Physiological Profile Assessment Research Articles

Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management

ObjectiveThis study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS). DesignSecondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States. SettingCommunity. ParticipantsAmbulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7±9.9 years disease duration). InterventionsNot applicable. Main Outcome MeasuresAll participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months. Results155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated that the odds of being classified as a recurrent faller significantly increased with increasing scores (PPA odds ratio [OR] 1.30 [95% CI 1.17-1.46], FESi OR 1.05 [95% CI 1.03-1.07]). Classification and regression tree analysis divided the sample into four groups based on cutoff values for the PPA: (1) low physiological/low perceived risk (PPA <2.83, FESi <27.5), (2) low physiological/high perceived risk (PPA <2.83, FESi >27.5), (3) high physiological/low perceived risk (PPA >2.83, FESi <35.5), and (4) high physiological/high perceived risk (PPA <2.83, FESi >35.5). Over 50% of participants had a disparity between perceived and physiological fall risk; most were in group 2. It is possible that physiological risk factors not detected by the PPA may also be influential. ConclusionsThis study highlights the importance of considering both physiological and perceived fall risk in MS and the need for further research to explore the complex interrelationships of perceptual and physiological risk factors in this population. This study also supports the importance of developing behavioral and physical interventions that can be tailored to the individual’s needs.

Gait parameters, functional mobility and fall risk in individuals with early to moderate primary open angle glaucoma: a cross-sectional study

ObjectiveThis study investigated the influence of early to moderate primary open angle glaucoma on gait, functional mobility and fall risk. MethodsThirty-three participants in the early and moderate stages of primary open angle glaucoma and 34 asymptomatic controls participated in the study. Spatiotemporal gait data were obtained with the GAITRite system and included: velocity, cadence, step length, base of support, swing, stance and double support times. Functional measures included the Timed Up and Go test, the Five-Repetition Sit-To-Stand test and the Dynamic Gait Index. Fall risk was measured using the Physiological Profile Assessment. ResultsThe variables contrast sensitivity, proprioception and the Timed Up and Go and Dynamic Gait Index tests were significantly different between groups. In addition, the glaucoma group presented significantly higher risk of falling compared to the control group. Individuals in the early and moderate stages of primary open glaucoma presented mobility and sensory deficits that increase the risk of falling. ConclusionsThe results of this study suggest that adding the Timed Up and Go and Dynamic Gait Index tests to routine physical therapy assessment of individuals with early glaucoma could be useful. Rehabilitation programs should focus on maintaining and/or improving mobility and balance, and prevention of falls in this population.

Longitudinal associations between serum 25-hydroxyvitamin D, physical activity, knee pain and dysfunction and physiological falls risk in community-dwelling older adults

AimsTo describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. MethodsData for 1053 participants (51% women; mean age 63 ± 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. ResultsBetween-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (β = −0.005 per nmol/l, 95% CI: −0.008, −0.002), log-MVPA (β = −0.16 per minute, 95% CI: −0.22, −0.10) and lower mean WOMAC score (β = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (β = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (β = −0.15 per minute, 95% CI: −0.24, −0.06), but not 25OHD, at the same time-point. ConclusionHaving higher WOMAC global score above an individual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors.

Perbezaan Pencapaian Ujian Timed Up and Go dan Kelajuan Berjalan antara Warga Emas dengan Risiko Jatuh Tinggi dan Rendah

Falls is one of the main problems in older adults, which indirectly contributes to deterioration of quality of life, morbidity and mortality. The purpose of this study was to examine the difference in values between timed up and go (TUG) and gait speed tests among community dwelling older adults with high and low risk of falls classified using PPA (Physiological Profile Assessment). This cross-sectional study involved 278 older adults aged between 60 to 88 years, recruited from senior citizen club around Klang Valley. 40.6% older adults had high risk of falls and mostly were women (75%). The results of the study showed that there was a significant (p<0.05) difference in TUG and Gait speed tests performance between older adults with high and low risk of falls. Declined mobility (longer time of TUG test) and increased age were identified as significant (p<0.05) risk factors for falls in this study. The TUG test reference values obtained in this study may be useful for early identification, prevention and management of falls among community dwelling older adults. DOI : http://dx.doi.org./10.17576/JSKM-2018-1602-12

Built Environment Characteristics and its Association between Physical Performance, Falls Risk and Functional Mobility among Malaysian Older Adults

