Tinetti Balance Research Articles

Risk factors for crash involvement in older motorcycle riders

A prospective cohort study was conducted to identify risk and protective factors for crash involvement in older motorcyclists. Over a 1-year study period from August 2013 to July 2014, study participants were recruited from local community centers of five cities in Taiwan. People aged ≥60 years who rode a motorcycle at least once per week were eligible and were invited to participate in the study. Among 256 older riders who completed the baseline assessment and at least one of the four follow-up assessments, 79 (33.7%) experienced a motorcycle crash over the study period. Results of the proportional hazards model showed that after controlling for age, gender, and riding distance, older riders who had sustained hearing impairment (hazard ratio (HR)=2.58; 95% confidence interval (CI), 1.30–5.15), rode a motorcycle at speeds of ≥41km/h (HR=2.31; 95% CI, 1.26–4.23), and had experienced a motorcycle crash in the past year (HR=1.81; 95% CI, 1.06–3.09) were more likely to be involved in a crash, compared to their counterparts. Conversely, older riders who were obese (HR=0.43; 95% CI, 0.22–0.82) were less likely to be involved in a crash than those with a normal weight, while longer functional reach distances (HR=0.96; 95% CI, 0.93–0.99) and higher Tinetti balance scores (HR=0.79; 95% CI, 0.69–0.91) were associated with a reduced risk of crash involvement. Among older people riding a motorcycle as their primary source of transportation, several factors associated with the occurrence of motorcycle crashes were identified. Restrictions and modifications of these risk factors may help design effective safety interventions for reducing crash and injury risks of this increasing riding population.

Differences in fitness level between women aged 60 and over participating in three different supervised exercise programs and a sedentary group

ABSTRACTThe aim of this study was to compare fitness levels in women aged 60 and over participating in a supervised exercise program (involving tai chi, recreational gymnastics, and/or aquatic fitness) with those in a sedentary group. An observational, descriptive, cross-sectional study was performed on a total of 171 women aged from 60 to 92 who attended public community clubs for older adults. The instruments used included the Senior Fitness Test, the Tinetti Balance Assessment Tool, the Katz Index, and the Lawton & Brody Activities of Daily Living Scale. Significant differences in fitness levels were observed when we compared the exercise groups with the sedentary group. Women with better fitness levels had a lower risk of suffering falls and greater autonomy in performing activities of daily living and instrumental activities of daily living. Agility and gait control were found to be independently associated with exercise groups.

The Flat feet Increased The Postural Instability on The Elderly in Nursing Home

Introduction: Flat feet or flatfeet are the postures that have a low medial longitudinal arch. The prevalence ofFlat feet was 10-25% of adults population. The lower feet arch might have an impact on body sway have duringstanding posture. Furthermore, increasing of the postural sway could have the higher risk of fall in elderly, thathas a prevalence of 30-50%. The aim study to find the correlation between the Flat feet posture with posturalstability, to prevent the risk of fall in the elderly.Method: This design was observational cross-sectional study. The study conducted in the elderly nursing home.The posture was examined by ink feet print on white paper. The Tinetti Balance Assessment assessed the posturalstability.Result: The subjects were 84 elderly, mostly were 60-74 years old, and 46 (54,8%) were female. The mostprevalence of the postural stability was the low risk of fall (59,5%). The frequency of Flat feet was 26 (31%).There was a relationship between Flat feet with postural stability in elderly (p = 0,020).Conclusion: There was a correlation between the Flat feet and the postural stability on elderly in the nursinghome.Keywords: Flat feet, postural stability, elderly

Tools for assessing fall risk in the elderly: a systematic review and meta-analysis.

