Icy Sidewalks Research Articles

Activities-specific balance confidence scale in elderly in community nursing home

Background: To investigate the incidence of falls in elderly in nursing homes and to determine the differences in confidence indexes of daily living in the Activities-Specific Balance Confidence Scale (ABC) in elderly fallers or nonfallers. Methods: We conducted a perspective study with elderly (ages >75 years old) from January 1, 2018, to December 31, 2020, living in community nursing homes in Tongzhou district, Beijing. All the participants were able to walk independently, had not experienced any fall episodes, were capable of following commands, and they sufficiently cooperated with the process of the examination. A face-to-face visit or telephone interview was conducted with participants on a regular basis for 12 months. The falling incidence and the differences of ABC scale confidence indexes between fallers and nonfallers were investigated. Results: This study included 87 older adults (67 nonfall participants and 20 fall participants). Falls occurred at a rate of 23 per 100 people per year. The ABC scale index of the faller group was 37%, which indicated very low balance confidence and a high risk of falling. The ABC scale index of the nonfaller group was 80%, which indicated normal balance confidence and no risk of falling. There were significant differences in ABC scale indexes between the faller and nonfaller groups (37% vs. 80%, P = 0.005). There were significant differences in activities such as walking around the house, climbing up and down stairs, picking up slippers from floor, reaching on tiptoes, standing on a chair to reach, walking outside to a nearby car, getting in/out of a car, walking across a parking lot, walking up and down a ramp, walking in a crowded mall between two groups of people, walking in a crowd (risk of bumping into other people), going up an escalator without rail assistance, and walking on an icy sidewalk between the two groups (P < 0.05). Conclusion: Nursing homes have a high rate of falls among older adults. The ABC scale can assess balance confidence and the risk of falling in older adults. To reduce or prevent falls, health-care professionals should screen those who are at high risk of falling and enroll them in a fall prevention program.

Rasch Analysis of the Activities-Specific Balance Confidence Scale in Individuals Poststroke

ObjectiveTo examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale using Rasch analysis for individuals poststroke. DesignRetrospective cohort. SettingData was extracted from the Locomotor Experience Applied Post-Stroke phase 3, multisite, randomized controlled clinical trial. ParticipantsCommunity-dwelling, ambulatory, older adults (N=406) (mean age ± SD, 61.97±12.76y; 45.07% female) approximately 2 months poststroke. InterventionNone. Main Outcome MeasuresWe examined unidimensionality, local dependence, rating-scale structure, item and person fit, person-item match, and separation index of the ABC scale. ResultsConfirmatory and exploratory factor analysis showed the ABC scale was adequately unidimensional and 3-item pairs had local dependence. A collapsed 5-category rating scale was superior to the 101-category scale. The hardest item was “walking outside on an icy sidewalk,” the easiest item was “getting into or out of a car,” and no items misfit. The ABC scale had high person reliability (0.93), despite 10.5% of individuals misfitting the expected response pattern. Mean ability level of the sample was slightly lower (−0.56 logits) than the mean item difficulty indicating that the ABC scale adequately matched our sample’s balance confidence. The ABC scale did not have a floor or ceiling effect and separated individuals into 5 statistically distinct strata (separation index=3.71). ConclusionsThe Rasch model supports the use of the ABC scale to measure balance confidence in individuals poststroke. The consistency of our results with previous Rasch analyses on the ABC scale demonstrates the instrument responds similarly across multiple populations; community-dwelling older-adults, outpatient orthopedic physical therapy, stroke, Parkinson disease, and lower-limb amputation. Recommendations include collapsing the rating scale and developing a computerized-adaptive test version of the scale to enhance clinical utility.

The beginning of the end: A qualitative study of falls among HIV+ individuals.

Falls are an important concern for individuals living with HIV (HIV+). The purpose of this study was to understand perceptions of HIV+ individuals who had fallen regarding what caused their falls, prevention strategies that they used, and the impact of falls on their lives. Qualitative Description was the approach best suited to our study. We conducted in-depth interviews with 21 HIV+ individuals aged 47 to 71 years who had fallen within the past two years and who received care in a primary care/HIV clinic. Participants identified causes of falls as intrinsic (HIV, opportunistic infections, antiretroviral therapy, substance use, polypharmacy) or extrinsic (icy sidewalks, wet floors). Among those who felt that their falls could be prevented, prevention strategies included physical therapy and avoiding extrinsic fall risk factors. Some participants, however, felt that their falls could not be prevented. While some participants responded adaptively to falls, for many, the experience of falling was connected with deep feelings of loss and suffering. For these individuals, falls were understood to be “the beginning of the end” and a source of social isolation, changing family roles, diminished sense of self, and stigma.

