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61.
P. Thoumie M. C. Do 《Experimental brain research. Experimentelle Hirnforschung. Expérimentation cérébrale》1996,110(2):289-297
The effects of lower limb deafferentation were examined during execution of a balance recovery step following a forward fall induced by release of an initial inclined posture. The subjects were healthy control subjects and patients with a unilateral loss of the Achilles tendon reflex following S1 radiculitis. Deafferentation of healthy subjects was obtained by unilateral leg ischemia (four subjects) and by foot anesthesia (five subjects). The balance recovery step was characterized by the surface electromyographic (EMG) activity of right and left soleus and tibialis anterior muscles and the kinetics of the center of gravity and center of foot pressure. Experimentally induced and pathological deafferentation decreased the EMG activity of the ipsilateral soleus and lowered the vertical ground reaction force. The lower limb motor activity was more affected by loss of muscle proprioceptive afferents than by loss of plantar cutaneous afferents. Patients showed early and bilateral changes in soleus and tibialis activities, whichever side was affected. The step length of patients was also shorter than that of controls, but it remained similar before and after deafferentation in the healthy subjects. The results are discussed in terms of ipsilateral and crossed pathway connections and functional adaptive strategies. 相似文献
62.
FOCUS-PDCA程序在预防老年住院患者跌倒中的应用 总被引:2,自引:0,他引:2
目的:探导老年住院患者跌倒的原因和预防对策。方法:对老年住院患者运用FOCUS-PDCA程序找出跌倒常见原因及制定防治措施,包括成立防跌倒管理小组、对高危跌倒风险患者筛查、高危跌倒风险告知书及警示牌、对高危跌倒风险患者的防治措施、跌倒之后处理流程图、评价实施后的效果。结果:实行FOCUS-PDCA程序后,住院患者跌倒率由2.15%下降到0.49%,医疗护理质量得到了提高(P〈0.01)。结论:执行FOCUS-PDCA程序可以减少老年住院患者跌倒的风险。 相似文献
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Nise Ribeiro Marques Dain Patrick LaRoche Camilla Zamfolini Hallal Luciano Fernandes Crozara Mary Hellen Morcelli Aline Harumi Karuka Marcelo Tavella Navega Mauro Gonçalves 《Clinical biomechanics (Bristol, Avon)》2013
Objective
To determine the nervous activation, muscle strength, and biomechanical parameters that influence the cost of walking in older fallers and non-fallers.Methods
Maximal voluntary isokinetic torque was measured for the hip, knee and ankle of older women. Oxygen consumption was measured at rest and during 8 min of walking at self-selected speed. An additional minute of walking was performed to collect kinematic variables and the electromyographic signal of trunk, hip, knee, and ankle muscles, which was analyzed by the linear envelope. Cost of walking was calculated by subtracting resting body mass-normalized oxygen consumption from walking body mass-normalized oxygen consumption. Stride time and length, and ankle and hip range of motion were calculated from kinematic data.Findings
Older adult fallers had 28% lower knee extensor strength (p = 0.02), 47% lower internal oblique activation at heel contact (p = 0.03), and higher coactivation between tibialis anterior and gastrocnemius lateralis in each of the gait phases (p < 0.05). For fallers, a higher activation of gluteus maximus was associated with a higher cost of walking (r = 0.55, p < 0.05 and r = 0.71, p < 0.01, before and after heel contact, respectively). For non-fallers, an association between cost of walking and age (r = 0.60, p = 0.01) and cost of walking and thigh muscle coactivation (r = 0.53, p = 0.01) existed.Interpretation
This study demonstrated that there may be links between lower-extremity muscle weakness, muscle activation patterns, altered gait, and increased cost of walking in older fallers. 相似文献65.
目的运用失效模式与效应分析(FMEA)改进住院患者防跌倒流程及措施,降低跌倒的发生率。方法对2011年1月至12月住院的32775例试验组患者运用FMEA方法分析失效模式与潜在原因,计算优先风险指数(RPN)值,改进需优先解决问题的相关措施,随访整改成效,并与2010年1月至12月住院的29500例仅接受医院常规跌倒管理的患者比较跌倒发生率。结果实施FMEA管理模式后2011年较2010年跌倒失效模式RPN值下降81.78%,跌倒发生率由0.44%0下降至0.12%。结论应用失效模式与效应分析法有助于预防和减少跌倒发生,有力地保障患者安全。 相似文献
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《Gait & posture》2021
BackgroundFalling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.Research questionDoes walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?MethodsIn this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.Results46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).SignificancePolio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population. 相似文献
69.
《Best Practice & Research: Clinical Rheumatology》2022,36(3):101759
In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy. 相似文献
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