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Fujio K, Takeuchi Y. Age-Related Changes in Inter-Joint Interactions for Global and Local Kinematics While Standing. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4357-4366. [PMID: 37910410 DOI: 10.1109/tnsre.2023.3328904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Inter-joint interactions are involved in human standing. These interactions work not only for global kinematics that control the center of mass (COM) of the entire body, but also for local kinematics that control joint angular movements. Age-related changes in these interactions are thought to cause unstable standing postures in older people. Interactions of global kinematics are known to be deficient owing to aging. However, it is unclear whether the interaction of local kinematics is affected by aging. We investigated the age-related changes in inter-joint interactions, especially local kinematics, during standing. Differences were investigated in these two inter-joint interactions between older and younger adults in three different postures: normal, eyes-closed, and foam-surface standings. The inter-joint interaction for local kinematics was computed using the induced-acceleration analysis with a double-inverted pendulum model and quantified using an uncontrolled manifold approach. Consistent with previous studies, the inter-joint interaction for COM acceleration (global kinematics) deteriorated in older adults. In contrast, the interactions for angular accelerations in the ankle and hip joints (local kinematics) were slightly better in the older adults. Moreover, the individual components of angular acceleration which were induced by net torques from homonymous and remote joints were significantly increased in older adults. Thus, global and local inter-joint interactions are driven by distinct neural mechanisms and the interaction of local kinematics can compensate for the increment of each component of joint angular acceleration in older adults.
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2
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Castiglia SF, Trabassi D, Tatarelli A, Ranavolo A, Varrecchia T, Fiori L, Di Lenola D, Cioffi E, Raju M, Coppola G, Caliandro P, Casali C, Serrao M. Identification of Gait Unbalance and Fallers Among Subjects with Cerebellar Ataxia by a Set of Trunk Acceleration-Derived Indices of Gait. Cerebellum 2023; 22:46-58. [PMID: 35079958 DOI: 10.1007/s12311-021-01361-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
This study aimed to assess the ability of 25 gait indices to characterize gait instability and recurrent fallers among persons with primary degenerative cerebellar ataxia (pwCA), regardless of gait speed, and investigate their correlation with clinical and kinematic variables. Trunk acceleration patterns were acquired during the gait of 34 pwCA, and 34 age- and speed-matched healthy subjects (HSmatched) using an inertial measurement unit. We calculated harmonic ratios (HR), percent recurrence, percent determinism, step length coefficient of variation, short-time largest Lyapunov exponent (sLLE), normalized jerk score, log-dimensionless jerk (LDLJ-A), root mean square (RMS), and root mean square ratio of accelerations (RMSR) in each spatial direction for each participant. Unpaired t-tests or Mann-Whitney tests were performed to identify significant differences between the pwCA and HSmatched groups. Receiver operating characteristics were plotted to assess the ability to characterize gait alterations in pwCA and fallers. Optimal cutoff points were identified, and post-test probabilities were calculated. The HRs showed to characterize gait instability and pwCA fallers with high probabilities. They were correlated with disease severity and stance, swing, and double support duration, regardless of gait speed. sLLEs, RMSs, RMSRs, and LDLJ-A were slightly able to characterize the gait of pwCA but failed to characterize fallers.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Davide Di Lenola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Ettore Cioffi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Manikandan Raju
- Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Pietro Caliandro
- Unità Operativa Complessa Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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Quijoux F, Nicolaï A, Chairi I, Bargiotas I, Ricard D, Yelnik A, Oudre L, Bertin‐Hugault F, Vidal P, Vayatis N, Buffat S, Audiffren J. A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code. Physiol Rep 2021; 9:e15067. [PMID: 34826208 PMCID: PMC8623280 DOI: 10.14814/phy2.15067] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
