Prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores. Barranquilla (Atlántico), Colombia

Introducción: El riesgo de caídas es de carácter multifactorial, ya sea debido a factores extrínsecos o intrínsecos. Las caídas se consideran el principal mecanismo de lesión no intencional en los mayores. Objetivo: Determinar la prevalencia de caídas y factores de riesgo intrínsecos en personas adultas mayores de la ciudad de Barranquilla (Colombia). Materiales y métodos: Estudio descriptivo correlacional, realizado en 98 adultos mayores, tanto institucionalizados como en comunidad, residentes en Barranquilla (Atlántico), Colombia. Se aplicó una encuesta sobre factores de riesgo intrínsecos; el riesgo de caída se midió con la escala de Berg y se establecieron niveles de Vitamina D en sangre. Resultados: El promedio de edad fue de 75 años, con edades más avanzadas en población institucionalizada. La prevalencia general de caídas fue de 49 % en el último año. El 68,8 % de la población que presentó caídas fueron mujeres, con mayor proporción de caídas en los residentes en hogares geriátricos (52,1 %). Las mujeres provenientes de la comunidad se cayeron más que los hombres (91,3 %) lo cual muestra significancia estadística frente a las caídas (p = 0,002). El consumo de antihipertensivos fue el de mayor proporción (92 %), lo cual demuestra que es estadísticamente significativa para la población institucionalizada (p = 0,0224). El riesgo de caída alto y moderado fue mayor en la población institucionalizada (32 %). El 79,2 % de los individuos que presentaron caídas presentó niveles de vitamina D insuficientes. Conclusión: La población adulta mayor presenta una alta prevalencia de caídas, especialmente las mujeres y la población institucionalizada en centros geriátricos. Los hechos que presentaron significancia estadística fueron ser mujer y provenir de la comunidad, junto con el consumo de antihipertensivos en población institucionalizada.

Introduction: Fall risk can be related to multiple factors, whether they are of extrinsic or intrinsic nature. Falls are considered the main mechanism of accidental injury in the elderly. Objective: To determine the prevalence of falls and intrinsic risk factors in older adults in the city of Barranquilla (Colombia). Materials and methods: A descriptive correlation study was carried out on 98 institutionalized and community elderly adults from Barranquilla (Atlántico), Colombia. A survey on intrinsic risk factors was applied; the risk of falling was measured with the Berg scale and levels of Vitamin D in the blood were established. Results: The participant's average age was 75 years old, considering that the oldest ages were in the institutionalized population. The general prevalence of falls was 49% in the last year, 68.8% of the population that presented falls were women, and the highest proportion of falls occurred with residents of geriatric homes (52,1%). Women coming from the community fell more than men (91,3%) showing statistical significance compared to falls (p-value of 0,002). The consumption of antihypertensive drugs was the one with the highest proportion (92%), which showed statistical significance for the institutionalized population (p-value of 0,0224). The high and moderate risk of falls was higher in the institutionalized population (32%). Insufficient vitamin D levels (79,2% of those that fell) had a higher prevalence in women, without statistical significance. Conclusion: The elderly population has a high prevalence of falls, especially in women and in the population institutionalized in geriatric centers. The facts that presented statistical significance were being a woman and coming from the community, along with the consumption of antihypertensives in the institutionalized population.

Correlation Of Medial Longitudinal Arch Height With Postural Stability, Sensory Integration, Balance And Fall Risk Among Healthy Young Adults.

A cross-sectional analytical study was conducted on 165 healthy young adults. With pes rectus and pes planus to correlate the medial longitudinal arch height with postural stability, sensory integration of balance and fall risk. Persons with pes cavus, congenital foot anomalies other than pes planus, leg length discrepancies, recent history of trauma, lower limb amputations, history of serious foot injury, ligamentous laxity, or an active inflammatory disorder were excluded. Outcome measurements included normalised truncated navicular height (NTNH), Chippaux Smirak index (CSI), athletic single leg stability (ASLS) index, fall risk (FR) index, postural stability (PS), clinical test of sensory integration of balance (CTSIB), and balance error scoring system (BESS). Spearman correlation and Mann Whitney U test were used for data analysis. CSI and NTNH were noted to have no significant correlation (p<0.05) with PS, FR, CTSIB, ASLS and BESS among healthy young adults. Males were observed to have poorer balance and fall risk as compared to females.

Efectos del control postural en la tasa de error anti-sacádico en personas mayores / Effects of postural control upon anti-saccade error rate in older people

Antecedentes La tasa de error anti-sacádico (AS) se utiliza como un medio diagnóstico para alteraciones neurológicas. El proceso natural del envejecimiento podría generar dificultad para realizar procesos paralelos neurales de inhibición motora y movimiento ocular consciente. Por lo tanto, si se le impone a una persona mayor el control del balance en posiciones bípedas durante un movimiento AS es esperable un aumento de la tasa de errores AS. Objetivo Estudiar los efectos del control postural sobre la tasa de error AS en un grupo de personas mayores y compararlos con los de un grupo de personas jóvenes. Métodos Se realizó una comparación intra e intergrupal de la tasa de error AS en un grupo experimental de personas mayores (PM) y otro grupo control de personas jóvenes (PJ). Para ello, se utilizaron bloques de movimientos AS y pro-sacádicos (control) aleatoriamente en 4 diferentes posturas: 1)sentado (SENT); 2)de pie normal (NORMAL); 3)pies juntos (REDUC), y 4)pies en línea (TANDEM). Resultados El grupo PM en comparación con el grupo PJ mostró aumento progresivo de la tasa de error AS desde la posición sentado a todas las posiciones de pie, con máxima tasa de error AS en posturas verticales más complejas. Por el contrario, el grupo PJ no presentó variabilidad significativa de la tasa de error AS en todas las posiciones. Conclusiones Se confirma que el proceso de envejecimiento se asocia a un aumento en la tasa de error AS. Este estudio revela por primera vez un aumento significativo en la tasa de error AS cuando se exige control del balance corporal a las PM, implicando una disminución en la capacidad de procesamiento múltiple en PM, para la ejecución de tareas complejas y paralelas (AU)

