Fall prevention among older adults: Case reports exemplifying the value of incorporating lumbar stabilization training during balance exercises

P Van Der Merwe,M.A Wilmarth

doi:10.4102/sajp.v69i3.30

Abstract

Background: Older adults are at risk of fallingeach year. Fall injuries results in many health care expenses anddisabilities, yet non-western countries lack the infra-structure andresources for prevention programs. Balance exercises have beenfound to be a cost effective evidence-based intervention in treatingand preventing falls among older adults in western countries.Purpose: The aim of this report was to show that lumbar stabilizationexercises are not only a beneficial addition to a balanceprogram for the prevention and treatment of falls in older adults,but to demonstrate that these exercise can more rapidly improve thefunctional status of older adults, limiting healthcare costs.Case description: Two high functional older adults with a historyof falls presented with poor balance and fear of falling. Both patientsreceived the same balance exercise regime however lumbar stabilization exercises were added to one of the patient’s exerciseprograms. Gait speed, lower extremity strength and balance were assessed with the Balance Evaluation systems test (BESTest),figure-of-eight, four-step-square (FSST), five-time-sit-to-stand tests (5TSTS) after two weeks and four weeks of treatment.Outcomes. All the outcome measures showed statistically significant improvements. Greater improvements in vertical stabilitylimits (14%), gait speed (9%), stability during gait (20%) and five-time-sit-to-stand test were seen with the addition of lumbarstabilization exercises.Discussion. The addition of lumbar stabilization exercises during balance training is of value to improve gait speed, balancetesting scores in stability in gait and vertical stability limits.

Highlights

Older adults are at risk of falling each year
The aim of this study was to demonstrate the value of additional lumbar stabili zation exercises during fall prevention balance training to lower fall risk
The single p-value statistical difference between the patients was calculated with the Friedman test and Chi square approximation

Summary

Introduction

Older adults are at risk of falling each year. Fall injuries results in many health care expenses and disabilities, yet non-western countries lack the infra-structure and resources for prevention programs. Case description: Two high functional older adults with a history of falls presented with poor balance and fear of falling. Both patients received the same balance exercise regime lumbar stabilization exercises were added to one of the patient’s exercise programs. Balance training is a cost effective fall prevention intervention in western societies (Madureira et al 2007). Additional lower extremity exercises improved center of pressure velocity, sensory interaction during balance, directional control, lower extremity strength and stability limits (Burke et al 2010). Evidence-based alternative balance training like Tai chi improves functional balance, directional control and walking velocity during gait, and postural stability (Li et al 2010). Postural stabi lity especially plays an important role in controlling and improving changes in spinal load transfer patterns during perturbation (Muthukrishnan et al 2009)

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