Older adults who walk in their neighbourhood with greater street connectivity are reported to have slower rate lower limb physical performance decline. There is limited information regarding the association between built environment characteristics and physical performance in older adults. The aim of this study was to examine the association between built environment characteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37 women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs in Kuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed using an adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measured using Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. Timed Up and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation between built environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speed test (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physical performance (R2 = 0.19, p < 0.001). Built environment characteristics is an important external factors in preserving physical performance in older adults. Programmes and policies for a more favourable built environment characteristics in the neighbourhoods should be encouraged to promote and maintain physical function among older adults. DOI : http://dx.doi.org./10.17576/JSKM-2018-25

Supervised Balance Training and Wii Fit–Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes

ObjectivesThis study examined the benefits of and differences between 12 weeks of thrice-weekly supervised balance training and an unsupervised at-home balance activity (using the Nintendo Wii Fit) for improving balance and reaction time and lowering falls risk in older individuals with type 2 diabetes mellitus (T2DM). DesignBefore-after trial. SettingUniversity research laboratory, home environment. ParticipantsSixty-five older adults with type 2 diabetes were recruited for this study. Participants were randomly allocated to either supervised balance training (mean age 67.8 ± 5.2) or unsupervised training using the Nintendo Wii Fit balance board (mean age 66.1 ± 5.6). InterventionThe training period for both groups lasted for 12 weeks. Individuals were required to complete three 40-minute sessions per week for a total of 36 sessions. MeasurementThe primary outcome measure was falls risk, which was as derived from the physiological profile assessment. In addition, measures of simple reaction time, lower limb proprioception, postural sway, knee flexion, and knee extension strength were also collected. Persons also self-reported any falls in the previous 6 months. ResultsBoth training programs resulted in a significant lowering of falls risk (P < .05). The reduced risk was attributable to significant changes in reaction times for the hand (P < .05), foot (P < .01), lower-limb proprioception (P < .01), and postural sway (P < .05). ConclusionsOverall, training led to a decrease in falls risk, which was driven by improvements in reaction times, lower limb proprioception, and general balance ability. Interestingly, the reduced falls risk occurred without significant changes in leg strength, suggesting that interventions to reduce falls risk that target intrinsic risk factors related to balance control (over muscle strength) may have positive benefits for the older adult with T2DM at risk for falls.

Investigating feasibility of use of an Android Smart Phone Application (MoveIt) as a clinical outcome measure

Purpose: Mobile accelerometry has been validated against gold-standard motion analysis and current low-cost, low-tech clinical (Physiological Profile Assessment) measures of stance stability (Patterson et al., 2014). This could offer a fast, portable, specific and feasible clinical Method to the PPA. This study assesses feasibility of use of ‘MoveIt’ for student physiotherapists (MoveIt: An android Smart Phone application with a standardised procedure to measure stance stability).

Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people

BackgroundReduced ability to adapt gait, particularly under challenging conditions, may be an important reason why older adults have an increased risk of falling. This study aimed to identify cognitive, psychological and physical mediators of the relationship between impaired gait adaptability and fall risk in older adults. MethodsFifty healthy older adults (mean±SD: 74±7years) were categorised as high or low fall risk, based on past falls and their performance in the Physiological Profile Assessment. High and low-risk groups were then compared in the gait adaptability test, i.e. an assessment of the ability to adapt gait in response to obstacles and stepping targets under single and dual task conditions. Quadriceps strength, concern about falling and executive function were also measured. ResultsThe older adults who made errors on the gait adaptability test were 4.76 (95%CI=1.08–20.91) times more likely to be at high risk of falling. Furthermore, each standard deviation reduction in gait speed while approaching the targets/obstacle increased the odds of being at high risk of falling approximately three fold: single task − OR=3.10,95%CI=1.43–6.73; dual task − 3.42,95%CI=1.56–7.52. Executive functioning, concern about falling and quadriceps strength substantially mediated the relationship between the gait adaptability measures and fall risk status. ConclusionImpaired gait adaptability is associated with high risk of falls in older adults. Reduced executive function, increased concern about falling and weaker quadriceps strength contribute significantly to this relationship. Training gait adaptability directly, as well as addressing the above mediators through cognitive, behavioural and physical training may maximise fall prevention efficacy.

