Fall Risk Index Research Articles

The influence of whole-body electromyostimulation training in middle-aged women

BACKGROUND: Whole-body electromyostimulation (WB-EMS) is a new tendency in training used to complement conventional training. OBJECTIVE: The aim was to analyze the effects of training with WB-EMS on body composition, strength and balance in middle-aged women. METHODS: Twenty-eight women were randomly assigned to two groups: the WB-EMS group (age = 48.1 ± 4.3 years) or the control group (CG) (age = 51.1 ± 5.4 years). All participants continued their training of 2 days⋅week-1 and 60 min⋅day-1 of endurance-dynamic strength exercises and additionally did 20 minutes more of dynamic strength exercises one day⋅week-1: the WB-EMS group did the additional training with WB-EMS and the CG did the same training but without WB-EMS. Body composition, muscle isokinetic strength of the knee flexors/extensors and postural stability were measured before and after 8 weeks of training. RESULTS: After the training program, the WB-EMS group showed lower values for the waist circumference (83.00 ± 7.37 vs. 78.50 ± 7.30 cm; p< 0.01), hip circumference (104.80 ± 8.61 vs. 101.00 ± 6.78 cm; p< 0.05) and total fat mass (37.04 ± 6.08 vs. 36.26 ± 5.78%; p< 0.05). In balance stability the WB-EMS group reduced their Fall Risk Index (1.70 ± 0.51 vs. 1.30 ± 0.38 AU; p< 0.01) and deviation (1.50 ± 0.43 vs. 1.03 ± 0.74 AU; p< 0.01) after training and showed lower values in the Fall Risk Index (p= 0.007) and deviation (p= 0.024). CONCLUSIONS: The WB-EMS training program helps reduce the risk of falling and improves body composition variables and balance results in middle-aged physically active women.

Effect of induced hyperopia on fall risk and Fourier transformation of postural sway.

Background and PurposeFall accidents are a social challenge in Korea and elsewhere. Most previous studies have focused on the effects of reduced visual acuity due to myopia on falls and body balance. The objective of this study was to investigate whether uncorrected hyperopia was a major risk factor for falls and to establish whether the risk of falls was absolutely correlated with visual acuity.MethodsFifty-one young subjects with a mean age of 22.75 ± 2.13 years were enrolled in this study. To induce hyperopic and myopic refractive errors, spherical lenses of ±1.0–6.0 D (1.0 D stepwise) were used. Under each induced condition, fall risk index and sway power were assessed via Fourier transformation of postural sway using a TETRAX system.ResultsThe fall risk index for eyes-closed was significantly greater than that of eyes-open with full correction (t = −5.876, p < 0.05). The fall risk index increased significantly from hyperopia induced with −4.0 D lenses (with visual acuity of 0.69 ± 0.32) compared to eyes-open with full correction (F = 3.213, p < 0.05). However, there was no significant change in the induced myopia conditions, despite a drastic decline in decimal visual acuity. Sway power increased significantly in the low-to-medium frequency band derived from the peripheral vestibular system when hyperopia was induced. A significant difference was detected in hyperopia induced with −6.0 D lenses compared to eyes-open with full correction (F = 4.981, p = 0.017).ConclusionAn uncorrected hyperopia rather than myopia may increase the risk of falls, although eyes may show normal visual acuity due to the inherent accommodation mechanism. Our findings suggest that the corrected state of refractive errors is more important than the level of visual acuity as the criteria for appropriate visual input, which contributes to stable posture. Therefore, clinicians should consider the refractive condition, especially the characteristics of hyperopia, when analyzing body balance, and appropriate correction of uncorrected hyperopia to prevent falls.

Body weight support-Tai Chi footwork for balance of stroke survivors with fear of falling: A pilot randomized controlled trial

Background and purposeBalance impairment is the predominant risk factor for falls in stroke survivors. This study examined the effects of body weight support-Tai Chi (BWS-TC) footwork on balance control among stroke survivors with fear of falling (FOF). Materials and methodsTwenty-eight stroke survivors with FOF were randomly allocated to either control or BWS-TC groups. Those in BWS-TC underwent Tai Chi training for 12 weeks. Outcomes were assessed in all participants by evaluation of the limits of stability test, modified clinical test of sensory integration of balance, fall risk index, and Fugl-Meyer assessment of lower limbs at baseline and 12 weeks. ResultsThe BWS-TC group displayed significant enhancement in dynamic control and vestibular and somatosensory integration. ConclusionBWS-TC may enhance dynamic control and sensory integration of balance and reduce the risk of fall in stroke survivors with FOF.