Background The anti-saccadic (AS) error-rate is used to diagnose neurological disorders. The natural aging process could generate difficulty in carrying out parallel neural processes of conscious motor inhibition and eye movement. Therefore, if balance control is imposed on an elderly person in biped positions during an AS movement, an increase in the AS error-rate is expected. Objective To study the effects of postural control on the AS error-rate in older people. Methods An intra and intergroup comparison was made of AS error-rate in an experimental group of older people (PM) and another control group of young people (PJ). For this, blocks of AS and pro-saccadic movements (control) were used randomly in four different postures: (1)sitting (SENT), (2)standing normally (NORMAL), (3)feet together (REDUC), and (4)feet in line (TANDEM). Results The PM group, compared to the PJ group, showed a progressive increase in the AS error-rate from the sitting position to all standing positions, with the maximum AS error-rate in more complex vertical postures. In contrast, the PJ group did not present significative variability of this AS error-rate in all positions Conclusions It is confirmed that the aging process is associated with an increase in the AS error-rate. This study reveals for the first time a significant increase in the AS error-rate when control of body balance is required for PM, implying a decrease in the multiple processing capacity in PM for the execution of complex and parallel tasks (AU)

[Effects of postural control upon anti-saccade error rate in older people]. / Efectos del control postural en la tasa de error anti-sacádico en personas mayores.

BACKGROUND: The anti-saccadic (AS) error-rate is used to diagnose neurological disorders. The natural aging process could generate difficulty in carrying out parallel neural processes of conscious motor inhibition and eye movement. Therefore, if balance control is imposed on an elderly person in biped positions during an AS movement, an increase in the AS error-rate is expected. OBJECTIVE: To study the effects of postural control on the AS error-rate in older people. METHODS: An intra and intergroup comparison was made of AS error-rate in an experimental group of older people (PM) and another control group of young people (PJ). For this, blocks of AS and pro-saccadic movements (control) were used randomly in four different postures: (1)sitting (SENT), (2)standing normally (NORMAL), (3)feet together (REDUC), and (4)feet in line (TANDEM). RESULTS: The PM group, compared to the PJ group, showed a progressive increase in the AS error-rate from the sitting position to all standing positions, with the maximum AS error-rate in more complex vertical postures. In contrast, the PJ group did not present significative variability of this AS error-rate in all positions. CONCLUSIONS: It is confirmed that the aging process is associated with an increase in the AS error-rate. This study reveals for the first time a significant increase in the AS error-rate when control of body balance is required for PM, implying a decrease in the multiple processing capacity in PM for the execution of complex and parallel tasks.

An overview of biofeedback techniques in mechanical low back pain: effects on sensory integration of balance.

Low back pain is a common musculoskeletal disorder involving the lumbar spine. It affects almost 80% of the world's population and is associated with functional limitations. The reported global prevalence ranges from15-30%. Postural control involves processing the information from sensory stimulus derivative of vestibular, visual, and somatosensory systems in a coordinated manner to precisely regulate center of mass and body positioning. Failure of one or more of these systems, or incorrect processing of sensory information leads to instability or risk of fall. Low back pain can also modify the sensory input for postural control. Biofeedback can be utilized to assist "down-train" elevated muscle activity or to "up-train" weak or inhibited, muscles. Clinicians can use biofeedback to determine if patients are able to relax and evaluate psychophysiological reactions of muscles. Using biofeedback, patients can be educated about physiological processes and how biopsychosocial factors can interact causing recurrent complaints of pain.

Efecto del ejercicio propioceptivo sobre el equilibrio en patinadores de carrera juveniles / Effect of Proprioceptive Exercise on Balance in Youth Race Skaters

El objetivo del presente estudio fue determinar el efecto de un programa de ejercicio propioceptivo sobre el equilibrio en patinadores de carrera juveniles. Se realizó un estudio de alcance cuasiexperimental. Se aleatorizaron tres clubes de patinaje, dos al grupo control y otro al experimental. Participaron 49 jóvenes de ambos sexos entre 11 y 15 años. Al grupo experimental se le aplicó un programa de ejercicio propioceptivo, mientras el grupo control recibió un programa de entrenamiento convencional. Se realizó una evaluación estabilométrica, se midieron los límites de estabilidad, la amplitud y frecuencia de oscilaciones y el equilibrio estático. Ambos grupos mejoraron la frecuencia de balanceo en ambas direcciones, con ojos abiertos y ojos cerrados (p<0,050). Ninguno de los límites de estabilidad y amplitud de balanceo, así como el equilibrio estático evidenciaron cambios significativos (p>0,050). No se encontraron diferencias significativas en las medidas de cambio entre grupos en ninguna de las variables estudiadas (p>0,050). (AU)

The objective of the present study was to determine the effect of a proprioceptive exercise program on balance in youth running skaters. A quasi-experimental scoping study was conducted. Three skating clubs were randomized, two to the control group and one to the experimental group. 49 young people of both sexes between 11 and 15 years old participated. The proprioceptive exercise program was applied to the experimental group, while the control received a conventional training program. Stabilometric evaluation was performed, the limits of stability, the amplitude and frequency of oscillations and the static balance were measured. Both groups improved roll frequency in both directions, with eyes open and eyes closed (p <0.050). Static balance and none of the limits of stability and roll amplitude showed significant changes (p> 0.050). No significant differences were found in the measures of change between groups in any of the variables studied (p> 0.050). (AU)

Ejercicio y educación mejoran equilibrio y la calidad de vida en mujeres con incontinencia urinaria de esfuerzo / Exercise and education improve balance and quality of life in women with stress urinary incontinence