Postural control is often quantified by recording the trajectory of the center of pressure (COP)-also called stabilogram-during human quiet standing. This quantification has many important applications, such as the early detection of balance degradation to prevent falls, a crucial task whose relevance increases with the aging of the population. Due to the complexity of the quantification process, the analyses of sway patterns have been performed empirically using a number of variables, such as ellipse confidence area or mean velocity. This study reviews and compares a wide range of state-of-the-art variables that are used to assess the risk of fall in elderly from a stabilogram. When appropriate, we discuss the hypothesis and mathematical assumptions that underlie these variables, and we propose a reproducible method to compute each of them. Additionally, we provide a statistical description of their behavior on two datasets recorded in two elderly populations and with different protocols, to hint at typical values of these variables. First, the balance of 133 elderly individuals, including 32 fallers, was measured on a relatively inexpensive, portable force platform (Wii Balance Board, Nintendo) with a 25-s open-eyes protocol. Second, the recordings of 76 elderly individuals, from an open access database commonly used to test static balance analyses, were used to compute the values of the variables on 60-s eyes-open recordings with a research laboratory standard force platform.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- ORPEA GroupPuteauxFrance
| | - Alice Nicolaï
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Ikram Chairi
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Groupe MSDAUniversité Mohammed VI PolytechniqueBenguerirMaroc
| | - Ioannis Bargiotas
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Service de Neurologie de l’Hôpital d’Instruction des Armées de PercySSAClamartFrance
- Ecole du Val‐de‐GrâceEcole de Santé des ArméesParisFrance
| | - Alain Yelnik
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- PRM DepartmentGH Lariboisière F. WidalAP‐HPUniversité de ParisUMR 8257ParisFrance
| | - Laurent Oudre
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | | | - Pierre‐Paul Vidal
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Institute of Information and ControlHangzhou Dianzi UniversityZhejiangChina
| | - Nicolas Vayatis
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Stéphane Buffat
- Laboratoire d’accidentologie de biomécanique et du comportement des conducteursGIE Psa Renault GroupesNanterreFrance
| | - Julien Audiffren
- Department of NeuroscienceUniversity of FribourgFribourgSwitzerland
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Song J, Lee E. Health-Related Quality of Life of Elderly Women with Fall Experiences. Int J Environ Res Public Health 2021; 18:ijerph18157804. [PMID: 34360100 PMCID: PMC8345432 DOI: 10.3390/ijerph18157804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 12/12/2022]
Abstract
This study aimed to describe the health-related quality of life of elderly women with experience in fall treatment as well as to prepare basic data for the development of interventions to improve the quality of life for this group. The study was based on raw data from the 2019 Korea Community Health Survey. Using the SPSS program, the characteristics of the subjects were tested by frequency, percentage, and chi-square test. To establish the impact of fall experience on the health-related quality of life of elderly women, the OR and 95% CI were calculated using multiple logistic regression analysis. Of the 4260 people surveyed, 44.7% of the elderly women said they had a high quality of life, whereas 55.3% of the elderly women said they had a low quality of life. A younger age was associated with a better-rated health-related quality of life. Those who lived in a city and had a high level of education tended to describe a high quality of life. The quality of life was considered high by those who exercised, but low by those who were obese or diabetic. The results of this study can lead to a better understanding of the experiences of elderly women who have experienced falls, and they can be used as basic data for the development of related health programs.
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Affiliation(s)
- Jiyoung Song
- College of Nursing, Korea University, Seoul 02841, Korea;
| | - Eunwon Lee
- Department of Nursing, Gwangju University, Jinwol-dong, Gwangju-si 61743, Korea
- Correspondence: ; Tel.: +82-62-670-2377
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Campanini I, Bargellini A, Mastrangelo S, Lombardi F, Tolomelli S, Lusuardi M, Merlo A. Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability. Int J Environ Res Public Health 2021; 18:1444. [PMID: 33557091 DOI: 10.3390/ijerph18041444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.
