Decrease Fall Risk Research Articles

V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial

BackgroundRecent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits. Indeed, everyday walking in complex environments utilizes executive function, dual tasking, planning and scanning, all while walking forward. Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction. The proposed randomized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk.Methods/DesignThree hundred older adults with a history of falls will be recruited to participate in this study. This will include older adults (n=100), patients with mild cognitive impairment (n=100), and patients with Parkinson’s disease (n=100). These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits. Subjects will be randomly assigned to the intervention group (treadmill training with virtual reality) or to the active-control group (treadmill training without virtual reality). Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks. Assessments will take place before, after, and 1 month and 6 months after the completion of the training. A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence (i.e., the number of falls, multiple falls and falls rate). In addition, we will measure gait under usual and dual task conditions, balance, community mobility, health related quality of life, user satisfaction and cognitive function.DiscussionThis randomized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality reduces fall risk, improves mobility and enhances cognitive function in a diverse group of older adults. In addition, the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit.Trial Registration(NIH)–NCT01732653

Prevention of falls in the elderly—a review

The proportion of elderly in the society increases and fall frequency increases with advancing age. Many falls result in fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, increased mortality, and excess in healthcare costs. Due to the magnitude of these negative effects, a variety of single- and multicomponent fall-preventive intervention programs has been initiated.This review identifies programs that, in randomized controlled trials (RCTs), have been shown with fall-reductive effects.The most effective strategies in community-dwelling elderly include regular physical training with program that includes several different training modalities. Modification of the overall or patient-specific risk factor profile in home hazard modification program has been proven to decrease fall risk in community-living elderly. The elderly in the community benefit also from wearing antislip shoe devices when walking in icy conditions, from adjustment of psychotropic medication, and from structured modification of multipharmacy. If vitamin D levels in blood are low, supplementation is beneficial as is the first eye cataract surgery and pacemaker implantation in patients with cardioinhibitory carotid sinus hypersensitivity. In addition to modification of specific risk factors, generalized and individualized multifactorial preventive programs, all including some sort of physical training, have been found to decrease the fall risk. In summary, there is now strong evidence in the literature that structured fall-preventive programs in the elderly, especially in high-risk groups, are beneficial in reducing both the number of fallers and the number of falls in community.

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.

地域在住高齢者における抑うつと転倒リスクの関連

To investigate the relationship between depression and fall risk in the elderly. Residents of a village in Kumamoto Prefecture, Japan (563 people), aged ≥65 years were given a self-administered questionnaire survey between June and July 2010. To evaluate depression status and fall risk, the Geriatric Depression Scale--Short Form and the Simple Screening Test for Risk of Falls were administered. Adjustment factors assessed were age, sex, medical history for diseases associated with falls, usage of hypnotics, and cognitive dysfunction. We examined the relationship between depression and fall risk using multiple logistic regression analysis. Given that some degree of correlation was expected among adjustment factors in the model, we constructed a model that introduced the adjustment factors stepwise to confirm the robustness of the model and any effect of multicollinearity. Overall (n=395), after excluding data from participants with significant cognitive disturbance or severe physical problems from among valid responders, a significant relationship was found between depression and fall risk in all models. The odds ratio was 2.28 (95% confidence interval: 1.31-3.96) in the final model, controlling for all adjustment factors. Our findings suggest a significant relationship between depression and fall risk in the elderly. This relationship implies that the improvement of depression could be an effective measure to decrease fall risk in the elderly.

Platform Tilt Perturbation as an Intervention for People With Chronic Vestibular Dysfunction

Training to improve responses to perturbations may be beneficial for individuals with unilateral vestibular dysfunction. We evaluated the effects of an incrementally increasing surface tilt perturbation intervention for individuals with chronic vestibular pathology on gait, activities of daily living, and dizziness. Participants (n = 29) were randomly assigned to 1 of 3 groups. The first group received random surface tilt perturbations of increasing angles and speed, half of the trials with vision-occluding goggles, 3 times weekly for 3 weeks (P group). The second group received tilt perturbation intervention (as above) plus a home program of vestibular rehabilitation exercises (P+EX group). The third group performed only the vestibular rehabilitation exercises (EX group). Outcome measures included temporospatial gait measures, Dynamic Gait Index (DGI), Dizziness Handicap Inventory (DHI), Patient Specific Functional Scale (PSFS), and a Perceived Outcomes Scale (POS). The P and P+EX groups showed greater improvement on the PSFS and the POS compared to the EX group. DGI scores indicated decreased fall risk in 8 of 9 individuals who participated in P or P+EX training and who initially scored below the 19-point cutoff score. Both the P and P+EX groups showed significant within-group changes on some gait characteristics, DGI, DHI, PSFS, and POS measures. The EX group showed within-group change only on the DHI. Surface tilt perturbation training appears to be more effective for improving abilities at the activities and participation levels than vestibular exercises alone. In addition, tilt perturbation training reduced fall risk as measured by the DGI.

