Decrease Fall Risk Research Articles

First‐line antidepressants decrease fall risk in elderly with depression

A cohort study examining Medicare data has found that use of first‐line antidepressants was associated with decreased risk of falls compared with no treatment in older adults with depression. Psychotherapy was found not to increase risk of falls in the population with depression.

Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review.

Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.

Fall Prevention Model at Local Non-Profit Equipment Exchange Program Utilizing the STEADI: a Compilation of Two Pilot Studies

Abstract Individuals picking up gently used durable medical equipment (DME) from a local non-profit equipment exchange program in Erie, Pennsylvania were prompted with the CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) 3-item abbreviated questionnaire and contacted by telephone 6 months later to assess if this survey tool can accurately predict falls. Individuals were also given a STEADI pamphlet upon equipment pickup to educate community members on fall risk. Ninety individuals, who ranged from caregivers to the individual themselves, chose to participate in the follow-up research phone call. Our researchers found that while the abbreviated 3-item STEADI suggested that 80% of community members (in need of DME by way of an equipment exchange program) were predicted to be at risk for a fall, only 22.5% suffered a fall within a six-month follow-up period. This questions the validity of the 3-item abbreviated STEADI, though additional studies are recommended to improve the participant percentage (only 90 out of 255 individuals, or 35%, answered the follow-up call questions) as well as increasing the length of wait time to assess for subsequent fall incident beyond six months. Additionally, only 34% of individuals recalled receiving a pamphlet when picking up equipment, and of those 31 individuals, only 10 of them (32%) remembered what the pamphlet said. This suggests that the simple use of a brochure handout to decrease fall risk amongst community-dwelling adults does not seem to be an effective educational strategy within the Erie, PA community.

Associations among frailty status, hypertension, and fall risk in community-dwelling older adults

ObjectivesFrailty and hypertension often coexist in older adults, which may lead to fall risks. This study aimed to examine the relationship between frailty status, hypertension, and fall risk. MethodsIn this cross-sectional study, a total of 401 older adults were conveniently recruited from communities in Wuxi, China, between September 2022 and November 2022. The fall risk self-assessment checklist from the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Toolkit was used to evaluate their fall risks. The FRAIL scale questionnaire was used to assess frailty status. Participants’ demographic information and comorbidities were collected. Multivariate logistic regression, generalized additive model, and smooth curve fitting were used to analyze the association between frailty, hypertension, and fall risk. ResultsFrailty had a strong association with increased prevalence of fall risk among the participants (OR 8.52, 95% CI 3.21–22.57; P < 0.001). Hypertension significantly increased the fall risk among older adults (OR 1.87, 95% CI 1.11–3.13; P = 0.019). The group with hypertension and frailty had the highest prevalence of fall risk (OR 12.24, 95% CI 3.51–42.65). Smooth curve fitting showed a nonlinear association between frailty and fall risk in hypertension status. In the progress of pre-frailty to frailty status, a higher tendency to fall was found among older adults with hypertension. ConclusionsFrailty status and hypertension independently and jointly influenced the increased prevalence of fall risk. Enhanced frailty and hypertension management may help decrease fall risk among this population.

Development of a statistical analysis software for determining effectiveness of a comprehensive fall risk management protocol

IntroductionAs the leading cause of fatal injuries in geriatric populations, falls are a serious health concern with a predicted rate of seven fall-related deaths per hour by 2030. The Timed...

EFFECTIVENESS OF TANDEM EXERCISE ON RISK OF FALL AMONG OLDER PEOPLE

The older people population in Indonesia is predicted to continue to increase over the year. Increasing the number of older people will be a challenge for all. Older people might have decreased in the physiological body, especially in balance control such as changes in posture, changes in muscle strength, and visual decline. Balance disorder will increase the risk of falls caused and may result in the elderly being more susceptible to various diseases. Balance exercise such as Tandem Exercise is one way to reduce risk of fall. This research aimed to find out the effect of Tandem exercises on the risk of falling on the older people in Yogyakarta. This research was a Quasy Experimental study With Non-Equivalent Control Group Research Design. Samples of this study were 36 older people trough purposive sampling technique and divided into two groups. Group 1 was given 15 minutes Tandem exercise, every day in two weeks. Group 2 was a control group. The risk of fall was measured by The Time Up and Go Test. This study found that mean score of group 1 was decrease after intervention. This study also found that there was no significant different mean score of fall risk between two groups before intervention (p&gt;0,05), meanwhile there was a significant different mean score after intervention (p&lt;0,05). A significant different on risk of fall score before and after intervention also found in group 1 (p&lt;0,05). In conclusion, health care provider should facilitate older people to participate in balance exercise such as Tandem exercise actively to decrease fall risk among older people.