The effects of toe grip training on physical performance and cognitive function of nursing home residents

BackgroundToe grip-related training requires individuals to actively exercise muscles that are not frequently used; therefore, it may improve not only toe grip strength but also cognitive function. The purpose of this study was to examine the effects of toe grip-related training on predictors of physical performance and cognitive function in nursing home residents.MethodsA total of 35 nursing home residents (35 left and 35 right feet; mean age, 82.1 ± 7.9 years) were included in this study. The participants were divided into two groups: a training group and a control group. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the participants, and the Fall Risk Index (FRI) was used to evaluate the risk of falls. Toe grip-related physical function was also assessed. Baseline endpoints were evaluated and the effects of toe grip-related training were examined following a 12-week training intervention.ResultsThe training group showed significant improvements in MMSE score, FRI score, toe grip strength, and the toe skill (TS) test; however, the control group did not show these changes. The training group showed significant increases in Δ MMSE, Δ toe grip strength, and Δ TS (right foot) than the control group. Stepwise regression analysis revealed that Δ toe grip strength is an independent factor of Δ MMSE.ConclusionsToe grip training improves not only toe grip strength itself, but also cognitive function. Furthermore, change in toe grip strength was an independent factor of change in MMSE in those populations.Trial registrationUMIN, UMIN000027437. Registered on 26 May 2017.

Using grey relational analysis and grey integrated multi-objective strategy to evaluate the risk factors of falling of aboriginal elders in Taiwan

Aboriginal elders falls have been a widely discussed topic; however, factors such as emotional and physical functions, and social and cultural backgrounds are lacking. Most studies focusing on fall correlations concentrate on medical institutions or non-tribal community areas. Few studies focus on falling of elders in mountainous areas. Applying grey relational and multi-objective decision making to predict the prevalence of falls and associated risk factors for aboriginal elders is the purpose of this study. We targeted the Atayal and Tsuo aboriginal elders in central Taiwan, involving 160 members settled in mountainous townships in Taiwan. For this research study, the components are as follows: The grey theory predicts and evaluates the commonly used fall risk assessment tools, that is, quantative questionaires include: (1) focused history: medication history and Brief Symptom Rating Scale questionnaire, BSRS-5; (2) functional Assessment: ADL (Barthel Index) and IADL; (3) prevention of falls health beliefs; and (4) prevention of falls self-efficacy. With qualitative and in-depth interviews, 18 tribal elders, 55 years and above, were interviewed: 9 from the Atayal and 9 from the Tsou. Based on the Nvivo 12.0 data analysis software, this study concluded that the most predictable fall risk assessment tool is Downton Fall Risk Index (weighting: 0.8657), followed by BSR-5 (weighting: 0.5701), prevention of falls health beliefs (weighting: 0.448), Barthel scale (weighting: 0.4296), IADL (weighting: 0.1661), prevention of falls self-efficacy (weighting: 0.1391) and medical history (weighting: 0.0615). Further, qualitative results indicated that the issue of health inequalities under the influence of ethnic culture, including physical and disease characteristics, tend to be more than the proportion of heart and hypertension diseases, healthy behaviors such as unbalanced diet, cultural beliefs in gender division of labor and ethnic communication barriers and lack of cultural adaptability care resources. The risky tribal environment of mountainous areas is a major factor that leads to falls. The results provide an accurate assessment tool suitable for Taiwanese aboriginal elders’ falls for future medical policy making and fall prevention intervention in cultural safety.