Associations between cerebral amyloid and changes in cognitive function and falls risk in subcortical ischemic vascular cognitive impairment

BackgroundTo determine the association between amyloid-beta (Aβ) plaque deposition and changes in global cognition, executive functions, information processing speed, and falls risk over a 12-month period in older adults with a primary clinical diagnosis of subcortical ischemic vascular cognitive impairment (SIVCI).MethodsThis is a secondary analysis of data acquired from a subset of participants (N = 22) who were enrolled in a randomized controlled trial of aerobic exercise (NCT01027858). The subset of individuals completed an 11C Pittsburgh compound B (PIB) scan. Cognitive function and falls risk were assessed at baseline, 6-months, and 12-months. Global cognition, executive functions, and information processing speed were measured using: 1) ADAS-Cog; 2) Trail Making Test; 3) Digit Span Test; 4) Stroop Test, and 5) Digit Symbol Substitution Test. Falls risk was measured using the Physiological Profile Assessment. Hierarchical multiple linear regression analyses determined the unique contribution of Aβ on changes in cognitive function and falls risk at 12-months after controlling for experimental group (i.e. aerobic exercise training or usual care control) and baseline performance. To correct for multiple comparisons, we applied the Benjamini-Hochberg procedure to obtain a false discovery rate corrected threshold using alpha = 0.05.ResultsHigher PIB retention was significantly associated with greater decrements in set shifting (Trail Making Test, adjusted R2 = 35.3%, p = 0.002), attention and conflict resolution (Stroop Test, adjusted R2 = 33.4%, p = 0.01), and information processing speed (Digit Symbol Substitution Test, adjusted R2 = 24.4%, p = 0.001) over a 12-month period. Additionally, higher PIB retention was significantly associated with increased falls risk (Physiological Profile Assessment, adjusted R2 = 49.1%, p = 0.04). PIB retention was not significantly associated with change in ADAS-Cog and Verbal Digit Span Test (p > 0.05).ConclusionsSymptoms associated with SIVCI may be amplified by secondary Aβ pathology.Trial registrationClinicalTrials.gov, NCT01027858, December 7, 2009.

Wii-Based and Supervised Exercise Training Decrease Falls Risk in Older Adults with Type 2 Diabetes

Loss of balance resulting in falls is a serious health issue for older persons with type 2 diabetes (T2D). One intervention shown to produce benefits for these individuals is various types of exercise training. However, motivation is commonly cited as a barrier to consistent physical activity participation in unsupervised conditions. Interactive video games, such as the Nintendo Wii system, have been viewed as an innovative tool for engaging individuals in activity at home. PURPOSE: To assess the differences between supervised and unsupervised (using the Nintendo Wii) exercise training aimed at improving balance, reaction time, lower limb strength, and falls risk in older adults with T2D. METHODS: 47 older adults with T2D participated in 12 weeks of training: 32 (mean age 67.7 + 5 yr) completed supervised training (ST) while 15 (mean age 66.3 + 5 yr) completed unsupervised Wii training. ST sessions (40 min each, 3 times a week) consisted of lower limb stretches followed by leg, abdominal, and lower back exercises. The Wii training group completed three 40-min sessions on the Wii balance board per week. The Wii-based exercises were self-selected to emphasize balance and postural control. Prior to and following training, assessments of lower limb strength (i.e., isometric knee extension and flexion), falls risk (using the Physiological Profile Assessment), balance, postural coordination, vision, proprioception and reaction time were performed. RESULTS: Following training, participants in both the ST and Wii groups showed a significant decline in overall falls risk (ST, 0.59 + 0.12 to 0.22 + 0.14; Wii, 0.33 + 0.13 to 0.17 + 0.11; p < 0.05). Falls risk reductions were driven by significant improvements in knee extension (ST, 31.5 kg to 36.4 kg; Wii, 31.1 to 34.3 kg), knee flexion (ST, 16.9 to 19.3 kg; Wii, 17.0 to 18.3 kg), faster reaction times (ST, 278 to 247 ms; Wii, 244 to 225 ms) and improved postural coordination (ST, 13.4 to 9.1 errors; Wii, 9.7 to 6.5 errors). CONCLUSION: Both ST and unsupervised Wii exercise training interventions led to a reduction in falls risk in older adults with T2D, accompanied by increases in leg strength, faster reaction times, and improved balance coordination. Thus, both supervised and unsupervised exercise may lead to improvements in falls risk in older adults with T2D.

The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults.