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Quijoux F, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study. Front Digit Health 2021; 2:604552. [PMID: 34713067 PMCID: PMC8521935 DOI: 10.3389/fdgth.2020.604552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/15/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- ORPEA Group, Puteaux, France
| | | | | | | | - Pierre-Paul Vidal
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Service de Neurologie de l'Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, Paris, France
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7
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Fujio K, Takeuchi Y. Discrimination of standing postures between young and elderly people based on center of pressure. Sci Rep 2021; 11:195. [PMID: 33420289 PMCID: PMC7794377 DOI: 10.1038/s41598-020-80717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022] Open
Abstract
Posturography is utilized to assess the influence of aging on postural control. Although this measurement is advantageous for finding group-level differences between the young and the elderly, it is unclear whether it has the potential to differentiate elderly individuals who are affected by various impacts of aging. The purpose of this study was to determine the utility of posturography to discriminate elderly individuals from young adults. We investigated the performances of the random forest classifiers constructed from center of pressure (COP) indices for discriminating standing postures between healthy elderly and young people. Postural sways in 19 young and 31 community-dwelling elderly participants were measured using force plates in 4 standing conditions: bipedal standing, standing on a narrow base, standing on foam rubber, and standing with eyes closed. We further verified the informative predictors that contributed to the prediction model. As the results, the classifier based on the COP indices for standing on foam rubber showed the best performance (accuracy: 93.4%, sensitivity: 94.4%, specificity: 93.6%, area under the curve of receiving operator characteristics: 0.95), followed by the classifier for standing with eyes closed. The informative predictors varied depending on the postural conditions. Our findings demonstrated the potential of posturography for identifying elderly postures. The evaluation of sensory re-weighting using the appropriate COP indices would be a useful clinical tool for detecting the progress of aging on postural control.
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Affiliation(s)
- Kimiya Fujio
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan.
| | - Yahiko Takeuchi
- Department of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan
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Affiliation(s)
- Earllaine Croarkin
- Board Certified Neurological Clinical Specialist, Physical Therapist, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Research Physical Therapist, Functional and Applied Biomechanics Laboratory, Clinical Research Center, National Institutes of Health, Bethesda, MD
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Seo JW, Kim SG, Kim JI, Ku B, Kim K, Lee S, Kim JU. Principal Characteristics of Affected and Unaffected Side Trunk Movement and Gait Event Parameters during Hemiplegic Stroke Gait with IMU Sensor. Sensors (Basel) 2020; 20:s20247338. [PMID: 33371295 PMCID: PMC7765925 DOI: 10.3390/s20247338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 11/16/2022]
Abstract
This study describe the characteristics of hemiplegic stroke gait with principal component analysis (PCA) of trunk movement (TM) and gait event (GE) parameters by the inertial measurement unit (IMU) sensors: (1) Background: This process can determine dominant variables through multivariate examination to identify the affected, unaffected, and healthy lower-limb sides; (2) Methods: The study monitored forty patients with stroke and twenty-eight healthy individuals comprising the control group for comparison. The IMU sensors were attached to each subject while performing a 6 m walking test. Sixteen variables extracted from the measured data were divided into 7 GE and 9 TM variables explaining pelvis tilt, oblique, and rotation. (3) Results: The tilt range variables of the trunk movement on the affected and unaffected sides were lower than those of the healthy side; this showed between-group differences in various GE variables. For the healthy and affected sides, 80% of variances were explained with 2 or 3 PCs involving only a few dominant variables; and (4) Conclusions: The difference between each side leg should be considered during the development of a diagnosis method. This research can be utilized to develop functional assessment tools for personalized treatment and to design appropriate training protocols.
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Affiliation(s)
- Jeong-Woo Seo
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
| | - Seul-Gee Kim
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
| | - Joong Il Kim
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
| | - Boncho Ku
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
| | - Kahye Kim
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
| | - Sangkwan Lee
- Department of Internal Medicine and Neuroscience, College of Korean Medicine, Wonkwang University, Iksan 54538, Korea;
| | - Jaeuk U. Kim
- Future medicine division, Korea Institute of Oriental Medicine, Daejeon 34504, Korea; (J.-W.S.); (S.-G.K.); (J.I.K.); (B.K.); (K.K.)
- Korean Convergence Medicine, University of Science and Technology, Daejeon 34054, Korea
- Correspondence: ; Tel.: +82-42-868-9558
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Bayot M, Dujardin K, Dissaux L, Tard C, Defebvre L, Bonnet CT, Allart E, Allali G, Delval A. Can dual-task paradigms predict Falls better than single task? - A systematic literature review. Neurophysiol Clin 2020; 50:401-440. [PMID: 33176988 DOI: 10.1016/j.neucli.2020.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022] Open
Abstract
With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall prevention. Since dual-task outcomes rely on the interaction between cognition and motor control, some studies have demonstrated the role of dual-task walking performance or costs in predicting future fallers. However, based on previous reviews on the topic, (1) discriminative and (2) predictive powers of dual tasks involving gait and a concurrent task are still a matter of debate, as is (3) their superiority over single tasks in terms of fall-risk prediction. Moreover, less attention has been paid to dual tasks involving postural control and transfers (such as gait initiation and turns) as motor tasks. In the present paper, we therefore systematically reviewed recent literature over the last 7 years in order to answer the three above mentioned questions regarding the future of lab-based dual tasks (involving posture, gait initiation, gait and turning) as easily applicable tests for identifying healthy older adult fallers. Despite great heterogeneity among included studies, we emphasized, among other things, the promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls. Further investigation of these is thus warranted.