Introducción: La incontinencia urinaria por esfuerzo (IUE) tiene una alta prevalencia en mujeres adultas, afectando variables psicológicas, sociales y funcionales como la disminución de capacidad de equilibrio, debido a una escasa contribución en los movimientos del tronco hacia una corrección postural. Objetivo: Determinar los efectos de un programa basado en ejercicio muscular de piso pélvico y educación sobre el equilibrio estático y la calidad de vida en mujeres con IUE. Materiales y métodos: Participaron 18 mujeres con IUE durante 12 semanas en 10 sesiones de ejercicio muscular de piso pélvico y educación (hábitos de higiene, micción, ingesta de líquidos). Pre y post-intervención se evaluó equilibrio estático mediante oscilografía postural y calidad de vida mediante el International Consultation on Incontinence Questionnaire Short-Form (ICQ-SF). Los datos fueron analizados con la prueba no paramétrica de Wilcoxon. Resultados: Se encontró una disminución significativa en el área de desplazamiento del centro de presión en el subtest ojos abiertos (p=0,027) y en el Subtest ojos cerrados (p=0,006). Disminuyó la sintomatología asociada a IUE (p=0,0001). Conclusiones: Pos-intervención mejora equilibrio estático y calidad de vida, confirmando los efectos positivos de este programa que pueden servir de orientación a profesionales de la salud que trabajan con mujeres con IUE.

Introduction: Stress urinary incontinence (SUI) has high prevalence in adult women, affecting psychological, social and functional variables, including decreased balance capacity, due to a lack of trunk movements that contribute to postural correction. Objective: To determine how a program based on pelvic floor muscle exercises and education affects static balance and quality of life of women with SUI. Materials and methods: 18 SUI female patients participated in a 12 week/10 sessions program that included pelvic floor muscle exercises and education (hygiene habits, urination, fluid intake). Static balance and quality of life were assessed before and after the intervention using postural oscillography and the International Consultation on Incontinence Questionnaire Short Form(ICQ-SF), respectively. Data were analyzed with the non-parametric Wilcoxon test. Results: The displacement area of the center of pressure in the open (p=0.027) and closed (p=0.006) subtests showed a significant reduction. Likewise, the amount of symptoms associated with SUI decreased (p=0.0001). Conclusions: Intervention improves static balance and quality of life, confirming the positive effects of this program, which can serve as a guide for health professionals who work with women with SUI.

Ultrasound Shear Modulus and Thickness of Lateral Abdominal Muscles in Different Contractile States in Relation To Self- Reported Hip/Groin Problems in Youth Soccer Players.

To date, no studies have assessed lateral abdominal muscles' (LAM) elasticity and thickness in relation to hip and groin symptoms in any population. The objectives were to a) assess the relationship between LAM ultrasound measurements (elasticity and thickness) and self-reported subscales of the Copenhagen Hip and Groin Outcome Score (HAGOS) and b) compare LAM elasticity and thickness between asymptomatic and symptomatic sides. Shear modulus and thickness of the oblique external (OE), internal (OI) and transversus abdominis (TrA) muscles in 25 young soccer players were assessed at rest and during isometric contraction using ultrasound shear wave elastography. HAGOS subscales were used to assess self-reported hip/groin problems. There was a significant (p < 0.05) moderate correlation between allometric-scaled OI resting thickness (mean of right and left) and the Activities of Daily Living (r = 0.40), Sport (r = 0.57) and Quality of Life (QOL) (r = 0.41) HAGOS subscales. Also, a moderate significant correlation was found between allometric-scaled TrA resting thickness and the QOL subscale (r = 0.47). Moderate correlations were found between resting OI shear modulus and the QOL (r = 0.44), between right TrA shear modulus during contraction and Symptoms (r = 0.57), and between the left TrA shear modulus during contraction and Physical Activity (r = 0.41) subscales. No differences were found between the symptomatic and asymptomatic side in thickness and elasticity measurements among soccer players with unilateral symptoms (p > 0.05). The relationships found between LAM and hip/groin problems in youth male soccer players indicate that muscles are thinner and more elastic (less stiff) in more symptomatic athletes.

FIFA11+ Parte 2 - Efeito no equilíbrio dinâmico em jovens atletas de voleibol / FIFA11 + Part 2 - Effect on dynamic balance in young volleyball athletes

Investigar os efeitos do programa FIFA11+ Parte 2 no equilíbrio dinâmico (ED) em jovens atletas de voleibol. Cross-over experimental, com amostra constituída por oito atletas (16,4±0,7 anos, 1,87±0,07m) divididos de maneira aleatória em dois grupos, submetidos a dez intervenções. Ambos os grupos foram considerados intervenção e controle em momentos distintos, respeitando o período de washout de 13 dias. Antes e após cada um destes momentos os jovens atletas realizaram o Y-Balance Test (YBT). Os resultados do efeito do FIFA11+ Parte 2 no YBT, a partir da variação de médias da distância anterior e escore composto, não mostraram diferenças estatísticas no ED entre intervenção (p=0,128; p=0,740; p=0,492, respectivamente), momento (p=0,612; p=0,697; p=0,237, respectivamente) e intervenção x momento (p=0,778; p=0,433; p=0,590, respectivamente). Não foi identificado aprimoramento no ED em jovens atletas de voleibol após a realização do programa FIFA11+ Parte 2.

The effects of FIFA11 + Part 2 program with dynamic balance (DB) on young volleyball athletes are investigated. Experimental cross-over, with a sample of 8 athletes (16.4 ± 0.7 years, 1.87 ± 0.07m), randomly divided into two groups, with 10 sessions. The two groups were submitted to intervention and control at different times, respecting the 13-day washout period. Y-Balance Test (YBT) was employed prior and posterior to each time. Results of FIFA11 + Part 2 effect on YBT, through the difference in anterior distance media and composite score, failed to show statistical effects on DB between interventions (p = 0.128; p = 0.740; p = 0.492, respectively), momentum (p = 0.612; p = 0.697; p = 0.237, respectively) and intervention x momentum (p = 0.778; p = 0.433; p = 0.590, respectively). No improvement in DB was detected in young volleyball athletes after applying FIFA11 + Part 2 Program.