While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure. The Beagley-Gibson (BG) method utilises microtopographical skin changes to quantify cumulative lifetime ultraviolet radiation (sun) exposure. This study aimed to describe the relationship between BG grade, BMD, falls risk and fractures in older adults. Eight hundred thirty-five community-dwelling adults aged 53-83years had silicone casts from the dorsum of both hands graded by the BG method. BMD was measured using DXA and falls risk using the short form of the Physiological Profile Assessment. Vertebral deformities and symptomatic fractures were assessed by DXA and questionnaire, respectively. The relationship between BG grade, spine BMD and vertebral fracture varied depending upon sex. In females, increasing grade was associated with lower vertebral fracture prevalence (OR=0.44/grade, p=0.018) and fewer fractures (OR=0.82/grade, p=0.021), particularly major fractures (OR=0.75/grade, p=0.03). In males, increasing grade was associated with more DXA-detected vertebral deformities (RR=1.28/grade, p=0.001), but not symptomatic fractures. These relationships were independent of BMD, falls risk, smoking and current 25-hydroxyvitamin D. BG grade was not associated with falls risk. For BMD, there were interactions between BG grade and both age and sex and a positive trend with hip BMD in younger males. BG grade demonstrated beneficial associations with fracture outcomes in females and BMD in younger males independent of current 25-hydroxyvitamin D. These data support the concept that cumulative ultraviolet radiation exposure is an important determinant of skeletal health. The association with vertebral deformities in males may reflect outdoor physical trauma in younger life.

Differences Between Gait on Stairs and Flat Surfaces in Relation to Fall Risk and Future Falls.

We used body-worn inertial sensors to quantify differences in semi-free-living gait between stairs and on normal flat ground in older adults, and investigated the utility of assessing gait on these terrains for predicting the occurrence of multiple falls. Eighty-two community-dwelling older adults wore two inertial sensors, on the lower back and the right ankle, during several bouts of walking on flat surfaces and up and down stairs, in between rests and activities of daily living. Derived from the vertical acceleration at the lower back, step rate was calculated from the signal's fundamental frequency. Step rate variability was the width of this fundamental frequency peak from the signal's power spectral density. Movement vigor was calculated at both body locations from the signal variance. Partial Spearman correlations between gait parameters and physiological fall risk factors (components from the Physiological Profile Assessment) were calculated while controlling for age and gender. Overall, anteroposterior vigor at the lower back in stair descent was lower in subjects with longer reaction times. Older adults walked more slowly on stairs, but they were not significantly slower on flat surfaces. Using logistic regression, faster step rate in stair descent was associated with multiple prospective falls over 12 months. No significant associations were shown from gait parameters derived during walking upstairs or on flat surfaces. These results suggest that stair descent gait may provide more insight into fall risk than regular walking and stair ascent, and that further sensor-based investigation into unsupervised gait on different terrains would be valuable.

Fatigue, Physical Activity, Quality of Life, and Fall Risk in People with Multiple Sclerosis.

Fatigue, inactivity, and falls are major health issues for people with multiple sclerosis (MS). We examined the extent to which fatigue and low walking activity are associated with quality of life and increased fall risk in people with MS. People with MS (N = 210, aged 21-74 years) were categorized as having either high or low reported fatigue and walking activity levels and were then followed up for falls using monthly fall diaries for 6 months. A high level of fatigue was significantly associated with higher MS Disease Steps scores, worse balance, high composite physiological (Physiological Profile Assessment) fall risk scores, greater fear of falling, lower World Health Organization Disability Assessment Schedule (WHODAS) quality of life scores, and more prospectively recorded falls. Low walking activity was significantly associated with higher MS Disease Steps scores, reduced proprioception, worse standing and leaning balance, slow stepping, slow gait speed, worse fine motor control, high Physiological Profile Assessment fall risk scores, more fear of falling, and lower WHODAS quality of life scores. Increased fatigue and low walking activity levels were significantly associated with increased fall risk and lower quality of life in people with MS. Interventions aimed at addressing fatigue and inactivity may have multiple benefits for this group.

Changes of the Microbial Community in Corn Soil Due to the Synergism Zeolite-Mineral Fertilizers

Microbial communities in agricultural ecosystems are characterized by a strong dynamic and radical change due to technological inputs applied. Corn is cultivated on large areas with high requirements for nutrients and an increased potential for activation of specific microbial groups. The aim of this study was to assess the unilateral and synergic effect of zeolite and mineral fertilizers on the development and transformation of microbial functional groups in the rhizosphere of corn. Physiological profile assessment of microbial communities has been carried out on the basis of substrate induced respiration, monitored over a period of 6 hours of incubation. The amount of CO2 registered in Microresp plates represents the activity of functional groups in decomposition of each type of substrate applied. Characteristic groups of microorganisms in maize rhizosphere are capable of decomposing acids: citric, L-malic, oxalic and α-Ketoglutaric. These substrates indicate the presence of high concentrations of organic matter in soil and the existence of a biological crust on the surface (citric acid), respectively the existence of powerful processes for the decomposition of organic material by actinomycetes (α-Ketoglutaric acid). The highest microbial activities were observed in groups of bacteria involved in processes of plant growth promotion and microbial groups with an important role in the processes of denitrification (oxalic acid). For the application of urea a triple value of activity of this type of microflora is observed. Functional groups codominant in soils cultivated with corn are specialized in efficient degradation of organic matter and biological crust, zeolite providing the complex substrate necessary for the development of these microorganisms.