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Affiliation(s)
- Madli Bayot
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Lucile Dissaux
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France
| | - Céline Tard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Luc Defebvre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France
| | - Cédrick T Bonnet
- Univ. Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, CNRS UMR 9193, F-59000 Lille, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Neurorehabilitation Unit, F-59000 Lille, France
| | - Gilles Allali
- Department of Neurology, Geneva University Hospitals and University of Geneva, Geneva 1211, Switzerland, Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, US
| | - Arnaud Delval
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
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Kozinc Ž, Löfler S, Hofer C, Carraro U, Šarabon N. Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis. Diagnostics (Basel) 2020; 10:E667. [PMID: 32899201 PMCID: PMC7554797 DOI: 10.3390/diagnostics10090667] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.
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Affiliation(s)
- Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Stefan Löfler
- Physiko- & Rheumatherapie, Institute for Physical Medicine and Rehabilitation, 3100 St. Pölten, Austria;
- Centre of Active Ageing—Competence Centre for Health, Prevention and Active Ageing, 3100 St. Pölten, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy;
- Interdepartmental Research Center of Myology, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy
- A&C M-C Foundation for Translational Myology, Padova, Galleria Duomo 5, 35141 Padova, Italy
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- InnoRenew CoE, Livade 6, SI6310 Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Tehnološki park 19, SI-1000 Ljubljana, Slovenia
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Quijoux F, Vienne-Jumeau A, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. Ageing Res Rev 2020; 62:101117. [PMID: 32565327 DOI: 10.1016/j.arr.2020.101117] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.
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Maranesi E, Riccardi GR, Lattanzio F, Di Rosa M, Luzi R, Casoni E, Rinaldi N, Baldoni R, Di Donna V, Bevilacqua R. Randomised controlled trial assessing the effect of a technology-assisted gait and balance training on mobility in older people after hip fracture: study protocol. BMJ Open 2020; 10:e035508. [PMID: 32546491 PMCID: PMC7299027 DOI: 10.1136/bmjopen-2019-035508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Deficits in balance and walking ability are relevant risk factors for falls during ageing. Moreover, falls are a risk factor for future falls, strongly associated with adverse health outcomes, such as fear of falling or fractures, particularly, hip fracture. For this reason, the development of prevention tools and innovative rehabilitation strategies is one of the main objectives in geriatrics. Effective interventions to promote hip recovery after hip fracture are characterised by intensive and repetitive movements. One treatment approach is to increase the number of steps during the rehabilitation sessions and to improve the balance and the endurance of the patients in the use of technological devices. METHODS AND ANALYSIS This randomised controlled trial aimed to evaluate an innovative rehabilitation treatment of elderly patients with hip fractures. A total of 195 patients with hip fractures will be recruited and randomly divided into three groups: traditional rehabilitation programme, traditional rehabilitation programme plus TYMO system and traditional rehabilitation programme plus Walker View. Assessments will be performed at baseline, at the end of treatment, at 6 months, and at 1 and 2 years after the end of the treatment. Only subjects hospitalised 4 weeks prior to the beginning of the study will be taken into consideration. Twenty treatment sessions will be conducted, divided into three training sessions per week, for 7 weeks. The technological intervention group will carry out 30 min sessions of traditional therapy and 20 min of treatment with a technological device. The control group will perform traditional therapy sessions, each lasting 50 min. The primary outcomes are risk of falling, gait performance and fear of falling. ETHICS AND DISSEMINATION The study was approved by the Istituto di Ricerca e Cura a Carattere Scientifica, Istituto Nazionale Ricovero e Cura Anziani Ethics Committee, with identification code number 19 014. Trial results will be submitted for publication in journals and conferences. TRIAL REGISTRATION NUMBER NCT04095338.