Effect of Exercise on Physical Function and Fall Risk among Elderly. A Randomized Controlled Trial

Decreased physical function is associated with increased fall risk. Fall risk increase with increasing age, and falls are associated with decreased quality of life in the elderly, as well as increased morbidity and mortality. Exercise is found to be effective in increasing physical function and preventing falls, but the preferred exercise program is still uncertain. PURPOSE: To investigate the effect of three different exercise programs on physical function and fall risk among elderly. METHODS: In this single blinded study, 90 men and women (74.4±6.5 yr) were randomized to one of three exercise groups: Traditional Senior Exercise Group (TSEG) (n=30), "InHarmony" Exercise Group (IHEG) (dynamic movements on unstable surface) (n=30), and outdoor Walking Exercise Group (WEG) (n=30). All groups followed instructor-guided exercise 2 × 60 minutes/week for 16 weeks. Fall risk was measured with the short version of the Physiological Profile Assessment (PPA) (including contrast sensitivity, reaction time, proprioception, knee extention force, and sway). In addition, physical function was measured using the following tests from the Senior Fitness Test Battery: 6-Minute Walk Test (6MWT), 30s Chair Stand Test (30sCST), and Time Up and Go Test (TUGT). Finally, dynamic balance was measured with the Four Square Step Test (FSST). RESULTS: There were no differences between the groups at baseline. Within group comparison, the TSEG improved their results in the 30sCST (21.8%), TUGT (6.5%) and FSST (18.8%) (all results, p<0.01). The IHEG improved their results in the 30sCST (17.1%) (p<0.001) and FSST (7.7%) (p<0.05). The WEG improved their results in the 6MWT (8.1%) (p<0.05), 30sCST (23.4%) (p<0.01), TUGT (7.3%) (p<0.05), and FSST (17.7%) (p<0.01). No differences in fall risk were found between the exercise groups based on a three group comparison. However, the WEG improved their result in the 6MWT from pre- to posttest as compared to the TSEG (p<0.05). CONCLUSION: All exercise programs in this study seem to improve physical function in the elderly. Outdoor walking on uneven ground may be just as effective as indoor, instructor-guided exercise in terms of improving physical function in elderly. On the other hand, more knowledge is needed regarding which exercise program is to be preferred in order to decrease fall risk in this age group.

Short‐Term, Light‐ to Moderate‐Intensity Exercise Training Improves Leg Muscle Strength in the Oldest Old: A Randomized Controlled Trial

To assess the effects of an 8-week exercise training program with a special focus on light- to moderate-intensity resistance exercises (30-70% of one repetition maximum, 1RM) and a subsequent 4-week training cessation period (detraining) on muscle strength and functional capacity in participants aged 90 and older. Randomized controlled trial performed during March to September 2009. Geriatric nursing home. Forty nonagenarians (90-97) were randomly assigned to an intervention or control group (16 women and 4 men per group). Eight-week muscle strength exercise intervention focused on lower limb strength exercises of light to moderate intensity. 1RM leg press. handgrip strength, 8-m walk test, 4-step stairs test, Timed Up and Go test, and number of falls. A significant group by time interaction effect (P=.02) was observed only for the 1RM leg press. In the intervention group, 1RM leg press increased significantly with training by 10.6 kg [95% confidence interval (CI)=4.1-17.1 kg; P=.01]. Except for the mean group number of falls, which were 1.2 falls fewer per participant in the intervention group (95% CI=0.0-3.0; P=.03), no significant training effect on the secondary outcome measures was found. Exercise training, even of short duration and light to moderate intensity, can increase muscle strength while decreasing fall risk in nonagenarians.