Effects of Tai Chi on Cognition and Fall Risk in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial.

To examine whether combined center- and home-based Tai Chi training can improve cognitive ability and reduce physiological fall risk in older adults with amnestic mild cognitive impairment (a-MCI). Randomized controlled trial. Chiang Mai, Thailand. Adults aged 60 and older who met Petersen's criteria for multiple-domain a-MCI (N = 66). Three weeks center-based and 12 weeks home-based Tai Chi (50 minutes per session, 3 times per week). Cognitive tests, including Logical Memory (LM) delayed recall, Block Design, Digit Span forward and backward, and Trail-Making Test Part B-A (TMT B-A), and fall risk index using the Physiological Profile Assessment (PPA). At the end of the trial, performance on LM, Block Design, and TMT B-A were significantly better for the Tai Chi group than the control group after adjusting for baseline test performance. The Tai Chi group also had significantly better composite PPA score and PPA parameter scores: knee extension strength, reaction time, postural sway, and lower limb proprioception. Combined center- and home-based Tai Chi training three times per week for 15 weeks significantly improved cognitive function and moderately reduced physiological fall risk in older adults with multiple-domain a-MCI. Tai Chi may be particularly beneficial to older adults with this condition.

Prospective Associations of Low Muscle Mass and Function with 10-Year Falls Risk, Incident Fracture and Mortality in Community-Dwelling Older Adults.

Purpose: To compare the performance of low muscle mass and function with falls risk, incident fracture and mortality over 10 years. 1041 participants (50% women; mean age 63±7.5 years) were prospectively followed for 10 years. Falls risk was measured using the Physiological Profile Assessment, fractures were self-reported and mortality was ascertained from the death registry. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry. Four anthropometric: (ALM/height2, ALM/body mass index, ALM/weight×100, a residuals method of ALM on height and total body fat) and four performance-based measures: (handgrip strength, lower-limb muscle strength, upper and lower-limb muscle quality) were examined. Participants in the lowest 20% of the sex-specific distribution for each anthropometric and performance-based measure were classified has having low muscle mass or function. Regression analyses were used to estimate associations between each anthropometric and performance-based measure at baseline and 10-year falls risk, incident fractures and mortality. Mean falls risk z-score at 10 years was 0.64 (SD 1.12), incident fractures and mortality over 10 years were 16% and 14% respectively. All baseline performance-based measures were significantly associated with higher falls risk score at 10 years. Low handgrip (RR 1.55, 95% CI: 1.09, 2.20) and ALM/body mass index (RR 1.54, 95% CI: 1.14, 2.08) were the only significant predictors of fracture and mortality respectively. Low handgrip strength, a simple and inexpensive test could be considered in clinical settings for identifying future falls and fractures. ALM/ body mass index could be most suitable in estimating 10-year mortality risk, but requires specialised equipment.

Feasibility of Using Tetrax Biofeedback Video Games for Balance Training in Patients With Chronic Hemiplegic Stroke