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Affiliation(s)
| | | | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
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Sbrollini A, Agostini V, Cavallini C, Burattini L, Knaflitz M. Postural data from Stargardt's syndrome patients. Data Brief 2020; 30:105452. [PMID: 32280738 PMCID: PMC7136594 DOI: 10.1016/j.dib.2020.105452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022] Open
Abstract
The database is a collection of postural data acquired from 10 patients affected by the rare Stargardt's syndrome, all having the ABCA4 gene mutation, and from 10 control healthy subjects. Specifically, the database includes a file (.xlxs) called SubjectsData and 20 datasets (MATLAB structures) containing postural signals. Each subject performed a total of 15 postural tests, 5 postural tests for 3 different conditions (‘C’: eyes-closed; ‘O’: eyes-open, still target fixation; ‘M’: eyes-open, moving target tracking). For each postural test, 11 postural derived signals (the anterior-posterior force, the medio-lateral force, the vertical force, the plate moment about x axis, the plate moment about y axis, the plate moment about z axis, the plate moment about top plate surface about x axis, the plate moment about top plat surface about y axis, the x-coordinate of the center of pressure, the y-coordinate of the center of pressure, and the free moment about z axis) were computed from 8 raw signals, acquired at the Ophthalmic Hospital of Turin, Italy, through an 8-channel Kistler 9286A force platform connected to a Step32 system. Thus, a total of 285 postural signals (120 raw and 165 derived) are available for each subject. The database may be useful to: (1) investigate postural adaptations of patients affected by Stargardt's syndrome; (2) support definition of rehabilitative procedures to reduce postural instability of patients affected by Stargardt's syndrome; and (3) support investigation on visual control of balance in the general population.
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Affiliation(s)
- Agnese Sbrollini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
| | - Valentina Agostini
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Chanda Cavallini
- Presidio Sperino, Ospedale Oftalmico di Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Laura Burattini
- Cardiovascular Bioengineering Lab, Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy
- Corresponding author.
| | - Marco Knaflitz
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
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Cimolin V, Cau N, Galli M, Capodaglio P. Balance Control in Obese Subjects during Quiet Stance: A State-of-the Art. Applied Sciences 2020; 10:1842. [DOI: 10.3390/app10051842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obese individuals are characterized by a reduced balance which has a significant effect on a variety of daily and occupational tasks. The presence of excessive adipose tissue and weight gain could increase the risk of falls; for this reason, obese individuals are at greater risk of falls than normal weight subjects in the presence of postural stress and disturbances. The quality of balance control could be measured with different methods and generally in clinics its integrity is generally assessed using platform stabilometry. The aim of this narrative review is to present an overview on the state of art on balance control in obese individuals during quiet stance. A summary of knowledge about static postural control in obese individuals and its limitations is important clinically, as it could give indications and suggestions to improve and personalize the development of specific clinical programs.
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Olchowik G, Czwalik A. Effects of Soccer Training on Body Balance in Young Female Athletes Assessed Using Computerized Dynamic Posturography. Applied Sciences 2020; 10:1003. [DOI: 10.3390/app10031003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the effect of regular soccer training on the balance system for young women. Computerized dynamic posturography of female footballers (n = 25) and control group (n = 50) was assessed during three tests: Sensory Organization Test, Motor Control Test, and Adaptation Test. Statistically significant differences between the groups was found in Composite Equilibrium Score with higher values, indicating better postural stability, for footballers. Regular trainees also showed better usefulness of vestibular system while maintaining balance. Weight symmetry of the lower limbs during Motor Control Test also showed statistically significant differences between the groups. This study shows that female footballers have better postural stability than their inactive peers and that regular workouts may improve the balance system.
