a new finite element (FE) model of the L4-L5-S1 segment of the human spine was developed based on the anthropometry of a typical Colombian worker. Beginning with medical images, the programs CATIA and SOLIDWORKS were used to generate and assemble the vertebrae and create the soft structures of the segment. The software ABAQUS was used to run the analyses, which included a detailed model calibration using the experimental step-wise reduction data for the L4-L5 component, while the L5-S1 segment was calibrated in the intact condition. The range of motion curves, the intradiscal pressure and the lateral bulging under pure moments were considered for the calibration. As opposed to other FE models that include the L5-S1 disc, the model developed in this study considered the regional variations and anisotropy of the annulus as well as a realistic description of the nucleus geometry, which allowed an improved representation of experimental data during the validation process. Hence, the model can be used to analyze the stress and strain distributions in the L4-L5 and L5-S1 discs of workers performing activities such as lifting and carrying tasks.