Rasch Analysis of the Activities-Specific Balance Confidence Scale in Older Adults Seeking Outpatient Rehabilitation Services.

Background The Activities-specific Balance Confidence (ABC) scale measures confidence in performing various ambulatory activities without falling or experiencing a sense of unsteadiness. Objectives This study (1) examined the ABC scale (0-100) using Rasch analysis, (2) assessed statistically reliable change, and (3) developed a functional staging to guide clinical interpretation of a patient's improvement. Methods The authors examined rating-scale structure, item difficulty hierarchy, item fit, person-item match, separation index, differential item functioning, test precision, and unidimensionality. Additionally, this cross-sectional study of 5012 older patients seeking outpatient rehabilitation therapy in 123 clinics estimated the minimal detectable change and developed a functional staging. Results The item "walk outside on icy sidewalks" was the most difficult item, while the item "reach for a small can off a shelf at eye level" was the easiest item. Overall, average patient ability estimates of 56.2 ± 20.3 were slightly higher than the average item difficulty estimates of 45.9 ± 7.8. With a separation index equal to 3.65, the ABC scale items can differentiate individuals into 5.2 statistically distinct strata. Most ABC scale items were free of differential item functioning. For example, "walk outside on icy sidewalks" was easier for patients who were underweight. Results supported unidimensionality of the ABC scale, with the first factor explaining 77% of the total variance. The estimated minimal detectable change was 15 points. The authors provided an example of functional staging application. Conclusion Results supported sound psychometric properties and clinical usage of the ABC scale for older adults seeking outpatient rehabilitation therapy. J Orthop Sports Phys Ther 2018;48(7):574-583. Epub 30 Mar 2018. doi:10.2519/jospt.2018.8023.

Unaffected first-degree relatives of essential tremor cases have more imbalance than age-matched control subjects

BackgroundEndophenotypes are measurable clinical characteristics that may be present in individuals with increased risk for disease (e.g., unaffected family members). Endophenotypes are useful; they may clarify diagnosis in genetic studies and foster the development of animal models. In recent years, problems with balance and mild gait ataxia have been associated with essential tremor (ET). We compared gait and balance of first-degree relatives of ET cases (FD-ET) to that of age-matched controls (Co). MethodsOne-hundred-ninety FD-ET and 68 Co, none of whom reported tremor or were diagnosed with ET, underwent a standardized assessment of gait and balance. ResultsFD-ET reported more near-falls in the past year (p = 0.015) and lower balance confidence according to the Activities of Balance Confidence (ABC-6) Scale (p = 0.03). The specific ABC-6 items for which FD-ET reported lower balance confidence than Co were being bumped into by people while walking (p = 0.006) and walking outside on icy sidewalks (p = 0.007). On videotaped neurological examination, FD-ET were able to stand in the tandem position for fewer seconds than were Co (p = 0.048). The differences between FD-ET and Co, although statistically significant, were clinically mild. ConclusionFD-ET reported more near-falls in the past year and a reduction in balance confidence; additionally, ability to maintain tandem stance was impaired compared to Co. These data suggest a more pervasive abnormality of cerebellar dysfunction than previously conceived, extending beyond ET cases themselves and manifesting in mild form in their unaffected family members.

Effect of the Matter of Balance Program on Balance Confidence in Older Adults

Abstract. This pre/posttest study investigated the effect of A Matter of Balance: Managing Concerns about Falls (MOB) on balance confidence in older adults. MOB is an evidence-based program designed to decrease fear of falling and increase activity in older adults. Thirty-three participants completed the Activities-specific Balance Confidence Scale (ABC) pre- and postprogram. Significant differences were found for 3 items: reach for small can off a shelf at eye level (p = .006), walk outside the house to a car parked in the driveway (p = .028), and walk outside on icy sidewalks (p = .009); and for total ABC scores (p = .024). The findings support the efficacy of MOB for increasing balance confidence through a combination of education and exercise.

Self-denigrating actions.