Efecto de un programa de realidad virtual para mejorar la estabilidad de tronco en lanzadores de bala y jabalina paralímpicos. Un estudio de casos / Effect of a virtual reality program to improve trunk stability in Paralympic shot put and javelin throwers. A case study

Introducción: El deporte paralímpico se originó como parte de procesos de re-habilitación para personas que tuvieran discapacidad. Durante la ejecución de las disciplinas paralímpicas el control motor en la región del tronco y en especial del abdomen es de gran importancia para prevenir lesiones y mejorar el registro de la marca deportiva. Son muchas las herramientas utilizadas por los entrenadores de-portivos para mejorar la fuerza muscular y por consiguiente la estabilidad de tronco, buscando disminuir el riesgo en el ámbito deportivo. Sin embargo, las investigaciones sobre el uso de realidad virtual, junto con plataformas de estabilometría para el en-trenamiento de deportistas paralímpicos con lesiones físicas, son escasas.Objetivo: Establecer el efecto de un programa de entrenamiento del tronco apoya-do en realidad virtual en deportistas de alto rendimiento paralímpicos, lanzadores de bala y jabalina con lesiones físicas y que compiten en sillas de lanzamiento. Materiales y método: La investigación fue diseñada como un estudio cuasiex-perimental intrasujeto. Se evaluaron cinco sujetos deportistas paralímpicos de alto rendimiento con discapacidad física. Se empleó un software de realidad virtual que incluye patrones y juegos lúdicos ajustables en tiempo e intensidad y una platafor-ma de bipedestación dinámico como parte del equipo de intervención, ajustable al paciente, que permite reeducar el equilibrio, la propiocepción, fortalecer y lograr el control del tronco. Las variables de análisis fueron el nivel del desplazamiento ante-roposterior y lateral del tronco y los cambios en el volumen de acción. Se realizó una evaluación inicial, una intervención que duró de seis semanas y la evaluación final. Resultados: En las evaluaciones iniciales de todos los atletas se observó una ten-dencia al desplazamiento en sentido posterior. En la evaluación final, los rangos de desplazamiento aumentan en casi todos los sujetos con excepción del sujeto 5, cuyos valores permanecen casi estables tanto en las evaluaciones iniciales como las finales. La diferencia en el desplazamiento entre la prueba inicial y final en promedio de los participantes fue de 6.26 grados. Conclusiones: los resultados positivos del entrenamiento del tronco apoyado en realidad virtual para los participantes constituyen un aporte al conocimiento sobre el tema y abren la posibilidad de incluir esta tecnología en protocolos de entrenamiento en deporte paralímpico.

Introduction: Paralympic sport originated as part of rehabilitation processes for people with disabilities. During the execution of Paralympic disciplines, motor con-trol in the trunk region and especially in the abdomen is of great importance to prevent injuries and improve the registration of the sports record. There are many tools used by sports coaches to improve muscle strength and therefore trunk stability to reduce the risk in the sports field. However, research on the use of virtual reality along with stabilometry platforms for the training of Paralympic athletes with phys-ical injuries are scarce.Objective: To establish the effect of a trunk training program supported by virtual reality in high performance Paralympic athletes, shot put and javelin throwers with physical injuries who compete in throwing frames. Materials and method: The research was designed as an intrasubject quasi-ex-perimental study. Five high-performance Paralympic athletes with physical disabili-ties were evaluated. A virtual reality software that includes patterns and playful games adjustable in time and intensity and a dynamic standing platform were used as part of the intervention equipment, adjustable to the patient, which allows reeducating balance, proprioception, strengthening, and achieving trunk control. The variables of analysis were the level of anteroposterior and lateral displacement of the trunk and changes in the volume of action. An initial evaluation, an intervention that lasted six weeks, and a final evaluation were carried out. Results: In the initial evaluations of all athletes, a tendency towards posterior dis-placement was observed. In the final evaluation, the displacement ranges increase in almost all subjects except for subject 5, which showed values that remain almost sta-ble in both the initial and final evaluations. The difference in displacement between the initial and final test on average of the participants was 6.26 degrees. Conclusions: the positive results of trunk training supported by virtual reality for the participants constitute a contribution to the knowledge on the subject and open the possibility of including this technology in training protocols in Paralympic sports.

Evaluating the effect of a water exercise routine on the postural stability of the elderly / Evaluación del efecto de una rutina de ejercicios acuáticos sobre la estabilidad postural de adultos mayores

Abstract Background: Postural stability enables humans to maintain the center of mass of their body within their base of support. Nevertheless, over time, such stability is affected by different factors such as age, repetitive strain, and accidents. Although studies in this field have investigated the effectiveness of hydrotherapy, only a few of them have explored its influence on postural stability, which is reflected in a lack of research that estimates its impact on rehabilitation. Aim: To determine the immediate and final effects of an aquatic routine protocol on the postural stability of elderly subjects. Methods: The postural stability of 20 adults over 60 years of age was analyzed using electromyographic and baropodometric methods. Electromyographic signals were obtained from the tibialis anterior, soleus, both gastrocnemius, vastus medialis, and biceps femoris to calculate the coactivation percentage of the muscles in charge of postural stability. The baropodometric data were collected to analyze the area of the stabilometric ellipse, mean plantar pressure, and weight distribution percentage. Results: The outcome of both methods revealed improvements in the elderly patients after the aquatic routine protocol was applied, which indicates that the type of water exercises implemented in this study has positive effects on their postural stability. Conclusion: The postural stability of the elderly participants was improved after each session because their stability index decreased along with the electrical activity of some muscle pairs, their body weight was better distributed, and the area of body oscillation was reduced. However, this effect was immediate and not final.