Neuroimaging signatures of cerebral small vessel disease and risk of falls in stroke-free older adults living in rural Ecuador. The Atahualpa Project

PurposeThis study aimed to assess the association between neuroimaging signatures of cerebral small vessel disease (cSVD) and the risk of falls in stroke-free older adults living in rural Ecuador. MethodsRisk of falls was evaluated by the Downton Fall Risk Index (DFRI). MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and > 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Logistic regression models were fitted to evaluate whether these neuroimaging signatures were associated with the DFRI, after adjusting for relevant confounders. ResultsWe included 288 participants. The DFRI was positive in 69 (24%). Moderate-to-severe WMH were noticed in 55 individuals (19%), deep CMB in 18 (6%), LI in 23 (8%), and > 10 BG-PVS in 65 (23%). Multivariate models showed a significant association between moderate-to-severe WMH and the DFRI (p = .016). There were no associations between other neuroimaging signatures of cSVD and the DFRI. Age was the single covariable remaining significant in all models. ConclusionsWMH is associated with the DFRI in stroke-free older adults living in a remote rural setting. A target for fall prevention should include the control of factors favoring the development of diffuse subcortical damage of vascular origin.

Clinical classification of fall risk using visually obtained information at a memory clinic

There are few studies concerning the classification of fall risk by nurses without established fall risk assessment tools. In the present study, clinical classification of fall risk using visually obtained information was compared with the assessment of fall risk in order to evaluate the rationale and validity of the clinical classification of fall risk by nurses. New patients who visited the center of comprehensive care and research for memory disorders at the National Center for Geriatrics and Gerontology were enrolled in the present study.Day-shift nurses separately recorded the clinical classification of fall risks through visually obtained information during the 10-minutes waiting time for outpatients.Fall risk assessments such as the Fall Risk Index and Timed Up & Go test, were performed by non-nurse medical staffs. Data were analyzed by an independent researcher who was not involved in obtaining clinical information. Nurse's clinical classification of fall risk using visually obtained information correlated well with Fall Risk Index, Timed Up & Go test, One-leg Standing test and Dorsiflex meter. In addition, subjects classified as having high fall risk were more frequently judged to be frail than classes of moderate or little fall-risk. Nurse's clinical classification of fall risk using visually obtained information was judged on their integrated impression including their evaluation of the muscle strength, gait speed and balance.

Prevalence, Severity, and Risk of Future Falls in Community-Dwelling Older Adults Living in a Rural Community: The Atahualpa Project.

Accidental falls are a leading cause of disability and death in older adults living in urban centers. However, little is known about the consequences of falls in rural communities. We aimed to assess characteristics and risk of falls in community-dwellers aged ≥ 60years living in rural Ecuador. Of 463 older adults enrolled in the Atahualpa Project, 327 (71%) were included. Multivariate logistic regression models were fitted to assess factors associated with history of falls and risk of future falls. Sensitivity analysis was conducted to determine which component of the Downton fall risk index (DFRI) better predicts risk of future falls. A history of falls was reported by 173 (53%) individuals. Most were related to stumbling due to uneven (non-paved) streets. Only three individuals had bone fractures after the fall. Previous falls were not associated with any of the investigated covariables. The DFRI was positive in 87 (27%) participants, and was associated with age (p < 0.001) and history of stroke (p < 0.001). None of the subjects were taking tranquilizers/sedatives. The most reliable component of the DFRI was the presence of sensory/motor deficits. History of falls in our population is similar to that reported elsewhere. However, the risk of future falls is lower. Such discrepancies are probably because the DFRI does not take into account environmental factors resulting in falls. There were almost no severe complications from falls, which could be partly related to the lack of use of tranquilizers/sedatives.

Postural stability pattern as an important safety factor of firefighters.

Firefighting is a hazardous profession that involves high fall risk and is crucial component for the safety of people. The aim of this study was to identify factors that impact on postural stability patterns of firefighters. The study examined 177 Polish firefighters from the National Firefighting and Rescue System (NFRS) aged 31.9±10.1 years, with body height of 179.6±5.93, body mass of 83.9±11.0 and BMI of 26.0±3.03. Postural stability was evaluated by means of the Balance System SD (Biodex USA) set at the level 12 of instability, in a sportswear, bunker gear, with and without visual input. The fall risk test (FRI) was also performed. Four indices were analysed: overall stability index (OSI), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and fall risk index (FRI). Mean results for fall risk index (FRI) were in the normal range for all age groups regardless of the type of clothing the firefighters were wearing. Individual results obtained in the fall risk test, 128 firefighters were in the normal range for their age, furthermore, 10 firefighters obtained better results than the normal range, 34 firefighters had worse results and 5 people failed to complete the test. Postural stability with eyes closed was found to decline with age. Wearing bunker gear did not have an effect on postural stability. Balance tests should be integrated into the firefighting training routines in order to improve balance and support fall prevention. Exercises with reduced visual input should also be incorporated into the training methodology.

Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia.

We aimed to evaluate balance using the Tetrax Interactive Balance System (TIBS) in patients with Chiari type I malformation (CM-I) and to assess their fall risk with other clinical parameters. This cross-sectional, prospective study was conducted at physical medicine and rehabilitation outpatient clinics and neurosurgery department of a university hospital between December 2013 and December 2014. The study included a total of 36 patients (31 females, 5 males; mean age 40.6±10.0 years; range, 18 to 60 years) with CM-I. Dynamic balance was assessed using the Berg Balance Scale (BBS), and posturographic examinations were performed using the TIBS. The mean Fall Risk Index (FI) value was 42.4±29.8 and the mean BBS score was 55.5±1.5. The most common complaints were neck pain (94.4%), headache (88.9%), paresthesia (86.1%), fatigue (83.3%), and vertigo (80.6%). The mean tonsillar herniation below the foramen magnum was 8.7±3.8 (mm). Of the patients, 15 (42.85%) had syringomyelia. The degree of tonsillar ectopia was statistically significantly lower in patients with syringomyelia (p<0.05). The BBS scores were near identical among the patients with or without syringomyelia, although the FI values were lower in the patients with syringomyelia. Comparing cerebellar ectopia ≤9 mm versus >10 mm, the FI values were slightly higher in the patients with ectopia >10 mm, although there was no statistically significant difference in the FI or BBS values. Our study results suggest that CM-I can decrease the body balance stability and, thus, increase the fall risk. Evaluation of balance in patients with CM using TIBS static posturography is a simple and effective technique.

Drugs in fall versus non-fall accidents with major trauma – A population-based clinical and medico-legal autopsy study

BackgroundThe main aim of the present population-based study was to compare drugs in fall versus non-fall accidents causing major trauma, including both clinical and medico-legal autopsy data. MethodsAll individuals with accidents resulting in major trauma, a new injury severity score (NISS)>15 or lethal outcome was identified at hospital and/or the Department of Forensic Medicine between 2011 and 2013. Modified Downton Fall Risk Index ranged from 0 to 7, and was based on specific pharmaceuticals (max 5 points), previous fall (1 point) and cognitive impairment (1 point). ResultsOne hundred and four individuals with major traumatic accidents were identified, 38 (36.5%) died. The median modified Downton Fall Risk Index was 2 for fall accidents and 0 for non-fall accidents (p < 0.001). Modified Downton Fall Risk Index was an age-independent factor associated with fall accident (p < 0.001). The medico-legal autopsy rate for in-hospital patients was 50% (6/12) for fatal fall accidents in comparison with 92.3% (12/13) for fatal non-fall accidents (p = 0.03). In individuals undergoing medico-legal autopsy, the proportion of individuals with any detected drug was 77% in fall accidents compared to 39% in non-fall accidents (p = 0.036). The presence of sedatives (p = 0.002) and bensodiazepines (p = 0.023) were higher for fall accidents compared to non-fall accidents. ConclusionThis population-based study on accidents with major trauma showed that drugs had high impact on fall accidents with major trauma. It seems warranted from a public health perspective to study if implementation of medication review guidelines at hospital managing polypharmacy issues may prevent fall accident recidivism.

Frailty and Risk of Falls in Community-Dwelling Older Adults Living in a Rural Setting. The Atahualpa Project.