Psychometric properties of Fullerton Advanced Balance Scale in patients with stroke

ABSTRACT Background Patients experience falls frequently after stroke. Preserved or acquired balance skills decrease fall risk and improve independence. Feasibility of Fullerton Advanced Balance Scale (FAB) has been shown in balance assessment in some neurological diseases except stroke. Objectives The purpose of this study was to investigate the reliability and validity of Turkish version of FAB (FAB-T) in patients with stroke (PwS). Methods This cross-sectional study included 51 PwS (60.64 ± 7.66 years). Reliability analyses were conducted with Cronbach’s alpha, intraclass correlation coefficient (ICC), and Spearman correlation analysis. Intra-rater and inter-rater reliability were assessed with three raters. FAB-T, Stroke Rehabilitation Assessment of Movement (STREAM), Brunnstrom Recovery Stages (BRS), Barthel Index (BI), and 36-Item Short Form Health Survey (SF-36) were used for convergent validity. Correlations of FAB-T with Berg Balance Scale (BBS) and Mini-Balance Evaluation Systems Test (Mini-BESTest) were measured for concurrent validity. Spearman correlation analysis was used for convergent and concurrent validity. For predictive validity patients’ self-reports of falling were analyzed with ROC. Results Intra-rater (ICC = 0.998) and inter-rater reliability (ICCs = 0.984; 0.984; 0.990), and internal consistency (Cronbach’s alpha = 0.930) were excellent. FAB-T had good correlations with STREAM (ρ = 0.677) and BI (ρ = 0.628), moderate correlations with BRS (ρ = 0.504 and ρ = 0.579) and physical function of SF-36 (ρ = 0.436). FAB-T excellently correlated with Mini-BESTest and BBS (ρ = 0.928 and ρ = 0.942). The cutoff score of FAB-T was determined to be 21.5 points, with sensitivity of 84% and specificity of 61% (AUC = 0.749). Conclusions FAB-T is a reliable and valid balance assessment tool with an acceptable accuracy of fall prediction in PwS.

Neurological Exam Findings Predictive of Falls in Patient’s with Parkinson’s Disease (P10-11.011)

<h3>Objective:</h3> To investigate the relationship between various neurological exam findings and number of falls in patients with Parkinson’s Disease <h3>Background:</h3> Parkinson’s Disease (PD) has significant effect on patient ability to ambulate. Difficulty in ambulating is often associated with patient falls. Findings of various studies estimate that 38 to 87% of patients with PD experience falls. A history of previous falls, disease duration, and dementia have been identified as independent predictors of falling in PD patients. As patient falls can result in detrimental consequences, such as fractures or head trauma, identifying patients at increased risk of falls is essential. This study sought to examine if components of the neurological exam were associated with an increased number of patient falls. <h3>Design/Methods:</h3> Data regarding neurological exam findings and reported number of patient falls were extracted from the most-recent visit of 242 patients charts at a single treatment center. All neurological exams were completed by one movement disorder specialist. Statistics were calculated using SPSS. <h3>Results:</h3> A higher UPDRS gait score was associated with an increased number of falls (beta=.62, p=.005). A gait score of 0 predicted 2.32 falls/month. A gait score of 4 predicted 8.16 falls/month. A higher UPDRS postural instability score was also associated with a higher number of falls (beta=0.42, p=.003). A instability score of 0 predicted 1.33 falls/month. An instability score of 4 predicted 8.42 falls/month. Utilizing the revised neuropathy disability score, PD patients with a clinical diagnosis of neuropathy did not have more falls than patients without neuropathy (p=0.537). <h3>Conclusions:</h3> Various components of the UPDRS neurological exam can be utilized to discuss fall risk with patients and guide actions to decrease fall risk. Although neuropathy on its own is a predictor of fall risk, it did not result in an additional need to address fall risk in our PD patient population. <b>Disclosure:</b> Miss Valerius has nothing to disclose.

Beyond vision:Cataract and health status in old age, a narrative review.

Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.