BackgroundDecreased weight bearing on the affected lower limb and poor weight shifting are common after a stroke occurs. The Tetrax biofeedback system is a center-of-pressure controlled video game system designed for patients with balance deficits. Although it is a commercial product, information about its clinical use for patients affected by stroke is limited. ObjectiveTo investigate the feasibility and potential efficacy of the Tetrax biofeedback system for balance training in patients with chronic stroke. DesignFeasibility study. SettingRehabilitation department of a medical center. ParticipantsParticipants who had sustained a hemiplegic stroke at least 6 months prior to enrollment but were still able to stand independently for more than 5 minutes. MethodsParticipants were randomly assigned to an intervention group (IG) or control group (CG). All participants received conventional rehabilitation training. The IG also received 20 minutes of exposure to Tetrax biofeedback games controlled by change in center of pressure 3 times a week for 6 weeks. Main Outcome MeasurementsThe primary outcome was feasibility, addressed by adherence, safety, and satisfaction. The secondary outcome was efficacy, which was evaluated by the subtests of physiological profile assessment, posturography, Timed Up and Go, and Forward Reach tests. We used percentage change (post-training score – pretraining score/pretraining score) to quantify the intervention effects. Mann-Whitney U tests were used to analyze differences in percentage of change between groups. ResultsA total of 14 participants were assigned to the IG, and 13 were assigned to the CG; 12 participants in the IG and 11 in the CG completed the study. In the IG group, those who completed the 6-week intervention attended 89.5% of planned sessions. No major adverse events or falls occurred within the intervention sessions. With use of 5-point Likert scales, participants rated their enjoyment of Tetrax games as 4.33 ± 0.78, their motivation as 4.17 ± 1.03, and perceived helpfulness as 4.25 ± 0.97. The IG demonstrated a significantly greater improvement in reaction time (P = .002), proprioception (P < .001), symmetric weight bearing (P = .027), Timed Up and Go (P < .001), and Forward Reach (P < .001) compared with the CG. ConclusionsUsing Tetrax biofeedback video games for balance training is a feasible adjunctive program that may augment conventional therapy in persons affected by chronic hemiplegic stroke. Level of EvidenceII

Can the Otago falls prevention program be delivered by video? A feasibility study

ObjectivesWe assessed the feasibility of delivering the Otago Exercise Programme (OEP) via an interactive DVD (ie, OEP-DVD) in combination with monthly physical therapist phone calls to older adults.DesignThis pre-post (baseline...

Walking-Induced Fatigue Leads to Increased Falls Risk in Older Adults

BackgroundFor older adults, falls are a serious health problem, with more than 30% of people older than 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person's balance, walking ability, and overall falls risk is affected by performing activities of daily living such as walking. ObjectiveThis study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait, and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into 5 equal groups based on their age (group 1, 30–39 years; group 2, 40–49 years; group 3, 50–59 years; group 4, 60–69 years; group 5, 70–79 years). MethodsEach person's falls risk (using the Physiological Profile Assessment), simple reaction time, leg strength, walking ability, and standing balance were assessed before and after a period of incline walking on an automated treadmill. The walking task consisted of three 5-minute trials at a faster than preferred pace. Fatigue during walking was elicited by increasing the treadmill incline in increments of 2° (from level) every minute to a maximum of 8°. ResultsAs predicted, significant age-related differences were observed before the walking activity. In general, increasing age was associated with declines in gait speed, lower limb strength, slower reaction times, and increases in overall falls risk. Following the treadmill task, older adults exhibited increased sway (path length 60–69 years; 10.2 ± 0.7 to 12.1 ± 0.7 cm: 70–79 years; 12.8 ± 1.1 to 15.1 ± 0.8 cm), slower reaction times (70–79 years; 256 ± 6 to 287 ± 8 ms), and declines in lower limb strength (60–69 years; 36 ± 2 to 31 ± 1 kg: 70–79 years; 32.3 ± 2 to 27 ± 1 kg). However, a significant increase in overall falls risk (pre; 0.51 ± 0.17: post; 1.01 ± 0.18) was only seen in the oldest group (70–79 years). For all other persons (30–69 years), changes resulting from the treadmill-walking task did not lead to a significant increase in falls risk. ConclusionsAs most falls occur when an individual is moving and/or fatigued, assessing functional properties related to balance, gait, strength, and falls risk in older adults both at rest and following activity may provide additional insight.

Fall risk in people with MS: A Physiological Profile Assessment study.

IntroductionThe Physiological Profile Assessment (PPA) is used in research and clinical practice for assessing fall risk. We compared PPA test performance between people with multiple sclerosis (MS) and healthy controls, determined the fall-risk profile for people with MS and developed a reference database for people with MS.MethodsFor this study, 416 ambulant people with MS (51.5 ± 12.0 years) and 352 controls (52.8 ± 12.2 years) underwent the PPA (tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway) with composite fall-risk scores computed from these measures. MS participants were followed prospectively for falls for 3 months.ResultsThe MS participants performed significantly worse than controls in each PPA test. The average composite fall-risk score was also significantly elevated, indicating a “marked” fall risk when compared with controls. In total, 155 MS participants (37.3%) reported 2 + falls in the follow-up period. Frequent fallers performed significantly worse than non-frequent fallers in the contrast sensitivity, reaction time and sway tests and had higher PPA composite scores.ConclusionsIn line with poor PPA test performances, falls incidence in people with MS was high. This study provides comprehensive reference data for the PPA measures for people with MS that could be used to inform future research and clinical practice.