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17
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Chen Z, Han J, Waddington G, Adams R, Witchalls J. Somatosensory perception sensitivity in voluntary postural sway movements: Age, gender and sway effect magnitudes. Exp Gerontol 2019; 122:53-59. [PMID: 31029824 DOI: 10.1016/j.exger.2019.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/22/2019] [Accepted: 04/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 1) to develop a reliable device for assessing somatosensory perception sensitivity in voluntary postural sway movement, specifically a sway discrimination apparatus (SwayDA) for testing voluntary lateral sway discrimination sensitivity (VLSDS); 2) to explore the relationship between mobility performance and VLSDS in older adults, and 3) to determine the effects of age, gender and sway magnitude on VLSDS. METHODS First, eighteen healthy young adults (8 males, 10 females, age ranging from 22 to 70) were recruited for a test-retest reliability study. During the SwayDA test, the participants were asked to discriminate between four possible medial-lateral sway extents when moving away from neutral standing. For Objective 2, twenty-five older participants (9 males, 16 females, mean age 70.1) undertook both the SwayDA and the mobility tests. The mobility testing battery consisted of single task and cognitive dual task timed-up and-go tests, and the 5 times sit-to-stand test. Pearson's correlation was calculated between SwayDA scores and mobility performance. For Objective 3, 20 community-dwelling adults over 65 years old (10 males, 10 females, mean age 71.3) and 20 young volunteers (10 males, 10 females, mean age 23.6) were recruited to study the effects of age, gender and sway magnitude on VLSDS. To obtain a bias-free measure of VLSDS, the probability of correct response was considered as the true-positive judgment, while the probability of incorrect response was considered as false-positive judgment, and these were cumulated across the response values. A receiver operating characteristic (ROC) curve was then generated and the Area Under the ROC Curve (AUC) was used to measure VLSDS. RESULTS There was no significant difference in AUC scores between Day 1 and Day 8 (p > 0.05). ICC(3,1) reliability indices were 0.750 for sway to the left and 0.879 for sway to the right. Pearson's correlation revealed a significant correlation between the SwayDA sores and timed-up-and-go (TUG), cognitive dual task TUG, 5 times sit-to-stand test (r = -0.456, -0.522, and - 0.416 respectively, all p < 0.05). Factorial ANOVA showed age and gender main effects (F = 8.144, p < 0.01, and F = 8.806, p < 0.01, respectively), suggesting older adults and females had worse VLSDS. In addition, a significant difference was found between the young and older participants in the inner range of VLSDS (t = -2.875, p < 0.017), indicating that the decline of somatosensory perception of postural sway in older people may be magnitude-specific, and greatest for small deviations from upright stance. CONCLUSIONS The SwayDA has good to excellent test-retest reliability. The finding that VLSDS score was significantly correlated with mobility performance in older adults highlights the importance of somatosensory perception in postural control. More importantly, the significantly worse VLSDS in older people observed in the inner lateral movement range may represent a unique characteristic of neuromuscular degeneration associated with aging, which should be monitored and addressed in rehabilitation programs.
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Affiliation(s)
- Zhengquan Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jia Han
- School of Kinesiology, Shanghai University of Sport, Shanghai, China; Research Institute for Sport and Exercise, University of Canberra, ACT AUS 2601, Australia.
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, ACT AUS 2601, Australia
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, ACT AUS 2601, Australia
| | - Jeremy Witchalls
- Research Institute for Sport and Exercise, University of Canberra, ACT AUS 2601, Australia
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18
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Roman-Liu D. Age-related changes in the range and velocity of postural sway. Arch Gerontol Geriatr 2018; 77:68-80. [PMID: 29684741 DOI: 10.1016/j.archger.2018.04.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/27/2018] [Accepted: 04/07/2018] [Indexed: 11/23/2022]
Abstract
The aim of this analysis was to compare values of centre of pressure (CoP) measures, which describe the ability to maintain static body balance (range of body sway and velocity in antero-posterior and medio-lateral directions), in two age groups on the basis of a systematic review and meta-analysis of available data published worldwide. After a systematic review of publications presenting values of selected CoP measures, a numerical database with means and standard deviations was created. Data were classified by eye condition (open or closed) and by age group (18-35 or ≥56). Allocation to each group was based on the mean value of age of each sub-group in the numerical database. The Mann-Whitney U test was used to test the statistical significance of differences between age groups and eyes-open and eyes-closed conditions. This article shows mathematical equations, which quantitatively express increases in body sway and its velocity with age. On the basis of those equations, higher values have been shown for both displacement and velocity measures for the EC vs. the EO conditions and for the elderly vs. the young. The differences between age groups are greater for the velocity measures.