Knee Extensor Strength, Dynamic Stability, and Functional Ambulation: Are They Related in Parkinson's Disease?

Nocera JR, Buckley T, Waddell D, Okun MS, Hass CJ. Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson's disease? Objective To evaluate the relationship between knee extensor strength, postural stability, functional ambulation, and disease severity in Parkinson's disease (PD). Design A cohort study. Setting University research laboratory. Participants Patients (N=44) with idiopathic PD. Intervention Not applicable. Main Outcome Measures Participants were evaluated on their isokinetic knee extensor strength. Additionally, participants completed an assessment of their postural stability (Functional Reach Test for static stability and a dynamic postural stability assessment as measured by the center of pressure–center of mass moment arm during gait initiation). Participants also underwent an evaluation of their functional ambulation as measured by a 6-minute walk test. Lastly, participants were evaluated by a neurologist specially trained in movement disorders to assess neurologic status and disease severity using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr disability score. Results Knee extensor strength positively correlated with dynamic postural stability and negatively correlated with disease severity. Further, dynamic postural stability was negatively correlated to disease severity and positively correlated with functional ambulation in this cohort of patients with PD ( P<.05). The results also suggest that the Functional Reach Test may be a valuable assessment tool to examine postural stability in PD. Conclusions These findings suggest a malleable relationship between knee extensor strength, dynamic stability, and disease severity in PD. Although strength is only one piece of the puzzle in the functional outcome of PD, these findings may assist clinicians in designing appropriate interventions aimed at increasing function and decreasing fall risk in PD.

Egomotion and Vection in Young and Elderly Adults

Background: Elderly people tend to rely upon their visual input more than upon that from other sensory systems due to age-related declines. This reliance upon vision places older adults at risk for falls because they are often not aware of the magnitude of their body motion. Objective: The purpose of this prospective study was to determine the influence of stationary anchors and vection upon egomotion in young, young-old and old adult age groups using the moving room paradigm. Methods: Forty-five healthy participants separated into 3 age groups (young, 18–20 years; young-old, 60–69 years; old, 70–79 years) were tested. Participants stood on a force platform in front of an oscillating virtual moving room. Optical flow fields were presented to the central and peripheral areas of the retina, individually and jointly. Postural motion was assessed through center of pressure (COP). There were 5 room conditions used to evaluate the role of central and peripheral vision upon postural motion. Participants rated their vection, perceived amount of motion, and the magnitude of the visual scene motion following each condition. Results: In all optical flow conditions, old adults produced more postural motion than the young and young-old adults. Participants were quite accurate at rating their postural motion and vection with their COP displacement; however, young adults rated their vection higher, yet produced significantly less COP displacement than the older adults. Postural responses were also decreased in both age groups when portions of the visual scene were occluded in central or peripheral vision. These findings indicate visual sensitivity to visual scene motion as a function of age when information is available to all areas of the retina. Static images in the visual scene provide a reference point which was found to assist in the stabilization of body position, decreasing fall risk. Conclusions: Older adults exhibited increased egomotion, yet decreased vection in response to visual scene motion. It is likely that the reduction in proprioceptive feedback due to healthy aging induces greater COP motion in the older adults before they perceive visual scene motion, placing them at an increased risk for incurring falls.

Medication interventions for fall prevention in the older adult

ObjectiveTo review fall epidemiology, risk factors, assessments and intervention methods, and outcomes in order to provide guidance to pharmacists. Data sourcesRecently published articles listed in Medline and resources on the Agency for Healthcare Research and Quality website (www.ahrq.gov) identified using the search terms falls, medications and falls, fall risk factors, and falls interventions and outcomes; personal data in preparation for publication consideration by the authors; and bibliographies from gathered articles. Data synthesisFalls may result from multiple risk factors that should be considered to both prevent falls and intervene when a fall has occurred. Careful consideration of the total psychoactive drug load, especially psychotropic drugs, and well-planned recommendations for tapering, discontinuing, and/or replacing drugs implicated in increasing fall risk are presented. A fall risk assessment method that incorporates fall history and risk factors, current disease states and conditions, and medications that may increase fall risk is provided. Two cases with interventions and outcomes are detailed. Because anemia may increase fall risk, adequate assessment of the cause(s) of anemia and conservative recommendations to correct it may decrease fall risk. Adequate vitamin D and calcium intake also may be essential to both decrease falls and fall-related fracture risk. Suggested alternatives and tapering for drugs implicated in increasing falls are considered. Osteoporosis risk assessment is a further area requiring delineation for possible pharmacist assistance to the patient and prescriber to reduce the risk of both fall-related and nontrauma fractures. Interventions to change medications may reduce falls by up to 70%. Additional fall-related resources on the Internet are provided. ConclusionPharmacists can play an important role by identifying patients who may have fall risk factors and history and by providing information for drug changes that may reduce fall risk.