Risk of Falls Associated with Sedative-Hypnotics in Polymedicated Older Patients

Introduction and Objective: To investigate whether reducing the use of ≥2 benzodiazepines and Z–drugs (BZD-Z) to ≤1 was associated with a decreased fall risk in polymedicated and elderly patients. Material and Methods: Prospective observational study to compare the fall risk in patients that remained taking 2 or more BZD-Z with those who tapered to 1 or none BZD-Z. Subjects were polymedicated patients, ≥65 years with concomitant use of ≥2 BZD-Z who received primary care in health centres. Main Measures: time to fall (Kaplan- Meier, Cox-regression model, multivariate analysis). Analyses was adjusted for confounder variables such as health problems and other treatments. Results: A total of 228 patients taking BZD-Z were followed during 1,085 days. Patients using ≥2 BZD-Z had 2.76 times (95%CI:1.34-5.68; p=0.006) greater risk of fall at any moment of the follow-up than those taking ≤1 BZD-Z. Antidepressants and oral corticosteroids were the other specific medication classes that showed a greater risk of fall:1.99 (95%CI:1.17-3.41; p=0.011) and 2.34 (95%CI:1.13-5.07; p=0.023), respectively. The Kaplan-Meier method revealed a significant increase of fall risk for patients continuously taking ≥2 BZD-Z compared with those intermittently taking ≥2 BZD-Z or taking ≤1 BZD-Z (p=0.008). Those patients concurrently using ≥2 BZD-Z and antidepressants showed a tendency to an increased fall risk (p&lt;0,043). Conclusions: Reducing the number of BZD-Z to below 2 is associated with a reduced fall risk. The concomitant BZD-Z use with antidepressants is associated with an increased fall risk in polymedicated elderly patients.

INFUSION OF AGE-FRIENDLY PRINCIPLES INTO CURRICULA USING INTERACTIVE MODULES

Abstract This presentation highlights the development of Age-Friendly care interactive modules to prepare the future healthcare workforce to care for older adults in Age-Friendly Health Systems. To date, there is a gap in the educational preparation of nurses, advanced practice nurses, and other health professionals to work in Age-Friendly Health Systems upon entry into practice. This project, funded by a faculty innovation grant at Seton Hall University, provides undergraduate and graduate nursing and interprofessional students with the background knowledge to care for older adults in Age-Friendly Health Systems. The aim of this project was to develop five interactive modules to embed in undergraduate and graduate nursing and interprofessional curricula focusing on the provision of care to older adults using the evidence-based 4Ms Framework: What Matters, Medication, Mentation, and Mobility. Faculty collaborated with instructional designers in development of the modules using Articulate 360 to embed them in curricula. The first module focuses on the background of the Age-Friendly Health Systems movement, how health systems may become an Age-Friendly Health System, and the evidence for the 4Ms Framework. The second module focuses on assessment and act on strategies related to What Matters to older adults including advance care planning strategies. The third module covers crucial information related to Medication such as avoiding potentially inappropriate medications, deprescribing, and antibiotic stewardship. The fourth module focuses on Mentation and covers assessment and act on strategies for depression, delirium, and dementia. The fifth module focuses on Mobility such as promoting mobility and decreasing fall risk.

The Effectiveness of the Otago Exercise Program on Fall Prevention in Rural-Dwelling Older Adults

<h3>Research Objectives</h3> To develop a sustainable, outcomes-based fall prevention program for rural Michigan older adults using the evidence-based Otago Exercise protocol in collaboration with community-based agencies serving older adults. <h3>Design</h3> Rural dwelling older adults have a higher prevalence of falls compared to non-rural older adults. In Michigan, Over 26% of older adults live in rural communities. Additionally, Isabella, Clare, and Gratiot counties are designated as medically underserved. Otago Exercise protocol is implemented to provide free fall prevention education resources to reduce falls and promote independence. Participants are screened before beginning the exercise protocol and complete balance assessments at baseline, three, six, nine, and twelve months to assess strength and balance as an outcome. <h3>Setting</h3> Classes are instructed by exercise trainers virtually via Zoom and at sites across Isabella, Clare, and Gratiot counties. <h3>Participants</h3> Criterion for inclusion are age 60 years or older, low to moderate assessed fall risk and living independently in the community. There are 68 participants enrolled in the program. <h3>Interventions</h3> Evidence-based Otago Exercise Program that incorporates seventeen strength and balance exercises over a year. <h3>Main Outcome Measures</h3> The primary outcome measurement is the comparison of baseline balance assessment to progression throughout the program. Score averages of the participants' peer group are utilized to analyze results. Below average scores indicate increased fall risk. <h3>Results</h3> Assessment of the Otago protocol utilizes the three-step balance assessment consisting of the Chair Stand Test, Four-Stage Balance Test, and Timed Up-and-Go. After six months of the program, average improvement of about 29.40% in the Four-Stage Balance Test, 2.40% in the Timed Up-and-Go test, and 20.30% in the Chair Stand test has been shown. <h3>Conclusions</h3> Results from participants who have completed six months within the program show improvement on balance assessment scores. It can be concluded that compliance with the Otago Exercise Program results in increased balance in participants and overall decreased fall risk. <h3>Author(s) Disclosures</h3> This program received funding from Region VII Area Agency on Aging. Institutional IRB provided a determination of "not research". We are declaring no conflicts of interest.

