Community-based tai chi and its effect on injurious falls, balance, gait, and fear of falling in older people

BACKGROUND AND PURPOSE: It is important to determine the effect of adherence to a tai chi program on falls and related functional outcomes in older people. This study examined the effect of a community-based tai chi program on injurious falls, balance, gait, and fear of falling among people aged 65 years and older in Taiwan. SUBJECTS AND METHODS: In 6 rural villages in Taichung County, 1,200 subjects participated in the initial assessment. During a 1-year intervention period, all study villages were provided with education on fall prevention. Two villages had been provided tai chi exercise (n=472 participants or "tai chi villagers"), and 4 villages served as control villages (n=728 participants or "control villagers"). Injurious falls were ascertained by telephone interviews every 3 months over a 2-year study period; additionally, balance, gait, and fear of falling were assessed in 2 follow-up assessments. RESULTS: Eighty-eight subjects, 83 from the tai chi villages and 5 from the control villages, participated and practiced in the tai chi program (the group labeled "tai chi practitioners"). After the tai chi program, injurious falls among the control villagers significantly declined by 44% (adjusted rate ratio [RR]=0.56; 95% confidence interval [CI]=0.36-0.92). Compared with the results for the control villagers, the decline was 31% greater (RR=0.69; 95% CI=0.30-1.56) among the tai chi villagers and 50% greater (RR=0.5; 95% CI=0.11-2.17) among the tai chi practitioners; the results did not reach statistical significance. Furthermore, compared with the scores for the control villagers, the scores for the tai chi practitioners increased by 1.8 points (95% CI=0.2-3.4) on the Tinetti Balance Scale and increased by 0.9 point (95% CI=0.1-1.8) on the Tinetti Gait Scale. No significant changes in the fear of falling were detected among the tai chi practitioners, tai chi villagers, and control villagers. DISCUSSION AND CONCLUSION: Tai chi can prevent a decline in functional balance and gait among older people. However, the reduction in injurious falls attained with tai chi did not reach statistical significance; the statistical inefficiency may have resulted partly from the large decline in injurious falls in control villagers. Finally, the unexpected effect of educational intervention on reducing injurious falls in different settings needs to be further examined.     

The effects of action observation gait training on the static balance and walking ability of stroke patients

[Purpose] The purpose of the study was to investigate the effects of action observation training on the static balance and walking ability of patients who had suffered a stroke. [Subjects] Forty patients with hemiplegia resulting from a stroke were divided into an action observation gait training group (AOGT group, n=20) and a general gait training group (GGT group, n=20). [Methods] The AOGT group watched a training video on flatland gait, slope gait, and stair gait. The GGT group watched a video on nature. Both groups watched their respective video for 10 minutes and then had gait training for 20 minutes per day, five times per week, for eight weeks. [Results] The static balance and gait ability of both groups significantly improved. Although there were significant differences between the groups, the AOTG group showed greater improvements in sway speed, limit of stability, and gait ability. [Conclusion] We recommend action observation training over general gait training for patients with hemiplegia. Action observational training had a positive effect on static balance and gait ability in stroke patients’ static balance and gait ability. Further research is needed to generalize the results of this study.Key words: Hemiplegia, Action observation training, Gait     

Effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force

[Purpose] The purpose of this study was to investigate the effects of Nordic walking and walking on spatiotemporal gait parameters and ground reaction force. [Subjects] The subjects of this study were 30 young adult males, who were divided into a Nordic walking group of 15 subjects and a walking group of 15 subjects. [Methods] To analyze the spatiotemporal parameters and ground reaction force during walking in the two groups, the six-camera Vicon MX motion analysis system was used. The subjects were asked to walk 12 meters using the more comfortable walking method for them between Nordic walking and walking. After they walked 12 meters more than 10 times, their most natural walking patterns were chosen three times and analyzed. To determine the pole for Nordic walking, each subject’s height was multiplied by 0.68. We then measured the spatiotemporal gait parameters and ground reaction force. [Results] Compared with the walking group, the Nordic walking group showed an increase in cadence, stride length, and step length, and a decrease in stride time, step time, and vertical ground reaction force. [Conclusion] The results of this study indicate that Nordic walking increases the stride and can be considered as helping patients with diseases affecting their gait. This demonstrates that Nordic walking is more effective in improving functional capabilities by promoting effective energy use and reducing the lower limb load, because the weight of the upper and lower limbs is dispersed during Nordic walking.Key words: Nordic walking, Ground reaction force, Spatiotemporal gait parameters     