The prevention of falls among the elderly is arguably one of the most important public health issues in today's aging society. The aim of this study was to assess which tools best predict the risk of falls in the elderly. Electronic searches were performed using Medline, EMBASE, the Cochrane Library, CINAHL, etc., using the following keywords: "fall risk assessment", "elderly fall screening", and "elderly mobility scale". The QUADAS-2 was applied to assess the internal validity of the diagnostic studies. Selected studies were meta-analyzed with MetaDisc 1.4. A total of 33 studies were eligible out of the 2,321 studies retrieved from selected databases. Twenty-six assessment tools for fall risk were used in the selected articles, and they tended to vary based on the setting. The fall risk assessment tools currently used for the elderly did not show sufficiently high predictive validity for differentiating high and low fall risks. The Berg Balance scale and Mobility Interaction Fall chart showed stable and high specificity, while the Downton Fall Risk Index, Hendrich II Fall Risk Model, St. Thomas's Risk Assessment Tool in Falling elderly inpatients, Timed Up and Go test, and Tinetti Balance scale showed the opposite results. We concluded that rather than a single measure, two assessment tools used together would better evaluate the characteristics of falls by the elderly that can occur due to a multitude of factors and maximize the advantages of each for predicting the occurrence of falls.

Variability of spatial temporal gait parameters and center of pressure displacements during gait in elderly fallers and nonfallers: A 6-month prospective study.

Considering that most of the falls in elderly population arise during walking, tests derived from walking performance would be desirable for comprehensive fall risk assessment. The analysis of spatial temporal parameters and the center of pressure displacement, which represents the interaction between the human body and the ground, would be beneficial. The aim of this study was to compare spatial temporal gait parameters and their variability and the variability of the center of pressure displacement between elderly fallers and nonfallers during gait at self-selected, defined and fast speeds. A prospective study design was used. At the baseline, measurements of ground reaction force during gait at self-selected, defined and fast walking speeds by two force plates were performed. In addition, the Tinetti balance assessment tool, the Falls Efficacy Scale-International and the Activities-Specific Balance Confidence Scale were used. Mean and coefficient of variation of spatial temporal gait parameters and standard deviations of center of pressure displacement during loading response, midstance, terminal stance and preswing phases were calculated. Comparison of the fallers and nonfallers exhibited no significant difference in clinical tool, scales or spatial temporal parameters. Compared to nonfallers’ increased variability of walking speed at self-selected and defined speed, step width at fast walking speed and center of pressure displacement during preswing phase in medial-lateral directions at defined walking speed was found in fallers. However, application of the Holm-Bonferroni procedure for multiple comparisons exhibited no significant effect of group in any of the gait parameters. In general, our study did not observe an effect of group (fallers vs. nonfallers) on variability of spatial temporal parameters and center of pressure movement during gait. However, walking speed, step width as well as standard deviation of COP displacement in the medial-lateral direction during preswing exhibited a certain potential for distinguishing between elderly fallers and nonfallers.

Robotic-assisted gait training in Parkinson's disease: a three-month follow-up randomized clinical trial

ABSTRACTPurpose: The aim of this study was to evaluate the efficacy of a robotic-assisted gait training (RAGT), together with a conventional exercise program (CEP), to improve PD ambulation, as compared to standard gait training. Methods: Thirty-eight patients with mild PD stage (H&Y 2–2.5) were randomly assigned to an experimental group (EG) or a control group. The 19 patients in EG received 30 min RAGT (using Lokomat device), whereas the 19 controls received a conventional gait training; both groups received 30 min of CEP. Participants were evaluated before (T0), immediately after (T1), and 12 weeks after the end of treatment (T2), by using 10-MWT, Tinetti Test and the motor score of the UPDRS-III. Results: We found that Tinetti Walking (TW) (X2(3) = 31.75; p < 0.001), Tinetti Balance (X2(3) = 74.07; p < 0.001), UPDRS-III (X2(3) = 6.87; p < 0.001) and GDS (X2(3) = 28.83; p < 0.001) scores were affected by the type of the rehabilitative treatment. At T2, we found a significant difference between the two groups for TW (t = 2.62; p < 0.02, d = 0.85). Concerning all the study outcomes, a significant improvement was observed from T0 to T1 in both groups. However, the functional motor gain at T2 was maintained only in the EG. Conclusions: RAGT may significantly improve walking ability, motor function and for a maximum period of three months. Thus, our findings support the importance of a RAGT as a valid rehabilitative tool for PD.