Resumen Antecedentes: La estabilidad postural permite a los humanos mantener el centro de masa de su cuerpo dentro de su base de apoyo. Sin embargo, con el tiempo, dicha estabilidad se ve afectada por diferentes factores como la edad, el esfuerzo repetitivo y los accidentes. Si bien los estudios en este campo han investigado la efectividad de la hidroterapia, solo algunos de ellos han explorado su influencia en la estabilidad postural, lo que se refleja en la falta de investigaciones que estimen su impacto en la rehabilitación. Objetivo: Determinar los efectos inmediatos y finales de un protocolo de rutina acuática sobre la estabilidad postural de adultos mayores. Métodos: Se analizó la estabilidad postural de 20 adultos mayores de 60 años mediante métodos electromiográficos y baropodométricos. Se obtuvieron señales electromiográficas del tibial anterior, sóleo, gastrocnemio, vasto interno y bíceps femoral para calcular el porcentaje de coactivación de los músculos encargados de la estabilidad postural. Los datos baropodométricos se recolectaron para analizar el área de la elipse estabilométrica, la presión plantar media y el porcentaje de distribución del peso corporal. Resultados: Ambos métodos mostraron mejoras en los pacientes luego de la aplicación del protocolo de rutina acuática, lo que indica que el tipo de ejercicios acuáticos implementados en este estudio tiene efectos positivos en su estabilidad postural. Conclusión: La estabilidad postural de los participantes mejoró después de cada sesión porque su índice de estabilidad disminuyó junto con la actividad eléctrica de algunos pares de músculos, su peso corporal se distribuyó mejor y se redujo el área de oscilación corporal. Sin embargo, este efecto fue inmediato y no definitivo.

Efectos de un programa de ejercicio multicomponente en personas mayores que viven en comunidad / Effects of a multicomponent exercise program in older people living in the community

RESUMEN Fundamento: una intervención basada en ejercicio multicomponente favorecería la funcionalidad. Sin embargo, son escasos los estudios locales, en Chile, que los han utilizado. Objetivo determinar los efectos del ejercicio multicomponente en la disminución del riesgo de caída y riesgo de deterioro cognitivo, la mejora del equilibrio, fuerza muscular, capacidad funcional y calidad de vida en personas mayores que viven en comunidad. Métodos: estudio preexperimental pre-post sin grupo control. La muestra fue intencionada (n=17; 47,1 % mujeres; 70 años de mediana). Se aplicó un plan de ejercicio multicomponente durante nueve semanas. Pre y post ejercicio se evaluó equilibrio dinámico con el test Timed Up and Go, equilibrio estático con un oscilógrafo postural y la prueba de Estación Unipodal, fuerza muscular con el test de Sentarse y Levantarse, capacidad funcional con el test de Marcha 6 Minutos, calidad de vida con el Cuestionario SF-36 y sospecha de deterioro cognitivo con el Mini Mental State. Para determinar diferencias pre-post ejercicio se aplicó la prueba de Wilcoxon. Resultados: después de los ejercicios se observó un mejor rendimiento en las pruebas: Timed Up and Go (p=0,004), Estación Unipodal (p=0,023 pierna derecha, p=0,005 pierna izquierda), Sentarse y Levantarse (p=0,014), Marcha de 6 Minutos (p=0,006) y en el Cuestionario SF-36: dolor corporal (p=0,003), salud mental (p=0,000) y puntaje total (p=0,002). Conclusiones: un programa de ejercicio multicomponente de nueve semanas logró disminuir el riesgo de caídas, mejorar equilibrio, fuerza muscular, capacidad funcional y calidad de vida de personas mayores que viven en comunidad.

ABSTRACT Background: a multicomponent exercise-based intervention would favor functionality. However, there are few local studies, in Chile, that have used them. Objective to determine the effects of multicomponent exercise in reducing the falling and cognitive deterioration risks, improving balance, muscle strength, functional capacity and life quality in elderly people living in the community. Methods: pre-post experimental study without control group. The sample was intentional (n = 17; 47.1% women; median 70 years old). A multicomponent exercise plan was applied for nine weeks. Pre and post exercise, dynamic balance was evaluated with the Timed Up and Go test, static balance with a postural oscillograph and the Unipodal Station test, muscle strength with the Sit and Stand test, functional capacity with the 6 Minute Walk test, quality life with the SF-36 Questionnaire and suspected cognitive impairment with the Mini Mental State. To determine pre-post exercise differences, the Wilcoxon test was applied. Results: after the exercises, a better performance was observed in the tests: Timed Up and Go (p = 0.004), Unipodal Station (p = 0.023 right leg, p = 0.005 left leg), Sitting and Getting up (p = 0.014), 6-Minute Walk (p = 0.006) and in the SF-36 Questionnaire: body pain (p = 0.003), mental health (p = 0.000) and total score (p = 0.002). Conclusions: a nine-week multicomponent exercise program was able to reduce the risk of falls, improve balance, muscle strength, functional capacity and quality of life in older people living in the community.

Alteraciones posturográficas y oculomotoras en las primeras 24 horas tras un latigazo cervical / Posturographic and oculomotor findings in the first 24 hours after whiplash

Introducción y objetivos La sensación de inestabilidad es un síntoma frecuente tras un latigazo cervical (LC), existiendo alteraciones objetivas del control postural en fases crónicas. El objetivo fundamental de nuestro estudio fue evaluar las alteraciones objetivas del control postural, así como la presencia o ausencia de alteraciones oculomotoras en las fases agudas tras un LC. Material y métodos Se realizó un estudio posturográfico mediante sistema NedSVE/IBV y una valoración oculomotora en una muestra de 44 sujetos afectos de LC en las primeras 24h tras el accidente. Resultados Más de la mitad de los pacientes estudiados presentaron una valoración global por debajo de la normalidad. El patrón sensorial predominante fue el denominado patrón vestibular. Los parámetros fundamentales del test de Romberg (desplazamiento total, área de barrido, velocidad media, desplazamientos anteroposterior y mediolateral y fuerza anteroposterior) aumentaron siguiendo la secuencia Romberg ojos abiertos, Romberg gomaespuma ojos abiertos, Romberg ojos cerrados y Romberg gomaespuma ojos cerrados. En cuanto a la comparación con la normalidad y utilizando los valores de referencia del Instituto de Biomecánica de Valencia, los datos de los pacientes de LC muestran diferencias significativas en todos los parámetros analizados, salvo en la valoración de la marcha y el control rítmico direccional mediolateral. Conclusiones Nuestros datos confirman que los pacientes en fase aguda del LC presentan un peor control postural desde las primeras horas tras el accidente. Los resultados evidencian que los pacientes con LC tienen una mayor dependencia visual. Solo una minoría de los pacientes presentan alteraciones oculomotoras durante la exploración temprana (AU)