While I applaud the majority of Drs. Davies and Tsuyuki’s suggestions, I must take exception to their views on pharmacy drive-through windows. No doubt there are examples of poor practice using this technology, but we built our window with the intention of improving patient access and quality of care. Our experience has been that it has enhanced the quality of patient interaction for many patients, most notably those with mobility issues and mothers with children. Snow accumulations and icy sidewalks in our northern city mean that even businesses that are wheelchair-accessible in summer can be tricky to access during the winter months. People who have an acute injury are likely safer staying in a vehicle rather than navigating their way into the pharmacy on crutches. Many mothers solo-parent while their partners work in the oil patch and are grateful for the drive-through window, especially in sub −20°C weather: They don’t have to unload babies or children and keep an eye on them in a distracting pharmacy while trying to listen to the pharmacist. While the drive-through window does present some communication and confidentiality challenges, the fact that we actually speak to the patient rather than a third party means the patient is able to ask questions and clarify issues directly with us. Febrile patients can receive direct counselling while not mingling with other patients in the pharmacy. Patients smoking in their vehicles have occasioned some productive counselling when no such opportunity would have existed in-store. The idling issue is valid (although I suspect it is no worse than for those patients who leave their vehicles running while they wait in a pharmacy), and we strongly urge drivers to turn their engines off while at the drive-through window. The drive-through window is just another technology in our armory of care. Used properly, it confers great benefit on our patients and reflects well on our practice and profession.

Aging and the Use of Pedestrian Facilities in Winter—The Need for Improved Design and Better Technology

Walking outdoors is often difficult or impossible for many seniors and people with disabilities during winter. We present a novel approach for conducting winter accessibility evaluations of commonly used pedestrian facilities, including sidewalks, street crossings, curb ramps (curb cuts and dropped curbs), outdoor stairs and ramps, building and transit entrances, bus stops, and driveways. A total of 183 individuals, aged 18-85 completed our survey. The results show that cold weather itself had little impact on the frequency of outdoor excursions among middle-aged and older adults while the presence of snow and/or ice on the ground noticeably kept people, especially older adults at home. The survey found that the key elements decreasing winter accessibility were icy sidewalks and puddles at street crossings and curb ramps. While communities have recognized the need to improve snow and ice removal, little attention has been paid to curb ramp design which is especially ineffective in winter when the bottom of the ramps pool with rain, snow, and ice, making it hazardous and inaccessible to nearly all users. We conclude that investigations of alternative designs of curb ramp are needed.

Assuming Responsibility

When i was growing up in New York City during the 1940s, people (ordinary people anyway) assumed responsibility for their own actions. That was back when falling on an icy sidewalk meant being careless and not that the City had failed in its duty of care; when you could go fishing in the local park without first climbing a chain link fence designed to stop kids from falling into the water and their parents suing the County for negligence; or, when you could ride a bicycle without a helmet and there were see-saws in the park alongside slippery-dips higher than the shoulders of a five year old. I am sure it was the same in Australia. Maybe some of the changes in social attitudes and the proliferation of rules and regulations are good things. Maybe it is good to wear a helmet when riding a bike; it certainly makes sense to use the seat belt when driving in a car and maybe kids should not be allowed to risk life and limb sliding down a 2.5 metre high slippery-dip. What is not good is the increasing refusal to assume responsibility, to be litigious, and the growth of the Nanny State where individuals are denied responsibility for their own actions and we are all dumbed down by the expectation of authorities that we will all behave and respond like the least intelligent, least educated, most anti-social and most physically inept member of society. I find this trend to state control of my freedom to choose what I do, how I do it and when I do it frustrating and annoying; for example, I am not allowed to carry a pocket knife so I can eat an apple for lunch or open a bag of crisps because of an irrational fear of youth violence in Sydney and politicians needing to appear ?tough? on crime. But not wanting to assign or assume responsibility for individual actions has more serious implications; ones that impact significantly on the future of global biodiversity and human survival.

Teaching Neuro Image : Traumatic internuclear ophthalmoplegia

A 26-year-old right-handed man presented to the emergency department with a scalp laceration following a fall while walking on an icy sidewalk. He was intoxicated at the time and was witnessed by a friend to lose his footing, falling backward. There was brief loss of consciousness, lasting less than a minute. The patient himself had amnesia for the fall and for his transportation by ambulance. In the emergency department he had a headache, nausea, and “fuzzy” vision when looking to the left. The patient admitted to use of alcohol earlier that day but denied the use …