Data supporting a link between frailty and risk of falls is mostly confined to individuals living in urban centers, where risk factors and lifestyles are different from that of rural settings. To assess the association between frailty and risk of falls in older adults living in rural Ecuador. Population-based cross-sectional study. Community-dwellers aged ≥60 years living in a rural Ecuadorian village, in whom frail status and risk of falls were assessed. Frailty was evaluated by the Edmonton Frailty Scale (EFS) and risk of falls by the Downton Fall Risk Index (DFRI). Multivariate models were fitted to evaluate whether frailty was associated with risk of falls (dependent variable), after adjusting for demographics, alcohol intake, cardiovascular risk factors, sleep quality, symptoms of depression, and history of an overt stroke. Correlation coefficients were constructed to assess confounders modifying this association. A total of 324 participants (mean age: 70.5±8 years) were included. The mean EFS score was 4.4±2.5 points, with 180 (56%) participants classified as robust, 76 (23%) as pre-frail and 68 (21%) as frail. The DFRI was positive in 87 (27%) participants. In univariate analysis, the EFS score was higher among participants with a positive DFRI (p<0.001). The number of frail individuals was higher (p<0.001), while that of robust individuals was lower (p<0.001) among those with a positive DFRI. Adjusted logistic regression models showed no association between frailty and the DFRI. Correlation coefficients showed that age, high glucose levels, and history of an overt stroke tempered the association between frailty and the risk of falls found in univariate analyses. Frailty is not independently associated with risk of falls in older adults living in a remote rural setting. Further studies are needed to assess the impact of frailty on the risk of falls in these populations.

Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial.

We attempted to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation. This system enables participant training with a realistic 3D interactive balance exercise and assessing movement parameters and joint angles by using a kinetic sensor system. We performed a randomized controlled trial in a general hospital. Thirty-six participants (age, 56-76 years) who could independently walk and stand on one leg were recruited. The participants were randomly assigned to either group. The control group (n = 18) underwent a conventional physical fitness program such as lower-extremity strengthening and balance training thrice per week for 1 month. The experimental group (n = 18) experienced 3D-ARS training thrice per week (1 session = 30 minutes) for 4 weeks. Training comprised a balloon game for hip exercise, cave game for knee exercise, and rhythm game for one-leg balance exercise. Lower-extremity clinical scale scores, fall index, and automatic balance score were measured by using Tetrax® posturography before, during, and after training. Significant group (3D-ARS vs. control) × time (before and after exercise) interaction effect was observed for Berg balance scale (BBS) scores (p = 0.04) and timed-up-and-go (TUG; p < 0.001). Overall improvements occurred in stability index, weight distribution index, fall risk index, and Fourier transformations index of posturography for both groups. However, score changes were significantly greater in the 3D-ARS group. Significant group × time interaction effect was observed for the fall risk index. This demonstrates that the 3D-ARS system can improve balance in the elderly more effectively.

Use of non-benzodiazepine hypnotics is associated with falls in nursing home residents: a longitudinal cohort study.

Falls and related injuries are common among older people, and several drug classes are considered to increase fall risk. This study aimed to investigate the association between the use of certain drug classes and falls in older nursing home residents in Sweden, and relate these to different age groups. Information on falls that occurred in the previous year and regular use of possible fall risk drugs including non-benzodiazepine hypnotics (zopiclone and zolpidem) was collected from 331 nursing home residents during 2008-2011. Over the following 6months, the occurrence of serious falls, requiring a physician visit or hospital care, was registered. Association between serious falls and drug use was compared between an older (≥ 85years) and a younger group. An increased fall risk (Downton Fall Risk Index ≥ 3) was found in 93% of the study subjects (aged 65-101years). Baseline data indicated an association between falls that occurred in the previous year and regular use of non-benzodiazepine hypnotics (p = 0.005), but not with the other studied drug classes. During the following 6months, an association between use of non-benzodiazepine hypnotics and serious falls in the older group (p = 0.017, odds ratio 4.311) was found. No association was found between the other studied drug classes and serious falls. These results indicate an association between falls and the use of non-benzodiazepine hypnotics, compounds that previously have been considered generally well-tolerated in older people. Caution is advocated when using non-benzodiazepine hypnotics regularly in older people living in nursing homes.

Mismatch between risk factors and preventive interventions? A register study of fall prevention among older people in one Swedish county.