Predictors of Falls in Community Dwelling Ambulatory Stroke Survivors

<h3>Research Objectives</h3> To investigate depression, sleep, and physical activity as predictors of falls in community dwelling stroke survivors. <h3>Design</h3> Retrospective survey from a national cohort of community dwelling stroke survivors. <h3>Setting</h3> Data set from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) health-related telephone survey, gathering geographically proportional data across the United States. This is the most recent dataset available. <h3>Participants</h3> 13,179 community dwelling stroke survivors. <h3>Interventions</h3> Presence or absence of depressive disorder; presence or absence of sleep deficit (under 7 hours per 24 hour period); presence or absence of regular physical activity. <h3>Main Outcome Measures</h3> Survey questions: "In the past 12 months, how many times have you fallen?"; "Were you ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression"; "Do you get 7 or more hours of sleep in a 24-hour period"; and "In the past month have you participated in regular physical activities or exercises such as ...". <h3>Results</h3> Data were obtained from the Centers for Disease Control and Prevention. Descriptive statistics and chi-square analyses were applied. Stroke survivors were significantly more likely to have sustained a fall in the previous 12 months compared to those who had not had a stroke (OR = 2.3, 95% CI 2.2-2.4, p < 0.001). Stroke survivors who engaged in physical activity were less likely to sustain a fall (OR = 0.94, 95% CI 0.93-0.95, p < 0.001). Stroke survivors with a depressive disorder were more likely to fall (OR = 2.6, 95% CI 2.4-2.8, p < 0.001), and stroke survivors that averaged less than 7+ hours of sleep in a 24-hour period were more likely to fall (OR = 1.5, 95% CI 1.4-1.6, p< 0.001). <h3>Conclusions</h3> Inadequate sleep and physical activity, as well as presence of depressive disorders, were found to be predictors of falls in community dwelling stroke survivors. Post-stroke rehabilitation programs should address depressive disorders, physical activity, and sleep. Optimizing mental health management and supporting regular engagement in physical activity and sleep may decrease fall risk. <h3>Author(s) Disclosures</h3> None.

Changes in Gait Self-Efficacy, Fear of Falls, and Gait Four and Eight Months after Bariatric Surgery.

After bariatric surgery, individuals improve walking characteristics related to fall risk. However, little is known about psychosocial factors, such as gait self-efficacy and fear of falling, after surgery. Our objectives were to (1) examine how weight loss affects psychosocial factors and gait four and eight months after bariatric surgery, as well as (2) determine if there is a relationship between gait self-efficacy and fear of falling. Fourteen adults scheduled to undergo bariatric surgery completed three visits: before surgery, four and eight months after surgery. Gait self-efficacy was measured with the Modified Gait Efficacy Scale, and fear of falls was measured with the Tinetti Falls Efficacy Scale. Gait measures were collected during five conditions: initial baseline and final baseline on flat ground, and crossing obstacles of three heights. Gait self-efficacy or fear of falling did not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower fear of falling were correlated with longer and faster steps during all conditions (all ps < 0.05). Focusing interventions on psychosocial measures related to gait may yield longer lasting improvements in walking after surgery, ultimately resulting in a decreased fall risk and higher quality of life.

The role of comprehensive geriatric assessment in predicting fall risk.