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Spector JT, Krenz J, Calkins M, Ryan D, Carmona J, Pan M, Zemke A, Sampson PD. Associations between heat exposure, vigilance, and balance performance in summer tree fruit harvesters. Appl Ergon 2018; 67:1-8. [PMID: 29122180 PMCID: PMC5912891 DOI: 10.1016/j.apergo.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/12/2017] [Accepted: 09/02/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND We sought to evaluate potential mediators of the relationship between heat exposure and traumatic injuries in outdoor agricultural workers. METHODS Linear mixed models were used to estimate associations between maximum work-shift Wet Bulb Globe Temperature (WBGTmax) and post-shift vigilance (reaction time) and postural sway (total path length) in a cross-sectional sample of 46 Washington State tree fruit harvesters in August-September 2015. RESULTS The mean (SD) WBGTmax was 27.4 (3.2)°C in August and 21.2 (2.0)°C in September. The mean pre-work-shift participant urine specific gravity indicated minimal dehydration. Twenty-four percent of participants exhibited possible excessive sleepiness. There was no association between WBGTmax and post-shift reaction time or total path length. CONCLUSIONS Heat exposure was not associated with impaired vigilance or balance in this study, in which the overall mean (SD) WBGTmax was 25.9 (4.2)°C. However, the study identified opportunities to ensure adequate pre-work-shift hydration and to optimize sleep and work-shift timing in order to reduce occupational injury and heat-related illness risk.
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Affiliation(s)
- June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Miriam Calkins
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Dawn Ryan
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Jose Carmona
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | - Mengjie Pan
- Department of Statistics, University of Washington, Seattle, WA, USA.
| | - Anna Zemke
- College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA.
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Campanini I, Mastrangelo S, Bargellini A, Bassoli A, Bosi G, Lombardi F, Tolomelli S, Lusuardi M, Merlo A. Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study. BMC Health Serv Res 2018; 18:18. [PMID: 29325560 PMCID: PMC5765700 DOI: 10.1186/s12913-017-2815-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.
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Affiliation(s)
- Isabella Campanini
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Agnese Bassoli
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Gabriele Bosi
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Francesco Lombardi
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Stefano Tolomelli
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
- Orthopaedic Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Mirco Lusuardi
- Respiratory Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Andrea Merlo
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
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Abstract
Maintaining and controlling postural balance is important for activities of daily living, with poor postural balance being predictive of future falls. This study investigated eyes open and eyes closed standing posturography with elderly adults to identify differences and determine appropriate outcome measure cut-off scores for prospective faller, single-faller, multi-faller, and non-faller classifications. 100 older adults (75.5 ± 6.7 years) stood quietly with eyes open and then eyes closed while Wii Balance Board data were collected. Range in anterior-posterior (AP) and medial-lateral (ML) center of pressure (CoP) motion; AP and ML CoP root mean square distance from mean (RMS); and AP, ML, and vector sum magnitude (VSM) CoP velocity were calculated. Romberg Quotients (RQ) were calculated for all parameters. Participants reported six-month fall history and six-month post-assessment fall occurrence. Groups were retrospective fallers (24), prospective all fallers (42), prospective fallers (22 single, 6 multiple), and prospective non-fallers (47). Non-faller RQ AP range and RQ AP RMS differed from prospective all fallers, fallers, and single fallers. Non-faller eyes closed AP velocity, eyes closed VSM velocity, RQ AP velocity, and RQ VSM velocity differed from multi-fallers. RQ calculations were particularly relevant for elderly fall risk assessments. Cut-off scores from Clinical Cut-off Score, ROC curves, and discriminant functions were clinically viable for multi-faller classification and provided better accuracy than single-faller classification. RQ AP range with cut-off score 1.64 could be used to screen for older people who may fall once. Prospective multi-faller classification with a discriminant function (-1.481 + 0.146 x Eyes Closed AP Velocity-0.114 x Eyes Closed Vector Sum Magnitude Velocity-2.027 x RQ AP Velocity + 2.877 x RQ Vector Sum Magnitude Velocity) and cut-off score 0.541 achieved an accuracy of 84.9% and is viable as a screening tool for older people at risk of multiple falls.
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Affiliation(s)
- Jennifer Howcroft
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | - Edward D Lemaire
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - Jonathan Kofman
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
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Yang ST, Seo JW, Kim DH, Kang DW, Choi JS, Tack GR. Evaluation of Standing Balance of the Elderly with Different Balance Abilities by using Kinect and Wii Balance Board. ACTA ACUST UNITED AC 2016. [DOI: 10.5103/kjsb.2016.26.4.391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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