Introduction and objectives Instability is a frequent symptom after whiplash (WL) with alterations in postural control in chronic phases. The main objective of our study was to evaluate if there were objective alterations in postural control in the acute phases after a WL, as well as to determine the presence or absence of oculomotor alterations in early phases. Material and methods A posturographic study was carried out using the NedSVE/IBV system, as well as an oculomotor assessment, in a sample of 44 patients with WL in the first 24h after the accident. Results More than half of the patients had a global assessment below normal. The predominant sensory pattern was vestibular. The main parameters of the Romberg test (total displacement, swept area, average speed, anteroposterior and mediolateral displacement and anteroposterior force) increased following the sequence Romberg open eyes, Romberg foam rubber open eyes, Romberg closed eyes, and Romberg foam rubber closed eyes. Concerning the comparison with normality and using the reference values of the Institute of Biomechanics of Valencia, the data from the WL patients showed significant differences in all the parameters analysed, except for gait assessment and the mediolateral directional rhythmic control. Conclusions Our data confirm that patients in the acute phase of WL have worse postural control than non-injured persons. The results suggest that patients with WL have greater visual dependence. Only a minority of patients had oculomotor abnormalities during early examination (AU)

Diseño de una prueba de equilibrio con características contextuales para adultos mayores / Design and validation of a balance test with context characteristics for older adults

Antecedentes La pérdida de equilibrio en los adultos mayores es multifactorial y aumenta el riesgo de caídas en esta población. Existen pruebas para evaluar el equilibrio, sin embargo, se centran en la evaluación de una sola tarea, en entornos estáticos, sin considerar las demandas del control postural en situaciones de la vida cotidiana, como la interacción de la persona con el contexto y las actividades multitarea. Objetivo Diseñar y validar una prueba de equilibrio para adultos mayores con características contextuales. Materiales y método Se desarrolló una metodología de recolección de datos mixta, con un diseño metodológico exploratorio secuencial DEXPLOX derivativo de un diseño de triangulación concurrente DITRIAC. Resultados Los resultados hallados en las primeras 3fases permitieron construir los ítems de la prueba de evaluación de equilibrio, luego se realizó la primera validación de expertos, con un coeficiente kappa de Fleiss de 0,4 y una validez de contenido de Lawshe de 0,95. La segunda validación por expertos dio como resultado en la validez facial una fuerza de concordancia interevaluadores excelente y una validez de contenido de Lawshe en relevancia de 0,95 y en pertinencia de 0,97. Conclusiones La prueba diseñada ha demostrado características de validez fuertes y puede ser aplicada en adultos mayores, pues se incluyen ítems que exigen respuestas somatosensoriales, como las que se realizan en las actividades de la vida diaria e ítems con actividades de doble tarea cognitivas en el contexto real (AU)

Background Balance impairment is multifactorial in older adults and increases risk of falls in this population. There are tests to evaluate balance; nevertheless, they are focused on the evaluation of a single task, in static environments, without representing postural control demands in everyday life situations, such as person interaction-context and multi-tasking activities. Objectives Design and validate a balance test with ecological validity for older adults. Materials and methods A mixed data collection methodology was developed, with an exploratory sequential DEXPLOX methodological design derived from a DITRIAC concurrent triangulation design. Results The results from the first 3phases permitted constructing the items of the balance assessment test to, then, conduct the first validation by experts, determining a Fleiss’ kappa of 0.4 and a Lawshe content validity ratio of 0.95. The second validation by experts yielded as a result in face validity an excellent strength of inter-rater agreement and a Lawshe content validity ratio of 0.95 in relevance and 0.97 in pertinence. Conclusions The test designed showed strong characteristics of ecological validity and can be applied to older adults, given that it includes items requiring somatosensory responses, like those performed in activities of daily living and items with cognitive dual task activities used in daily routines (AU)

Suscetibilidade à cinetose em crianças de oito a onze anos / Susceptibilidad al cinetosis en niños de 8 a 12 años de edad / Susceptibility to motion sickness in children from eight to eleven years of age

RESUMO A cinetose se caracteriza pela intolerância ao movimento, resultante de um conflito sensorial entre os sistemas visual, proprioceptivo e vestibular. Na população infantil, a cinetose é frequente, porém o difícil diagnóstico acaba subestimando a prevalência nesse grupo específico. As alterações vestibulares pediátricas têm importante influência no desenvolvimento infantil. O objetivo do artigo foi analisar a suscetibilidade à cinetose em crianças e verificar possíveis fatores associados, bem como identificar diferenças entre as respostas, quando comparados os sexos, as faixas etárias e a autopercepção dos pais. Trata-se de um estudo transversal. A amostra de conveniência consecutiva foi constituída por crianças de ambos os sexos, com idade entre oito e onze anos. Para avaliar a suscetibilidade à cinetose, foi aplicado o motion sickness questionnaire short form (MSSQ), realizado individualmente com cada criança. A análise estatística foi realizada por meio do SPSS Versão v.21. Adotou-se nível de significância de 0,05. Utilizaram-se os testes estatísticos Kolmogorov-Smirnov; T de Student; Anova e teste de Friedman. Ao total, foram analisadas 223 crianças. Observou-se que 89,7% das crianças avaliadas eram suscetíveis à cinetose. Houve diferença significativa na comparação da suscetibilidade à cinetose entre os sexos, sendo as meninas, mais suscetíveis em relação aos meninos (p=0,001). Na comparação entre as faixas etárias, não houve significância estatística. Crianças com onze anos apresentaram maior suscetibilidade à cinetose. Houve diferença nas respostas relatadas pelas crianças e pais sobre a suscetibilidade das crianças à cinetose.