A reflection on the experience of COP-3

This case series described changes in motor outcomes across 4 cases of older adults (mean age – 64.75) with chronic stroke (&gt;6 months) after implementation of a 6-week proprioceptive neuromuscular...

Arzneimittel und Stürze im Alter

Falls with and without injuries in elderly persons commonly have multiple causes. Exposure to drugs does contribute to these causes. Therefore, complete assessment and evaluation of prescription and over the counter drugs are essential parts of fall-prevention concepts. Frail elderly persons frequently treated with several medications are particularly predisposed to adverse drug effects which may increase the risk of falling. Risk increasing drug effects are dose dependent which have been best studied with psychotropic medication. Apart from psychotropic drugs, cardiovascular drugs contribute to FRIDs (Fall-Risk Increasing Drugs). Fall risk is particularly increased with drugs of the same therapeutic class combined or combinations of psychotropics and cardiovascular drugs. Intervention studies on withdrawal and dose reduction of fall-risk increasing drugs were successful in reducing the risk of falling. There is relatively few knowledge on whether and how drug treatment does decrease fall risk in elderly patients by improving safe mobility and walking ability relevant to activities of daily living.

Multifactorial Intervention with Balance Training as a Core Component Among Fall-prone Older Adults

The purpose of this randomized controlled trial was to measure the effectiveness of A Matter of Balance, a small-group based balance program, on muscle strength, gait, balance, and fall risk among older community-dwelling adults at risk for falls. A secondary aim was to measure the effects of the program on actual fall rates over the 3-month study. Twenty-three older adults were randomly assigned to either an experimental group that participated in a 12-week small-group based balance program or a control group. Subjects were assessed at baseline and following an intervention using the following outcome measures: lower extremity manual muscle testing (MMT) and range of motion; gait analysis on the GAITRite system; balance parameters on the SMART EquiTest, the Timed Up and Go test, the Berg Balance Scale, and incidence of falls. A repeated measures ANOVA revealed that there was a significant interaction between groups over time in the Berg Balance Scale scores, P < or = .05. The experimental group improved over time (48.1 to 52.9/56, respectively), whereas the control group decreased in performance (49.1 to 47.8/56, respectively), P < or = .05. The mean number of falls was significantly less in the experimental group during the intervention compared with the control group (0.09 and 0.50, respectively), P < or = .05. A community-based multifactorial intervention including individualized fall risk assessment, exercise, and home assessment appears to safely and effectively reduce the number of falls, resulting in significant improvements in functional balance ability and decreased fall risk.

Clinical Use of Nintendo Wii™ Bowling Simulation to Decrease Fall Risk in an Elderly Resident of a Nursing Home

Of the estimated 1.7 million residents of nursing homes in the United States, approximately half fall annually; and 11% of these sustain injury. This is twice the rate for persons dwelling in the community. By addressing fall risk, physical therapists have an opportunity to reduce falls which are the leading cause of injury deaths, as well as the most common cause of nonfatal injuries for older adults in the United States. This case report examines the effect of a novel interactive video game intervention to address balance dysfunction in an elderly resident of a nursing home who was at risk for falls. The patient is an 89-year-old resident diagnosed with an unspecified balance disorder and a history of multiple falls. Self reports of gait abnormalities, scores on several clinical measures, and her fall history classified her as having substantial risk for future falls. A nontraditional approach to balance training, employing the Nintendo Wii bowling simulation, was used as intervention for this patient's balance disorder. After 6 one-hour treatment sessions, the patient's Berg Balance Score improved from 48 to 53. On the Dynamic Gait Index, the patient improved her score from 19 to 21. The patient's Timed Up and Go Test improved from 14.9 to 10.5 seconds, all suggesting a reduced risk of falling. The patient's ABC Score improved from 88 to 90%. Physical therapy intervention, using the Nintendo Wii bowling simulation, may have decreased fall risk for this individual.