The Virtue of Defeat: Plessy v. Ferguson in Retrospect

The Virtue of Defeat: Plessy v. Ferguson in Retrospect Clarence Thomas As we near the end ofthis century, I would like to discuss a decision that came at the close of the last: Plessy v. Ferguson, the notorious 1896 case that helped usher in (or at least sanc­ tion) more than half-a-centuiyoflegalizedrac­ ism.' In particular, I would like to discuss it from the standpoint ofthose who were on the losing side and the virtues oflosing, especially in the face ofinsurmountable odds. I must say, in passing, that, as virtuous as it may be, losing is not an experience to which I hope to become that accustomed on this Court. The hundredth anniversary of Plessy has passed with almost the same lack of general interest that the decision received when Jus­ tice Henry Billings Brown delivered the opin­ ion for a 7-1 Court on May 18, 1896. As the historian C. Van Woodward describes it, in con­ trast to the great controversy that arose when the Court struck down much ofthe 1875 Civil Rights Act in the Civil Rights Cases,1 “the Plessy decision was accorded only short, in­ conspicuous news coverage and virtually no editorial comment outside the Negro press.”3 Reviewing the newspapers of the day, one writer of today observes that several papers ignored Plessy in favor ofdecisions involving an heiress’s million-dollar inheritance and a claimofplagiarismbyawell-knownplaywright.4 Progressivejournals such as the Harvard Law Review and the Yale LawJournalbusied them­ selves with articles such as “The Law of Icy Sidewalks in New York State,”5 and “Two Years’ Experience ofthe NewYork State Board of Law Examiners,”6 but paid no attention to Plessy. Aside from a sprinkling of law review ar­ ticles and law school addresses, Plessy’s cen­ tenary also has passed with little attention.7 This may be the case (at least in part) because the excellent scholarly work on Plessy done by Professor Charles Lofgren and by Professor Owen Fiss8 has discouraged others from en­ tering the field. Plessy, however, may be re- 16 JOURNAL1997VOL.il 26th. he will speak hi Algiers. Should the hall ate to accommodate the platform at the head of et will be utilized. g at an early hour M. id Joseph Rainey, residida and Morgan streets. from that corner and drunkeness and disturbThey pleaded not guElta were ordered against g at 4:45 o'clock the male rla Alien, colored, of No. eet, died without mediThe coroner was notl- :he State against Andrew ed with the murder of was called before Judge a preliminary hearing By agreement the ease 1 until Thursday week, was crowded when the id. ase was called to-day stenographer in court, )le noted this as being a as Mr. Borden should een on hand. IE CITY HALL. fr Murphy PromulFew AppointmentK— Committee Meeting;.. In a communication to the •e. notified that body that the lion of a school building on between Lafayette and Cyixamlncd . The bid of O'Neill* • $25,940 and that of John Mc25 ,493. As the specifications ird of the contract to the lotvtell Recommended that the btd >e accepted. papers it was made fo appear aphlcal error and transposition IcNally'B bid was for $25,943, itance was suggested. It may le bid of McNally while very that of the other bidders, does rice of filling, but Inasmuch as h the school Is intended to be inires grading, this item is not very important. lie order committee met last night and passed upon some minor matters. JIMCROWLAW. UPHELD BY THE UNITED STATES SUPREME COURT. Statute Within the Competency of the Loalniana Legislature and There are the usual nui seekers here. -They hav New Orleans and from ot the State. Some of them fu.ly in the interest of tl lion in the last light, I others probably who an office who did not beconi the administration until certain that Governor Fc i continued in the chair. Kail ron 1 frie is canvassing for ...msel usually runs in hard lucl gets beaten, but he has a ty of winning the fights t ges for others: and he h daily successful whew handled any of Mr. Price Mr...

Comminuted Fracture Dislocation of the Proximal Humerus

Dr. Turner: This 53-year-old truck driver fell on an icy sidewalk, injuring his left shoulder. Despite considerable pain, marked swelling, and ecchymosis about the shoulder, the patient did not come to the hospital until 24 hours following his injury. Physical examination revealed marked ecchymosis and swelling about the left shoulder. There was no evidence of damage to the circumflex nerve. Circulation and sensation in the upper extremity were normal. X-ray films demonstrated a fracture-dislocation of the left shoulder with the shaft of the humerus displaced superiorly into the shoulder joint and the humeral head displaced anteriorly and inferiorly. There was comminution of both the greater and lesser tuberosities (Fig 1,2,3). Dr. Aufranc: This patient has sustained a very severe fracture dislocation of the shoulder with at least four separate fragments visible: the greater tuberosity, the lesser tuberosity, the dislocated humeral head, and the shaft of the humerus. This injury is

The Law of Icy Sidewalks in New York State

The Law of Icy Sidewalks in New York State

Contributory Negligence. Icy Sidewalks. Manross v. Oil City, 35 Atl. Rep. 959 (Penn.)

Contributory Negligence. Icy Sidewalks. Manross v. Oil City, 35 Atl. Rep. 959 (Penn.)