RESUMEN El cinetosis es la intolerancia al movimiento pasivo, resultado de un conflicto sensorial entre los sistemas visual, propioceptivo y vestibular. La población infantil padece con frecuencia del cinetosis, pero su prevalencia se subestima debido al difícil diagnóstico en este grupo específico. Los trastornos vestibulares en niños influyen significativamente en su desarrollo. El objetivo de este artículo fue analizar la susceptibilidad al cinetosis en niños y sus factores asociados, así como identificar las diferencias entre las respuestas en la comparación entre los sexos, los grupos de edad y la autopercepción de los padres. Se trata de un estudio transversal. La muestra de conveniencia consecutiva estuvo compuesta de niños de ambos sexos, con edades comprendidas entre 8 y 12 años. Para evaluar la susceptibilidad al cinetosis, se aplicó el motion sickness questionnaire short form (MSSQ) de manera individual en cada niño. Para el análisis estadístico se utilizó el software SPSS, versión 21.0. El nivel de significancia adoptado fue de 0,05. Se utilizaron pruebas estadísticas de Kolmogorov-Smirnov; T de Student; Anova y test de Friedman. Participaron en total 223 niños. Se observó que el 89,7% de los niños evaluados eran susceptibles al cinetosis. Hubo una diferencia significativa en la comparación de la susceptibilidad al cinetosis entre los sexos, en la cual las niñas eran más susceptibles que los niños (p=0,001). En cuanto a los grupos de edad, no hubo significación estadística. Los niños de 12 años fueron más susceptibles al cinetosis. Hubo una diferencia en las respuestas informadas por los niños y los padres sobre la susceptibilidad de los niños al cinetosis.

ABSTRACT Motion sickness is characterized by intolerance to movement, resulting from a sensory conflict between the visual, proprioceptive and vestibular systems. In the child population, motion sickness is frequent, but the difficult diagnosis ends up underestimating the prevalence in this specific group. Pediatric vestibular changes are of great importance in child development. The objective was to analyze the susceptibility to motion sickness in children and to verify possible associated factors, as well as to identify differences in the responses when compared to sex, age group and parents' self-perception. This is a cross-sectional study. The consecutive convenience sample consisted of children of both sexes, aged between eight and eleven years old. The motion sickness questionnaire short form (MSSQ) was applied individually with each child. Statistical analysis was performed using the SPSS Version v.21 (Chicago: SPSS). A significance level of 0,005 was adopted. Kolmogorov-Smirnov, Student's T, Anova and Friedman's were the statistical tests used. In total, 223 children were analyzed. 89.7% of the sample was susceptible to motion sickness. There was a significant difference in the comparison of susceptibility to motion sickness between genders, with girls being more susceptible, compared to boys (p=0.001). When comparing age groups, there was no statistical significance. Eleven-year-old children were more susceptible to motion sickness. There was a difference in the responses reported by children and parents about the children's susceptibility to motion sickness.

Comparative analysis of cervical sagittal balance with radiographs in different postures / Análise comparativa do equilíbrio sagital cervical com radiografias em diferentes posturas / Análisis comparativo del equilibrio sagital cervical con radiografías en diferentes posturas

ABSTRACT Objective: To compare the cervical sagittal balance in groups of patients submitted to lateral radiographs of the cervical segment, with the upper limbs in two different positions. Methods: This is a cross-sectional, quantitative, prospective, descriptive study using radiographic analysis of 100 adult individuals, aged between 20 and 70 years. Two lateral radiographs were taken of each patient, one image with the upper limbs crossed over the trunk (flexed elbows) and the other with the upper limbs elevated in front (extended elbows). All patients answered a questionnaire about age, sex, presence of pain in the cervical spine, as well as degree of pain based on the Likert scale. The radiographic parameters evaluated were the COBB angle (Cobb), thoracic inlet angle (TIA), T1 slope, neck tilt and distance from the center of gravity (COG) of the skull to C7 (COG-C7) with the elbows in extension (Ext) and flexion (Flex). A p-value of less than 0.05 was considered a statistically significant difference. Results: Sixty patients were female (60%) and forty were male (40%). The data analysis obtained showed statistical significance in Cobb Flex vs. Cobb Ext (p = 0.000), TIA Flex vs. TIA Ext (p = 0.000), T1 Flex vs. T1 Ext (p = 0.000), Neck tilt Flex vs. Neck tilt Ext (p = 0.000), and COG-C7 Flex vs. COG-C7 Ext (p = 0.000). Conclusion: There was statistical significance in relation to the positioning of the upper limbs in the lateral radiographs, yielding higher values in the angulations with the limbs raised towards the front (extended elbows). Level of evidence II; Prospective Comparative Study.

RESUMO Objetivo: Comparar o equilíbrio sagital cervical em grupos de pacientes submetidos a radiografias laterais do segmento cervical, com os membros superiores em duas posições distintas. Métodos: Trata-se de um estudo transversal, quantitativo, descritivo prospectivo por meio de análise radiográfica de 100 indivíduos adultos com idade entre 20 e 70 anos. Duas radiografias na incidência lateral foram obtidas de cada paciente, sendo uma imagem com os membros superiores cruzados sobre o tronco (cotovelos fletidos) e outra com os membros superiores elevados à frente (cotovelos estendidos). Todos os pacientes responderam a um questionário sobre idade, sexo, presença de dor na coluna cervical, assim como grau de dor baseada na escala de Likert. Os parâmetros radiográficos avaliados foram: ângulo de Cobb (Cobb), ângulo de entrada torácica (TIA), Inclinação de T1, Inclinação do pescoço (Necktilt) e distância do centro de gravidade (COG) do crânio até C7 (COG-C7) com cotovelos em flexão (Flet) e extensão (Est). Considerou-se o valor do p menor que 0,05 para a diferença estatisticamente significante. Resultados: Sessenta pacientes eram do sexo feminino (60%) e quarenta do sexo masculino (40%). A análise dos dados obtidos demonstrou significância estatística em Cobb Flet vs. Cobb Est (p = 0,000), TIA Flet vs. TIA Est (p = 0,000), T1 Flet vs. T1 Est (p = 0,000), Necktilt Flet vs. Necktilt Est (p = 0,000), COG-C7 Flet vs. COG-C7 Est (p = 0,000). Conclusão: Houve significância estatística com relação ao posicionamento dos membros superiores nas radiografias de perfil, evidenciando valores maiores nas angulações com os membros elevados para frente (cotovelos estendidos). Nível de evidência II; Estudo Prospectivo Comparativo.