Falls are a common and often a devastating health hazard for older people, causing suffering, morbidity and mortality. Falls are costly for society in terms of both resources and direct medical costs. Although knowledge about falls and fall prevention is well known, falls among older people are still a major problem. The aim was to estimate the prevalence of the risk of falls among older people receiving municipal health care. A further aim was to investigate the consistency between fall risk factors and preventive nursing interventions. A cross-sectional register study. Data containing risk assessments based on the Downton Fall Risk Index (DFRI) and planned interventions by the municipal health care were collected from the Swedish national quality registry, Senior Alert. Data were analysed using descriptive and analytic statistics. In the sample of 5,427 older people, the prevalence of the risk of falling was 79%. There was a difference in prevalence between the different types of municipal health care, sex and age. The most common preventive intervention was environment adjustments, and the least planned intervention was information/education about falls. Physical activity as an intervention was planned among 13.2% of the participants. Approximately 27% of the older people did not have any planned interventions despite being at risk of falling. Planned interventions did not always correspond with the risk factors; for instance, only 35.4% of those at risk of falling due to medication obtained pharmaceutical reviews as a preventive measure to decrease the risk. The risk of falling is common among older people, and the preventive interventions do not sufficiently follow current evidence. This implies that systematic implementation of fall-prevention guidelines is needed in municipal care. A better match between identified risk factors and preventive interventions is warranted.

Predictors of falls in persons with spinal cord injury-a prospective study using the Downton fall risk index and a single question of previous falls.

Prediction study. To investigate the prediction accuracy of the Downton fall risk index (DFRI) and a question of falls the previous year; further to examine the association between time to first fall and risk indicators for falls in wheelchair users and ambulatory persons with Spinal Cord Injury (SCI). Two SCI centres in Norway and Sweden (Sunnaas Rehabilitation Hospital, Rehab Station Stockholm /Spinalis). Two hundred and twenty-four persons with traumatic SCI, ≥1 year post-injury, ≥18 years participated. Prospective falls were reported by text messages every second week for one year. Sensitivity, specificity and time to first fall (Kaplan Meier) were investigated for DFRI and the question of falls in the previous year. DFRI ≥3 was defined as a high risk of falls. Cox survival analysis was used to calculate hazard ratios for functional independence, gait speed and fear of falling. The sensitivity was 36-57% for DFRI and 82-89% for the question of falls, while specificity was 74-83%, and 34-49%. For DFRI, time to first fall was shorter in the high-risk group, for both wheelchair users (p = 0.005) and ambulatory persons (p = 0.006). Falls previous year increased the hazard ratio of falls for wheelchair users (HR = 3.35, 95% CI = 1.86 to 6.02) but not for ambulatory persons. Falls in the previous year showed a better predictive accuracy than DFRI due to the low sensitivity of DFRI. As previous falls had low specificity, it still remains difficult to predict falls in those who have not fallen yet.

Downton Fall Risk Index during hospitalisation is associated with fall-related injuries after discharge: a longitudinal observational study.

Among older people who are hospitalised, what is the predictive validity of the Downton Fall Risk Index (DFRI) in relation to fall-related injury after discharge? What is the predictive validity of the DFRI among males and females in this setting? Prospective, longitudinal, observational study. All hospital admissions during 2012 at three geriatric clinics in the Stockholm County Council were monitored. Patients aged>65years who did not die during the admission and who lived in the Stockholm County Council region were included. The DFRI consists of five modules: previous falls, medication, sensory deficits, mental state, and gait. Three or more points indicate an increased fall risk. Data on DFRI, health status and medications were collected prior to discharge. Data regarding fall-related injuries were collected up to 6 months after discharge. Poisson multivariate regression analyses were conducted to evaluate the association between DFRI and fall-related injuries. In total, 6650 patients were analysed. The cut-off≥3 points in the DFRI was significantly associated with fall-related injury when confounding variables were controlled for (IRR 1.94, 95% CI 1.60 to 2.38). Among individual modules, only previous falls (IRR 2.58, 95% CI 2.22 to 3.01) and unsafe gait (IRR 1.79, 95% CI 1.53 to 2.09) were associated with fall-related injuries. Stratified analyses showed a higher risk ratio for men compared to women regarding the DFRI, but the test for an interaction effect was not significant. The risk of post-discharge fall-related injury is increased among older hospitalised people with an increased fall risk, according to the DFRI, especially those who had previous falls or unsafe gait. Although the DFRI tool is predictive, previous falls and gait are the measures that are most worthy of focus. [Mojtaba M, Alinaghizadeh H, Rydwik E (2018) Downton Fall Risk Index during hospitalisation is associated with fall-related injuries after discharge: a longitudinal observational study. Journal of Physiotherapy 64: 172-177].