Effects of adding whole-body vibration to routine day activity program on physical functioning in elderly with mild or moderate dementia: a randomized controlled trial.

To evaluate the effects of whole-body vibration (WBV) added to a routine activity program on lower limb strength, balance, and mobility among community-dwelling individuals with mild or moderate dementia, compared with the routine program alone. Fifty-four older adults (40 women; mean (SD) age: 79.8 (6.1) years) with mild or moderate dementia were recruited from two daycare centers. The participants were randomly allocated to undergo a routine day activity program combined with WBV training (WBV at 30 Hz, 2-mm peak-to-peak amplitude) or the routine program only without WBV for 9 weeks (18 sessions). The primary outcome was functional mobility, measured using the timed up-and-go test. The following secondary outcomes were evaluated: Berg Balance Scale, Tinetti balance assessment, time to complete 5 repetitions of sit-to-stand, Quality of Life in Alzheimer's disease questionnaire, and Activities-specific Balance Confidence scale. The attendance rate and incidence of adverse events were also recorded. The attendance rate for the training was high (86.0%). The incidence of adverse events was low, with only two of the 27 participants in the WBV group reporting mild knee pain. While significant improvement in timed up-and-go, Berg Balance Scale, and Tinetti balance score was found in both groups, none of the outcomes demonstrated a significant group by time interaction. WBV training is feasible and safe to use with people with mild or moderate dementia. However, it did not lead to further improvement in physical function and quality of life than the usual activity program provided at the daycare centers. Copyright © 2017 John Wiley & Sons, Ltd.

Risk of Falling after Femoral Nerve Block for Total Knee Arthroplasty: Periprosthetic Fractures—A Serious Concern

Objective: Femoral nerve block (FNB) is a popular, minimally invasive postoperative pain management procedure followingtotal knee arthroplasty (TKA). Prolonged motor blockade has been associated with increased risk of fall. The primary objective of the present study was therefore, to evaluate the risk of falling or near falling for FNB in patients who underwent TKA. Materials and methods: After Institutional Review Board approval, prospective cohort (142) of patients was randomized into two groups: the intervention (FNB as an adjunct to analgesia) vs the control (standard treatment) at our hospital for unilateral primary conventional TKA. The risk of falling as assessed using Tinetti Gait and Balance Instrument and Timed Up and Go (TUG) test was evaluated on the day of hospital discharge, and 1, 2, and 3 months after TKA. All data were collected and critically analyzed and p < 0.05 was considered statistically significant. Results: Patients in FNB group displayed significant low visual analog scale (VAS) scores than control (p < 0.05). Thirty-seven patients (26.05%) reported falls in the 3 months after surgery. Patients who received FNB following TKA experienced an expected significant worsening of physical function and had increased risk of falling as evaluated by TUG test and Tinetti Gait and Balance Instrument (p < 0.05). Due to unexpected fall, eight patients (28.57%) in FNB group sustained periprosthetic fractures and two patients (22.2%) in control group had opening of arthrotomy. At 3 months, 55 patients in FNB group had reported postoperative neuritis. Significant delay in rehabilitation and early ambulation in patients received FNB, which in turn increases the risk of prolonged hospitalization (p < 0.05). Conclusion: The Tinetti and gait index and TUG test time showed increased risk of fall for the patients who received FNB owing to substantial functional deficits.

Relationship between the plasma levels of neurodegenerative proteins and motor subtypes of Parkinson's disease.