The prevention of falls among older adults is one of the most important public health issues in today's aging society. There are many factors significantly affecting the risk of falls. This study aimed to investigate the factors on fall risk in older adults. A total of 335 elderly outpatients aged 65 and over were included in this cross-sectional study. Comprehensive geriatric assessment was performed on the participants. Tinetti Balance and Gait Assessment Tool (TBGA) and Mini-Mental State Examination (MMSE) were used to assess fall risk and cognitive functions, respectively. The mean age of 335 participants was 72.1 ± 6.0years and 55.2% was female. Of the participants, 40.6% had a moderate-high fall risk according to TBGA and 31.6% had a history of falls within the last year. Although there was no significant difference in MMSE results between the medium-high fall risk group and the low fall risk group, higher MMSE attention and calculation domain score was found to be an independent variable for decreased fall risk and sarcopenia for increased fall risk (p = 0.039, OR = 0.70 and p = 0.037, OR = 3.43, respectively). The role of sarcopenia in fall risk is well established. In this study, we also showed that attention and calculation play important roles in fall risk. Elderly individuals with low scores in attention and calculation domains need a more detailed assessment in terms of fall risk, even if cognitive functions are considered normal according to the MMSE.

Fall arrest strategy training improves upper body response time compared to standard fall prevention exercise in older women: A randomized trial

Introduction Exercise can decrease fall risk in older adults but less is known about training to reduce injury risk in the event a fall is unavoidable. The purpose of this study was to compare standard fall prevention exercises to novel Fall Arrest Strategy Training (FAST); exercises designed to improve upper body capacity to reduce fall-injury risk in older women. Method Forty women (mean age 74.5 years) participated in either Standard (n = 19) or FAST (n = 21) twice per week for 12 weeks. Both interventions included lower body strength, balance, walking practice, agility and education. FAST added exercises designed to enhance forward landing and descent control such as upper body strengthening, speed and practice of landing and descent on outstretched hands. Results Both FAST and Standard significantly improved strength, mobility, balance, and fall risk factors from pre to post-intervention. There was a significant time by group interaction effect for upper body response time where FAST improved but Standard did not (p = 0.038). Discussion FAST resulted in similar gains in factors that reduce fall risk as a standard fall prevention program; with the additional benefit of improving speed of arm protective responses; a factor that may help enhance landing position and reduce injury risks such as head impact during a forward fall.

Use of real-time multimodal sensory feedback home program improved backward stride and retention for people with Parkinson Disease: A pilot study

IntroductionParkinson disease (PD) impairs sensory integration, contributes to motor dysfunction, loss of gait automaticity, and increased fall risk. Employing multimodal sensory feedback (MMSF) has the potential to improve proprioceptive integration and gait safety while reducing exercise burden especially for backward gait. MethodsThis single-blinded, randomized controlled pilot study used a home program with or without real-time visual, proprioceptive, and auditory feedback with stepping exercises which progressed in speed and distance. Both groups completed a six-week intervention followed by 6 weeks without exercise to assess long-term retention. Six additional weeks of exercises were completed to assess recovery of potential losses after the washout session.Eleven people with PD exercised with real-time MMSF and 7 exercised without MMSF. Outcome measures included backward stride length, velocity, cadence, and double support time. The Dual Timed Up and Go measured automaticity. Self-perceived improvements in gait, activities of daily living, participation, and quality of life were registered by a questionnaire. ResultsAnalysis was by repeated measures ANOVA. Using MMSF significantly improved backward stride length at 12 and 18 weeks, p = .007, η2 = 0.239. Both groups improved in all outcome measures after the initial 6-week exercise program, supporting efficacy of stepping exercises. The MMSF + ex group's significant improvements after a 6-week washout supported automaticity development. Questionnaire items received higher agreement percentages from MMSF + ex participants. ConclusionUsing real-time MMSF in a home program for pwPD provided significant and lasting improvements in backward stride, and potentially decreased fall risk and exercise burden compared to the same program without MMSF.

THE EFFECT OF TAI CHI ON BALANCE IN WOMEN WITH OR AT RISK OF OSTEOPOROSIS: A SYSTEMATIC REVIEW

Background: As women age, hormone levels change and put them at increased risk for osteoporosis. Tai Chi is a weight bearing exercise intervention that incorporates balance. Balance training and weight bearing exercises have both been shown to be beneficial to those with or at risk of osteoporosis by benefiting bone mineral density and decreasing fall risk. Objective: The purpose of this systematic review is to determine whether Tai Chi is an effective intervention for improving balance in women with or at risk for osteoporosis. Methods: A search of PubMED and EMBASE databases was completed using search terms related to osteoporosis, Tai Chi, and balance, and was limited to randomized control trials, clinical trials, and research articles. The authors screened the resultant studies by title, abstract, and full text. In order to qualify for inclusion in this study, articles must have had a measure for balance before and after intervention, Tai Chi as an intervention, and women 45 or older as study subjects. Five studies were assessed for quality using the PEDro Scale and one study was assessed using the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Results: Six articles remained for inclusion in the review after screenings. Four out of six studies reported significant differences in at least one balance outcome measure post-intervention. Studies that had longer intervention periods resulted in more significant findings in the outcome measures of interest. Conclusion: Results from this systematic review suggest that Tai Chi may have positive effects on balance in women with or at risk of osteoporosis. Further research is recommended due to the heterogeneity of balance outcome measures, as well as length of intervention, with some studies indicating that longer intervention periods may increase benefits of Tai Chi.

