Role of spine in falls: Prevention of falls and unsteadiness of gait through reeducation of proprioceptors of vertebral facet joints

Abstract

The aim of this study was to determine the outcome of dynamic counterstrain and proprioceptive stimulation of specific vertebral facet joints to achieve reduction in risk of falls by reducing gait unsteadiness. Two groups were studied. Group A consisted of 39 patients who had gait disorder and propensity to falls, referred for fall prevention. All had comprehensive musculoskeletal and neurological evaluations. Subjects in this group were not able to return for follow up due to the distance from our institution. They all signed the consent form and were videotaped. Group B consisted of twelve subjects who were able to return for follow up and all underwent 2 supervised training sessions in our outpatient clinic. They had formal laboratory gait analysis and computerized dynamic posturography at baseline and follow up. They were instructed for a 4-week spinal proprioceptive extension exercise dynamic (SPEED) program to be performed at home with use of a weighted kypho-orthosis (WKO). The WKO applied properly accentuates a patient's perception of spinal joint position. All subjects had the trial of spinal proprioceptive extension exercise dynamic (SPEED) program. Results of Gait lab analysis, computerized dynamic posturography, strength evaluation or videotapes were reviewed. Group A was videotaped before and after SPEED and displayed noticeable improvement to their surprise. Group B, after a 4-week intervention, showed a significant change in balance ( P = .003) and several gait parameters ( P < .05). Mean back extensor strength improved significantly from baseline (144.0 ± 46.5 N) to follow-up (198.6 ± 55.2 N; P < 00l). Gait and risk of falls improved significantly after trial of SPEED program for reeducation of proprioception by application of mechanical counterstrain to specific areas of spine. This method of intervention might potentially lead to novel investigations for managing patients with unsteadiness of gait and propensity to falls.