The aim of our study is to examine the plasma levels of the four kinds of neurodegenerative proteins in plasma: α-syn, T-tau, P-tau181, and Aβ-42 in Parkinson's disease (PD) and to evaluate the relationship between their plasma levels and PD motor subtypes. 84 patients with PD were enrolled in our study, and finally, 73 of them were classified into the tremor-dominant subtype (TD) and the postural instability gait difficulty subtype (PIGD). Their motor performance was evaluated by a series of clinical assessments: Freezing of Gait Questionnaire (FOGQ), Timed Up and Go (TUGs), Tinetti balance, and Tinetti gait. Plasma levels of these proteins were measured by enzyme-linked immunosorbent assay (ELISA). The plasma level of α-syn was significantly higher in PD patients when compared to controls (p=0.004), and significantly higher in the PIGD group when compared to the TD group (p=0.03). While the plasma level of Aβ-42 was significantly lower in PD patients than in controls (p=0.002), and significantly lower in the PIGD group than in the TD group (p=0.05). In PD patients, the plasma level of α-syn (r=-0.355, p<0.001) was significantly related to the severity of Tenitti Gait score, even after performing multiple linear regression (p=0.002). While the plasma level of Aβ-42 (r=-0.261, p<0.05) was significantly associated with the severity of PIGD score and remained correlate when performed multiple linear regression (p=0.005). The patients with PIGD subtype are characterized with a lower level of plasma Aβ-42 and a higher plasma level of α-syn, which may be used as biomarkers for diagnosis and progression of the subtypes of PD.

Multiscale and Shannon entropies during gait as fall risk predictors—A prospective study

Although entropy-based measurements of gait dynamics are becoming widely used tools for fall risk assessment, their relationship to fall occurrence is still unclear. The aim of this study was hence to compare fallers and non-fallers in terms of gait dynamics assessed by the multiscale and Shannon entropy. This study included 139 participants, aged 60–80 years, divided into two groups according to fall occurrence during a 6-month prospective observation (38 fallers, 101 non-fallers). The methodology involved the use of the Tinetti balance assessment tool (TBAT) and 5min of overground walking with 3D accelerometers located near the L5 vertebra and shanks. We analyzed 150 strides for gait complexity, an index of complexity (CI), computed from multiscale entropy (MSE) and Shannon entropy (ShE) derived from the recurrence quantification analysis. We found no significant differences between groups in MSE and CI. The TBAT total score was significantly higher in non-fallers (P=0.033), however, both groups showed low risk of falls. ShE in the anterior-posterior direction from trunk and in the medial-lateral direction from the shanks were both significantly higher in fallers (P=0.020; P=0.024). ShE was negatively correlated with CI, the shank ShE in the vertical direction was positively correlated with TBAT. Taken together, our findings suggest that MSE is not able to distinguish between highly functional groups, whereas Shannon entropy seems to be sufficient in fall risk prediction.

Terapia Assistida por Animais como recurso fisioterapêutico para idosos institucionalizados

Aims: To evaluate the effects of Animal-assisted Therapy on the gait and balance of institutionalized elderly. Methods: This is a non-controlled before-after clinical trial. The study was conducted at “Lar da Velhice São Francisco de Assis,”, a nursing home located in Caxias do Sul, Rio Grande do Sul, Brazil. Elderly volunteers of both sexes were selected, and those with any musculoskeletal, neurological, or cognitive conditions that could interfere with the results were excluded. Three dogs that were properly trained by a professional trainer and met the specific criteria for animal-assisted therapy were used. The group performed 10 therapy sessions in four weeks. The following tests were used for assessing the gait and balance of the elderly participants: Berg Balance scale, Tinetti Balance test, Functional Reach test, and Six-Meter-Walk test. The tests were applied before and after animal-assisted therapy. Results: The study included nine subjects, aged 68 to 79 years. Regarding balance and postural control, individuals showed a significant improvement in post-treatment outcome when compared to pre-treatment, according to the Berg Balance scale (z=2.26 p=0.02) and Functional Reach test (z=2.2 p=0.02). In the gait assessment, the Tinetti test score averaged 7.9±2.8 before therapy and 9.2±1.6 after therapy (z=2.02 p=0.04). The Six-Meter-Walk test after therapy revealed a significant decrease in the time necessary to complete the six-meter course. The average time was 20.2±19 seconds prior to therapy and&nbsp; 9.2±7 seconds after therapy (z=2.47 p=0.01). Conclusions: Both assessed parameters showed significant improvement, suggesting important outcomes regarding gait and balance after the use of Animal-assisted Therapy in institutionalized elderly individuals.

Falls and Their Associated Risks in Parkinson's Disease Patients in Nigeria.