Effects of anthropometric factors on postural stability in individuals with hearing impairment.

Identification of factors that affect postural stability may help to improve diagnostic accuracy and enhance the quality of treatment and rehabilitation. This study sought to assess the relationship between postural stability parameters and anthropometric factors of persons with hearing impairment (HI). The study included 128 individuals - 42 subjects with HI and 86 without HI (healthy controls). Research methodology included an interview and a medical examination, anthropometric measurements and stabilometric tests on platforms with stable and unstable surfaces. In the group of female study participants with HI, significant correlations were only noted between body height and the Fall Risk Index (FRI). In the group of male subjects with HI, the study revealed significant correlations between FRI and body mass, BMI, % MM (muscle mass percentage) and % FAT (fat percentage). Moreover, moderate correlation was found between COP path with eyes open and body mass, while high correlation was observed between COP path with eyes open and BMI, % MM and % FAT. No significant correlation was noted between FRI and body height in men with HI. The examination of correlations between postural stability and body build of persons with HI did not confirm the effects of body height on postural stability in the examined group of individuals with HI, but revealed a greater influence of somatic parameters (body mass, BMI, % MM, % FAT) on postural stability in hearing-impaired men.

Body balance at static posturography in vestibular migraine

IntroductionMigraine is one of the most frequent and incapacitating headaches, with a high degree of impairment in quality of life. Its association with vestibular symptoms is common, including imbalance and postural instability. ObjectiveTo evaluate the body balance of patients with vestibular migraine through a static posturography test. MethodsAn experimental group of 31 patients with a medical diagnosis of vestibular migraine in the intercritical period of the disease, and a control group of 31 healthy individuals, matched for age and gender, were submitted to the eight sensory conditions of the Tetrax Interactive Balance System. The parameters analyzed were: stability index, which measures the amount of sway, global stability and ability to compensate postural modifications; weight distribution index, which compares deviations in weight distribution; synchronization index, which measures the symmetry in the weight distribution; postural sway frequency, which indicates the frequency range with more sway; and fall risk index, which expresses the probability of falls. ResultsThe stability index was higher in the experimental group in all eight sensory conditions, with a significant difference between the groups in six of them. The weight distribution index was higher in the experimental group in all conditions, with a significant difference in three of them. The number of cases with preferential sway in F2–F4 was significantly higher in the experimental group in three conditions, and in F5–F6 in two, while the fall risk was significantly higher in the experimental group than in the control group. ConclusionPatients with vestibular migraine showed compromised body balance at the static posturography test.

Relationship between the severity of cerebral white matter hyperintensities and sympathetic nervous activity in older adults.

White matter hyperintensities (WMH), visualized on brain magnetic resonance imaging, represent an abnormality related to the development of geriatric syndromes. Recently, it has been found that low sympathetic nervous activity might be associated with physical and cognitive dysfunction in older adults. Therefore, we investigated the relationship between the severity of cerebral WMH and sympathetic nervous activity, measured by the heart rate variability. We carried out a cross-sectional study of 39 older patients. Holter recording was carried out for 30 min. From the RR intervals on the electrocardiogram, the standard deviation of the normal-to-normal intervals, the standard deviation of all normal-to-normal intervals in all the five segments of the entire recording, low frequency (LF), high frequency (HF) and LF/HF were calculated. In regard to the WMH, periventricular hyperintensities and deep white matter hyperintensities (DWMH) were rated according to the Fazekas classification. The WMH were also rated semiquantitatively according to the methods developed by Junque (periventricular hyperintensities) and de Groot (DWMH). The LF/HF showed significant negative correlations with the total and regional periventricular hyperintensities, as well as DWMH. Multiple regression analysis showed that the negative associations remained significant between the LF/HF and DWMH (total, temporal, occipital). Furthermore, fall risk index significantly correlated with the LF/HF, total and the occipital DWMH. The severity of the DWMH was associated with the LF/HF and the fall risk, one of the important geriatric syndromes, suggesting that WMH, sympathetic nervous dysfunction and geriatric syndrome are interrelated to each other. Geriatr Gerontol Int 2018; 18: 569-575.