Effectiveness of the anodyne therapy system in treating diabetic peripheral neuropathy: a systematic review

Objective: A systematic review was performed of clinical research on the efficacy of the anodyne therapy system (ATS) for treating patients with diabetic peripheral neuropathy.Method: MedLine, CINAHL, Cochrane Databases, and Physical Therapy, the Journal of the American Physical Therapy Association web sites were searched in the 1986–2006 time period.Results: Ten studies were identified. All studies evaluated patients who were on average >60 years of age; few identified disease duration or whether its onset was genetic or acquired. Two prospective, randomised, placebo-controlled studies were identified with one supporting its use. Results indicate efficacy for improving lower extremity sensation, balance, gait and decreasing fall risk, particularly if subjects have a relatively recent diabetic peripheral neuropathy onset (short duration).Conclusion: Poor study designs, small sample sizes, limited information regarding treatment volume or intensity, concomitant use of conventional physical therapy modalities, and a lack of long-term follow-up decrease the validity of most studies. Well-designed, prospective, randomised, controlled trials with larger subject numbers are needed to determine true treatment effectiveness.

Hemiparetic Optimal Practice and Evaluation (H.O.P.E.) for the Stroke Survivor with Very Low Hand Function

Purpose: The purpose of this study is to describe an approach that may benefit persons with severe hemiparesis following stroke. Method: The subjects were 3 stroke survivors who had experienced a stroke that left their dominant right extremity severely disabled (mean age 43 years, mean time since stroke 26.6 months, mean Fugl-Meyer UE motor score 14.3/66). A multiple baseline, preintervention-postintervention case series design was used. The intervention consisted of structured whole body, increased intensity, activity-dependent practice strategy, with 3 to 5 sessions lasting for more than 3 hours per day, for 1–5 weeks for an average of 170 hours of therapy over 2.5 years. Subjects completed therapies such as body weight—supported treadmill training, overground multidirectional gait training, balance retraining, upper extremity functional activity, and trunk and extremity mobility. Results: The subjects experienced decreased fall risk (mean Timed Up and Go [TUG] scores decreased from 14.9 s to 6.8 s) and improved community safety (mean speed of gait in 10 m improved from 18.3 s to 8.3 s) and decreased impairment level as measured by the Fugl-Meyer Assessment (FMA: mean UE motor score from 14.3/66 to 53/66). Finally, subjects demonstrated an increase in their hemiparetic UE functional ability (mean amount of tasks completed in the Wolf Motor Function Test [WMFT] from 3.6/15 tasks to 15/15 tasks) following the intervention. Conclusion: The findings indicate that hemiparetic optimal practice and evaluation (H.O.P.E) rehabilitation led to a decrease in the level of impairment along with a corresponding increase in function of the severely hemiparetic arm. The outcomes are significant: few treatment approaches have demonstrated an increase in the function of the severely affected arm in this population.

Nonpharmacological approaches to improve bone health and reduce osteoporosis

With an aging population, osteoporosis has become a public health concern and an area of increased awareness among both patients and medical practitioners. Timely screening and pharmacologic treatment of low bone mass effectively reduces fracture risk. Nonpharmacologic interventions, however, deserve equal emphasis both in the prevention and treatment of osteoporosis. Recent advances in bone biology have established that exercise in the form of short, repetitive mechanical loading leads to the greatest gains in bone strength. As demonstrated by both observational and randomized exercise intervention trials, these gains are best achieved in childhood but can be maintained in adulthood with continued regular weight-bearing exercise. In the later years, evidence supports the implementation of balance training to decrease fall risk, especially in elderly patients with low bone mass. Following an osteoporotic fracture, a multidisciplinary rehabilitation program with an emphasis on early mobilization, fall prevention, use of orthoses, and noninvasive surgical procedures is emerging as a promising approach. Clinically, these findings should imply greater emphasis on high impact exercise during skeletal growth and on maintenance of weight bearing and balance training in the later years. Future research should examine the effect of these interventions on fracture prevention.