ObjectiveFalls are a devastating consequence of Parkinson’s disease (PD) and are due to motor imbalance. However, the frequency of falls and their risk factors among Nigerians with PD is not known despite the significant increase in PD cases in the country. To assess fall risk factors and frequency in Nigerian PD patients.MethodsUsing an analytical design to compare falling versus non-falling patients, 81 PD patients were assessed for clinical factors, frequency of falls, and candidate risk factors for falls according to the Tinetti Balance and Gait, Unified Parkinson’s Disease Rating Scale subsection 1, and Timed Up and Go Tests. Descriptive, bivariate, and multivariate analyses were performed at the 95% confidence level.ResultsThe mean age of participants was 65.6 ± 9.7 years. Falls were about three times (p < 0.001) more common in PD patients. Of the falling patients, 67.7% sustained injuries, 67.7% had recurrent falls and 44.9% admitted to having a fear of falling. The independent statistical predictors of fall were fear of falling [odds ratio (OR): 3.86], disease severity (OR: 1.09) and disease duration (OR: 1.01).ConclusionThe frequency of falls in PD patients was significantly higher when compared with the healthy adult population, and the modifiable predictor was fear of falling with a potential to significantly reduce falls when strategically addressed.

Positive Effects of Specific Exercise and Novel Turning-based Treadmill Training on Turning Performance in Individuals with Parkinson's disease: A Randomized Controlled Trial.

Two different training strategies to improve turning performance in individuals with Parkinson’s disease (PD) were designed and investigated in this study. Subjects were randomly assigned to a specific exercise group, turning-based training group, or control group to receive training that emphasized balance and strengthening, turning-based treadmill training, and general exercise training, respectively. A total of 12 30-min training sessions followed by 10 min of turning training on a level surface were administered over 4 to 6 weeks. The results (n = 12 for each group) showed that both the specific exercise and turning-based training group experienced improved turning performance, the primary outcome, compared with the control group (specific exercise, 33% change, p = 0.016; turning-based training, 35% change, p = 0.021). For the secondary outcomes, the specific exercise group performed better than the control group on the Tinetti balance scale, limit of stability test and lower extremity extensor and abductor strength. The turning-based training groups performed better than the control group in sensory organization and ankle plantar flexor strength. In summary, specific exercise training and turning-based treadmill training were both effective in improving turning performance in participants with PD. However, the improvements in turning performance of these two groups resulted from improving different aspects of impairment in individuals with PD.

209 QUANTITATIVE ANALYSIS OF THE TIMED UP AND GO IN ELDERLY PATIENTS POST HIP FRACTURE IN A SUB-ACUTE REHABILITATION SETTING

Introduction The Timed Up and Go is an outcome measure, which has been shown to be reliable and valid to assess change in patients post hip fracture. Advances in technology have included the use of inertial sensors for the quantitative analysis of the Timed Up and Go (QTUG) and enhance the scope for harnessing information from the test. However no studies have investigated their use in hip fracture patients. Aims and Objectives The aim of this study was to investigate the use of the QTUG in the assessment of hip fracture patients in a sub-acute geriatric rehabilitation setting. This included investigating which components of the QTUG were sensitive to change pre and post rehab and investigating the use of the QTUG as a measure of falls risk and frailty level. Methods A prospective cohort study design was employed using a sample of convenience. Sixteen participants post hip fracture admitted to an inpatient post-acute rehabilitation unit were assessed on admission and at discharge using the QTUG. Individual components of QTUG (e.g. sit to stand, walk, turn time) were compared between admission and discharge. Falls risk and frailty level were also assessed using QTUG and these were compared to secondary measures of Tinetti Gait and Balance Assessment and Clinical Frailty Scale (CFS). Results There was a significant improvement in the main outcome measure of overall QTUG time between admission and discharge of 9.3 (95% CI 5.6 to 12.9) seconds with a p value

Predicting falls with the cognitive timed up-and-go dual task in frail older patients