RESUMEN Objetivo: Comparar el equilibrio sagital cervical en grupos de pacientes sometidos a radiografías laterales del segmento cervical, con los miembros superiores en dos posiciones distintas. Métodos: Se trata de un estudio transversal, cuantitativo, descriptivo, prospectivo por medio de análisis radiográfico de 100 individuos adultos con edad de entre 20 y 70 años. Fueron obtenidas dos radiografías en la incidencia lateral de cada paciente, siendo una imagen con los miembros superiores cruzados sobre el tronco (codos flexionados) y otra con los miembros superiores elevados al frente (codos extendidos). Todos los pacientes respondieron a un cuestionario sobre edad, sexo y presencia de dolor en la columna cervical, así como el grado de dolor basado en la escala de Likert. Los parámetros radiográficos evaluados fueron: ángulo de COBB (Cobb), ángulo de entrada torácica (TIA), Inclinación de T1, Inclinación del cuello (Necktilt) y distancia del centro de gravedad (COG) del cráneo hasta C7 (COG-C7) con codos en flexión (Flet) y extensión (Est). Se consideró el valor del p menor que 0,05 para la diferencia estadísticamente significativa. Resultados: Sesenta pacientes eran del sexo femenino (60%) y cuarenta del sexo masculino (40%). El análisis de los datos obtenidos demostró significancia estadística en Cobb Flet vs Cobb Est (p = 0,000), TIA Flet vs TIA Est (p = 0,000), T1 Flet vs T1 Est (p = 0,000), Necktilt Flet vs Necktilt Est (p = 0,000), COG-C7 Flet vs COG-C7 Est (p = 0,000). Conclusión: Hubo significancia estadística con relación al posicionamiento de los miembros superiores en las radiografías de perfil, evidenciando valores mayores en las angulaciones con los miembros elevados al frente (codos extendidos). Nivel de evidencia II; Estudio Prospectivo Comparativo.

[Design and validation of a balance test with context characteristics for older adults]. / Diseño de una prueba de equilibrio con características contextuales para adultos mayores.

BACKGROUND: Balance impairment is multifactorial in older adults and increases risk of falls in this population. There are tests to evaluate balance; nevertheless, they are focused on the evaluation of a single task, in static environments, without representing postural control demands in everyday life situations, such as person interaction-context and multi-tasking activities. OBJECTIVES: Design and validate a balance test with ecological validity for older adults. MATERIALS AND METHODS: A mixed data collection methodology was developed, with an exploratory sequential DEXPLOX methodological design derived from a DITRIAC concurrent triangulation design. RESULTS: The results from the first 3phases permitted constructing the items of the balance assessment test to, then, conduct the first validation by experts, determining a Fleiss' kappa of 0.4 and a Lawshe content validity ratio of 0.95. The second validation by experts yielded as a result in face validity an excellent strength of inter-rater agreement and a Lawshe content validity ratio of 0.95 in relevance and 0.97 in pertinence. CONCLUSIONS: The test designed showed strong characteristics of ecological validity and can be applied to older adults, given that it includes items requiring somatosensory responses, like those performed in activities of daily living and items with cognitive dual task activities used in daily routines.

[Posturographic and oculomotor findings in the first 24 hours after whiplash]. / Alteraciones posturográficas y oculomotoras en las primeras 24 horas tras un latigazo cervical.

INTRODUCTION AND OBJECTIVES: Instability is a frequent symptom after whiplash (WL) with alterations in postural control in chronic phases. The main objective of our study was to evaluate if there were objective alterations in postural control in the acute phases after a WL, as well as to determine the presence or absence of oculomotor alterations in early phases. MATERIAL AND METHODS: A posturographic study was carried out using the NedSVE/IBV system, as well as an oculomotor assessment, in a sample of 44 patients with WL in the first 24h after the accident. RESULTS: More than half of the patients had a global assessment below normal. The predominant sensory pattern was vestibular. The main parameters of the Romberg test (total displacement, swept area, average speed, anteroposterior and mediolateral displacement and anteroposterior force) increased following the sequence Romberg open eyes, Romberg foam rubber open eyes, Romberg closed eyes, and Romberg foam rubber closed eyes. Concerning the comparison with normality and using the reference values of the Institute of Biomechanics of Valencia, the data from the WL patients showed significant differences in all the parameters analysed, except for gait assessment and the mediolateral directional rhythmic control. CONCLUSIONS: Our data confirm that patients in the acute phase of WL have worse postural control than non-injured persons. The results suggest that patients with WL have greater visual dependence. Only a minority of patients had oculomotor abnormalities during early examination.

Efficacy of Vestibular Rehabilitation in Patients With Neurologic Disorders: A Systematic Review.

OBJECTIVE: The aim of this systematic review is to critically assess the effectiveness of vestibular rehabilitation (VR) administered either alone or in combination with other neurorehabilitation strategies in patients with neurologic disorders. DATA SOURCES: An electronic search was conducted by 2 independent reviewers in the following databases: MEDLINE (PubMed), the Physiotherapy Evidence Database, and the Cochrane Database of Systematic Reviews. STUDY SELECTION: All clinical studies carried out on adult patients with a diagnosis of neurologic disorders who performed VR provided alone or in combination with other therapies were included. DATA EXTRACTION: Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using a modified version of the Newcastle-Ottawa Scale. DATA SYNTHESIS: The summary of results was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Twelve studies were included in the review. All the included studies, with 1 exception, report that improvements provided by customized VR in subject affected by a central nervous system diseases are greater than traditional rehabilitation programs alone. CONCLUSIONS: Because of the lack of high-quality studies and heterogeneity of treatments protocols, clinical practice recommendations on the efficacy of VR cannot be made. Results show that VR programs are safe and could easily be implemented with standard neurorehabilitation protocols in patients affected by neurologic disorders. Hence, more high-quality randomized controlled trials of VR in patients with neurologic disorders are needed.