Fall Risk Characteristics of the Elderly in an Exercise Class

The purpose of this study was to clarify the fall risk characteristics of the elderly participating in an exercise class. The subjects were comprised of 206 elderly Japanese aged 60 or older (37 males, 169 females) who participated in an exercise class, approved by the local government, once a week for 6 months. Physical fitness and ADL capability were evaluated by the physical fitness test of the Ministry of Education, Culture, Sports, Science and Technology. Fall risk was evaluated using the Fall Assessment Chart. Subjects were divided into two groups, high fall risk (total fall risk score > or =5) and low fall risk (total fall risk score <5), and the percentage of subjects in the high risk group was calculated. The percentage of subjects with a high fall risk was 15.8%, lower than the documented rate of the community-dwelling elderly in a previous study. Significant differences between fall risk groups were found in balance and ADL capabilities of walking, holding and changing posture and muscular strength. These functions also were significantly related to fall risk elements such as fall anxiety and slipping or stumbling at home in the partial correlation analyses. Improvement of these functions during exercise class may be useful in decreasing fall risk in the elderly.

Case Report Vestibular Rehabilitation Decreases Fall Risk and Improves Gaze Stability for an Older Individual with Unilateral Vestibular Hypofunction

Partial or total unilateral vestibular loss is the third most common cause of peripheral vestibular dysfunction. Dysfunction of one or both of the vestibular mechanisms can manifest physically as abnormalities of posture, balance, and/or visual acuity. This case report describes physical therapy examination and individualized intervention with vestibular rehabilitation for a patient with unilateral vestibular hypofunction. The patient was an 80-year-old male with electronystamographically confirmed unilateral vestibular loss of 98.3%. He demonstrated altered balance and gaze stability classifying him as having an increased risk for falling. After 5 weeks of individualized vestibular rehabilitation, the patient significantly decreased his fall risk from 11 to 20 of 24 on the Dynamic Gait Index. His gaze stability also improved from a 4 to 1 line disparity with dynamic visual acuity testing. The patient also had a decrease in perceived disability on the Dizziness Handicap Inventory from 30/100 at evaluation to 12/100 at discharge. Individualized vestibular rehabilitation decreased fall risk and improved gaze stability for a patient with significant unilateral vestibular hypofunction.

THE EFFECT OF A MODIFIED JAZZ DANCE CLASS ON BALANCE IN OLDER WOMEN.

Purpose/Hypothesis: The purpose of this study was to assess the impact of age-appropriate jazz dance class instruction on balance for women utilizing dynamic posturography. Subjects: Fourteen healthy elderly women aged from 52 to 88 participated in the study. All were a sample of convenience of volunteers recruited from a Senior Dance Techniques course offered by the Department of Dance at the University of Nevada, Las Vegas. Materials/Methods: The subjects completed a 15-week jazz dance program in which the subjects attended one time per week for 50 minutes in duration. Baseline balance data were collected through the use of the Sensory Organization Test (SOT) as administered using the NeuroCom Smart® Balance Master System (Balance Master) during weeks 1 and 2 of the class. The second measurement was recorded between weeks 7 and 8 and the final measurement was taken after week 15 of the class. Means and standard deviations were calculated for the outcome variables. A repeated measures ANOVA was used to compare the means of each subjects' SOT composite equilibrium score over the 3 measurement time frames. The composite equilibrium score reflects the overall performance on the SOT and is the sum of all 6 conditions. Alpha levels were set at 0.05. Results: There was a statistically significant difference among the mean SOT composite equilibrium scores (F(2,22) = 23.185) for pre, mid, and post time intervals as follows: Pre= 67.333, SD= 10.430; Mid= 75.250, SD= 6.969; Post= 79.000, SD= 4.973, (p<0.0005). Pairwise (Bonferroni) post-hoc analyses revealed the following statistically significant findings for SOT composite equilibrium scores for the pre, mid, and post measurements: Pre-Mid (p= 0.008); Pre-Post (p< 0.0005); Mid-Post (p= 0.033). Conclusions: The results of this study suggest that administration of a jazz dance program as an alternative to a traditional exercise program is beneficial in improving balance as measured by the Balance Master. Future research should consider the comparison of different exercise or dance groups and larger sample sizes. Clinical Relevance: Many elderly may not have the opportunity or desire to perform an exercisebased program. Since many elderly experience a loss of stability, they seek to compensate by restricting their activity levels, thereby avoiding falling. However, given the social proclivity of elderly individuals, many do find dance as an attractive alternative to an exercise regimen. The findings from this study reveal that dance-based training is beneficial in improving balance, which may help to decrease fall risk.