BackgroundThe cognitive timed up-and-go dual task (CogTUG) has been proposed to improve the performance of the timed up-and-go (TUG) test for predicting falls in older patients and as a screening tool for early detection of frailty. We aimed to determine whether the CogTUG score is associated with a history of falls in frail older outpatients with gait disorders. MethodsThis retrospective study involved outpatients >75 years old with or without previous falls who were admitted from 2012 to 2014 to a geriatric day hospital for gait disorders. Patients took the TUG and CogTUG tests on the day of comprehensive geriatric assessment. ResultsAmong the 161 patients included (157 analyzed; mean age 84.4±6.2 years; 72% women), 84 (53.5%) had fallen in the previous year: 105 (66.9%) were considered pre-frail and 52 (33.1%) frail. As compared with non-fallers, fallers had lower Tinetti balance scores (P=0.0004) and handgrip strength (P=0.03), more lost weight (P=0.04), and they took longer to perform the TUG test (P=0.04). Fallers and non-fallers did not differ in time taken to perform the CogTUG test (30.7±11.2 vs. 28.5±10.2s, P=0.20). History of falls was associated with only weight loss (odds ratio 3.43; 95% CI 1.13–11.30, P=0.03) and handgrip strength (0.88; 0.78–0.97, P=0.02) on multivariate analysis. ConclusionUnlike TUG scores, the CogTUG score was not associated a history of falls in frail older outpatients with gait disorders. Our results underline that weight loss and low muscle strength are related to falls.

Motor performance differentiates individuals with Lewy body dementia, Parkinson’s and Alzheimer’s disease

IntroductionDifferential diagnosis of dementia with Lewy bodies (DLB), Parkinson’s disease with dementia (PDD), Parkinson’s disease (PD) and Alzheimer’s disease (AD) is challenging. Comparative motor profiles of these neurodegenerative disorders may aid in earlier diagnosis but have not been extensively studied. MethodsGroups were rigorously matched by age, education, and sex. DLB/PDD participants were matched by Mini-Mental State Examination Score to individuals with AD and by Unified Parkinson’s Disease Rating Scale motor scores to individuals with PD. Gait, balance, dual task walking and hand dexterity measures were compared between a combined group (n=21) of individuals with Lewy body dementia (LBD) consisting of those with DLB (n=11) and PDD (n=10) to individuals with PD (n=21) or AD (n=21). ResultsIndividuals at the same disease stage with LBD walked significantly slower with shorter stride lengths (p<0.05), demonstrated poorer balance on both the Tinetti and Berg Balance Scale, and poorer performance on dual-task and figure-of-eight walking compared to PD and AD (p<0.05 for all) groups. Upper extremity coordination on the 9-hole peg test differentiated LBD from both PD and AD and was the only motor test in which individuals with AD performed worse than those with PD. Tinetti balance subscores were significantly lower in PDD compared to DLB participants (10.4±2.3 versus 12.8±2.3; p=0.027). ConclusionsMotor features distinguish individuals with LBD from those with AD and PD. Measures of gait, balance and finger dexterity provide an additional means of differentiating individuals with LBD from those with AD and PD.

Nintendo Wii Fit for balance rehabilitation in patients with Parkinson's disease: A comparative study

BackgroundImpaired postural stability places individuals with Parkinson's disease (PD) at an increased risk for falls. ObjectiveWe evaluated the effectiveness of 10 vs. 15 sessions of Nintendo Wii Fit for balance recovery for outpatients PD. MethodsTwenty-seven patients, 48.1% female (66 ± 8 years), with PD. Patients with PD were consecutively assigned to one of two groups receiving either 10 or 15 sessions (low dose or high dose group, respectively) with Nintendo Wii Fit in recovering balancing ability. All outcome measures were collected at baseline, immediately following the intervention period, and 1-month following the end of the intervention. Main outcome measure: Falls risk test (FRT), Stability index (PST), Berg balance scale (BBS) and Tinetti scale. ResultsThe patients undergoing the 10 sessions demonstrated significantly improvement on the balance performances (Tinetti balance and gait scales, BBS and BSF) (all, P < 0.05) as those undergoing 15 treatment with Nintendo Wii Fit, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. ConclusionsThe results suggest that functional improvement can be made in fewer visits during outpatient rehabilitation sessions with Nintendo Wii Fit improving the efficiency of intervention.