Efficacy of C-Mill gait training for improving walking adaptability in early and middle stages of Parkinson’s disease

BackgroundWalking adaptability is an obvious manifestation of Parkinson’s disease (PD). Augmented reality technologies such as interactive walkways may improve walking adaptability in patients with Parkinson’s Disease (PWP). Research questionHow effective is C-Mill gait adaptability training in the early and middle stages of PD for improving walking adaptability in motor subtypes of the disease? MethodsFifty-two patients with early- or middle-stage PD were divided into two groups according to motor subtype (postural instability/gait disorder [PIGD] and non-PIGD) and received 7 days of training (0.5 h every day, 2 h after medication) on an augmented reality treadmill with built-in visual targets and obstacles. Functional assessments were performed before and after intervention, including posture control and walking, C-gait assessment, and participant experience. The Parkinson Disease Quality of Life questionnaire was administered at 3-month follow-up. ResultsBoth the PIGD (n = 29) and non-PIGD (n = 23) groups showed improved tandem walking, obstacle avoidance, and overall score in C-gait assessment and Timed Up and Go test after C-Mill training. However, there were no differences between the two groups. The PIGD group showed improvement in visually guided stepping and Speed adaptations, whereas the non-PIGD group did not improve. The non-PIGD group reported they could complete the training with less exertion after the intervention and at the 3-month follow-up, these patients reported improvement in quality of life. SignificanceC-Mill gait adaptation training in the early and middle stages of PD improves walking adaptability in both motor subtypes. Cue strategies are the probable mechanism and may decrease fall risk after training. There was no difference between the groups in the improvements of perceived exertion and quality of life at follow-up. Although PIGD patients showed statistic improvements in visually guided stepping compared with non-PIGD patients, but the difference was not likely to be clinically meaningful. Specific effects of C-mill training for different types of PD were not observed in our study.

Yoga Balance: Decreasing Fall Risk in Seniors

<h3>Research Objectives</h3> To investigate the effect of yoga in decreasing fall risk for activities of daily living and community mobility in the senior population thru occupational therapy. <h3>Design</h3> Basic yoga poses related to primal movement were selected/ executed with NDT techniques; 1 year. <h3>Setting</h3> Continuing Care Retirement Community(CCRC). <h3>Participants</h3> 10 clients with inclusion criteria of age 80+, live in the CCRC, can include co-morbidities, joint replacements accepted. <h3>Interventions</h3> Example of pose: horse stance was selected because as children we have a wide base of support with hips in external rotation and equine stance. Overtime this integrates to a narrower base of support, external/ internal rotation equalizes, and equine stance becomes plantar. Utilizing poses that follow typical patterns allows for neuro plasticity to engage in a way it has before enhancing the progression of decreased fall risk as it relates to ADL's. Alignment is key when addressing posture and fall risk in occupational therapy as well as in Iyengar yoga. Used handling techniques, visual work (mirror), and verbal cueing. Cues were a combination of OT and yogic cues to create proper alignment. Handling promoted neck retraction, scapular depression/ stabilization, shoulder/ pelvic girdle anterior alignment, and knee/ ankle alignment. <h3>Main Outcome Measures</h3> Tinetti: scores increased by an average of 11 points. <h3>Results</h3> When used as an individual therapeutic intervention yoga postures with NDT regressive handling techniques increases the Tinetti score by an average of 11 points; proving a marked decrease of fall risk for ADL's in seniors. Secondary outcomes that were reported by patients included scoliosis curvature decrease, bladder control improvement, and an increased ability to orgasm. <h3>Conclusions</h3> With an average number of Tinetti score improvement by 11 for the total of 10 clients with no regression this study does prove that yoga is effective in decreasing fall risk in seniors. Due to our results we believe expanded studies utilizing yoga as an individualized intervention during therapy sessions is necessary to promote decreased fall risk in elderly patients. <h3>Author(s) Disclosures</h3> N/A.