6-Minute Walk Test: A Simple Objective Test in Screening and Monitoring of Spinal Claudication: Prospective Study on 1182 Patients

Introduction The diagnosis, disease severity and outcome assessment of spinal claudication depend on patient's subjective report. In the past, the gold standard for diagnosing and screening for troubling spinal claudication was lacking. Quantify severity of claudication by standing and walking tolerance test used to be the best measure but was tedious. Simple quantitative test is lacking. The present study uses 6-minute walk test (6MWT) to solve these problems. Material and Methods Patients suspicious of spinal claudication were prospectively tested on standing and walking ability. Time when symptom becomes intolerable constituted the tolerance time. They were tested on distance (6MWD) they can maximally walk on level ground in shuttle between a 15m-distance in 6 minute; and screened for standing and walking instability with Tinetti score. Patients underwent surgery were monitored. The study was conducted in 2 stages. The first stage is a pilot study on a small group of patients which aim to establish the correlation among the different tests modality; standing tolerance test, walking tolerance test, 6 minute walk test, tinetti gait and balance test. After the best correlated tests modalities were found, the study was modified. The standing tolerance test and the 6 minute walk test were performed on a larger group of patients to generate sizable database. Results Since 2004, 1182 patients were included. The age-matched 6MWD correlate with 20 minute standing tolerance well with sensitivity and specificity above 0.7. Using ROC curve, 6MWD that distinguish 20 minute claudication tolerance are: 392m (age: 41–50); 377m (age: 51–60); 330m (age: 61–70); 267m (age: 71–80); 236m (age: 81–90). These findings agreed with the findings of another study on the reference values of 6MWD for normal Chinese subjects. That study showed that the minimal value of 6MWD for normal Chinese adults of different age groups was 330m. For those who underwent surgery, their standing and walking tolerance significantly improved in first 3 months but not later. The balance and gait score improved significantly only after 3 months post-operatively. The 6MWD increased significantly at both 3 and 6 months post-operatively, implying that 6MWD is more sensitive in picking up changes. Conclusion 6-minute walk test is a simple, practical method in screening for spinal claudication. The age matched 6MWD for incapacitating claudication was found. The 6-minute walk test also provides useful quantitative data for disease progression and treatment outcome monitoring. In the present study, we were able to demonstrate that 6MWD increased significantly at 3 months post-operative period comparing to pre-operative status and at 6 months post-op comparing to 3 months post-op period. The improvement of 6MWD was a reflection of improvement of walking tolerance and standing tolerance since both tolerance time increased significantly at 3 months after surgery. The improvement from 3 months to 6 months post-op was on the other hand a reflection of the improvement in gait pattern and balance ability instead, since only the 6MWD, Tinetti balance and gait score improved significantly during this period.

Effects of an Ai Chi fall prevention programme for patients with Parkinson's disease

IntroductionOne of the main symptoms of Parkinson's disease is the high incidence of falls occurring due to the decline of both static and dynamic balance. The aim of this study is to determine the effect of an Ai Chi programme designed to prevent falls in patients with Parkinson's disease by improving both functional independence and perception of physical pain. MethodsFifteen patients diagnosed with Parkinson's disease (Hoehn and Yahr stages 1–3) participated in a 10-week Ai Chi programme consisting of 30–45-minute aquatic exercise sessions twice a week. The assessment measures used in this study were the pain visual analogue scale (VAS), the Tinetti gait and balance assessment tool, and the Timed Get Up and Go test. ResultsThe results were calculated by applying the Friedman test to 3 related measurements: patients at baseline, at post-treatment (at the end of the 10 week programme) and after one month of follow-up. The data obtained showed a significant improvement (P<.001) in scores for pain perception, balance, and gait function after the treatment programme. Furthermore, patients continued to show significant improvements and the benefits remained at the one-month follow-up visit. ConclusionAi Chi is a promising and feasible aquatic treatment for improving pain perception, balance, and functional capacity in patients diagnosed with mild or moderate Parkinson's disease.

Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations.

Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD. A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice. One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach). We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. © 2016 International Parkinson and Movement Disorder Society.