Effects of Tai Chi exercise on balance, functional mobility, and fear of falling among older women

The purpose of this study was to determine the effects of Tai Chi exercise among older women. Multiple regression analysis revealed statistically significant improvements in scores for balance (p <.001), functional mobility (p <.05), and fear of falling (p <.001) and associated demographic factors. Three months of twice weekly, 30-minute Tai Chi classes was associated with statistically significant improvements in balance and functional mobility and a reduction in the fear of falling in this sample of older women living in retirement communities. T'ai Chi exercises may be an age-appropriate and acceptable form of exercise for older women.     

Fear of falling,balance, and gait velocity in patients with stroke

After a stroke balance can be impaired, that may influence the physical activities which can be undertaken. A person's confidence in performing activities without falling could be as important as the real balance ability in situations of daily living. The aims of the study were to evaluate the relationship between perceived self-confidence in task performance without falling, using the Falls Efficacy Scale, Swedish version, (FES(S)) and observer-assessed balance, measured by the BDL Balance Scale (BDL BS) and also between the FES(S) and gait velocity. Thirty-one subjects with stroke, 32–62 years of age, time since onset between 3 and 104 months, participated. The FES(S) was significantly correlated with the BDL BS (r = 0.49, p = 0.008). Furthermore there were significant correlations between the FES(S) and self-selected (r = 0.53, p = 0.003) as well as for maximum (r = 0.55, p = 0.002) gait velocity. The results indicate that the use of the FES(S) can be recommended in subjects with stroke and balance deficit in order to map out the dimension of self-confidence in balance problems. However, in more highly functioning subjects with stroke other fall-efficacy assessments with major demands on balance performance may be preferable due to partly ceiling effect in the study population.     

Fear of falling, balance, and gait velocity in patients with stroke

After a stroke balance can be impaired, that may influence the physical activities which can be undertaken. A person's confidence in performing activities without falling could be as important as the real balance ability in situations of daily living. The aims of the study were to evaluate the relationship between perceived self-confidence in task performance without falling, using the Falls Efficacy Scale, Swedish version, (FES(S)) and observer-assessed balance, measured by the BDL Balance Scale (BDL BS) and also between the FES(S) and gait velocity. Thirty-one subjects with stroke, 32-62 years of age, time since onset between 3 and 104 months, participated The FES(S) was significantly correlated with the BDL BS (r = 0.49, p = 0.008). Furthermore there were significant correlations between the FES(S) and self-selected (r = 0.53, p = 0.003) as well as for maximum (r = 0.55, p = 0.002) gait velocity. The results indicate that the use of the FES(S) can be recommended in subjects with stroke and balance deficit in order to map out the dimension of self-confidence in balance problems. However, in more highly functioning subjects with stroke other fall-efficacy assessments with major demands on balance performance may be preferable due to partly ceiling effect in the study population.     

Effects of horse-riding exercise on balance,gait, and activities of daily living in stroke patients

[Purpose] This study aimed to investigate the effects of horse-riding exercise on balance, gait, and activities of daily living (ADLs) in stroke patients. [Subjects] Among 20 participants with stroke, 10 were randomly assigned to the experimental group, and 10 were randomly assigned to the control group. The experimental group participated in horse-riding exercise for 30 minutes per day, 5 days a week for 6 weeks. Balance was tested with the Berg Balance Scale (BBS). Gait was measured using the 10-Meter Walk Test (10MWT). ADLs were tested with the Modified Barthel Index (MBI). Differences between pre- and post-experiment values within the two groups were compared using paired t-tests. Between-group differences were compared using independent t-tests. [Results] The experimental group showed significant improvements in balance, gait, and ADLs following horse-riding exercise. Additionally, the experimental group showed significant differences in balance, gait, and ADLs compared with in the control group. [Conclusion] These results support that horse-riding exercise enhances balance, gait, and ADLs in stroke patients. This study supports the need for further research on horse-riding exercise programs.Key words: Horse-riding exercise, Balance, Activities of daily living     

Kinematic effect of Nintendo WiiTM sports program exercise on obstacle gait in elderly women with falling risk

[Purpose] This study evaluated the changes in balance ability and obstacle gait after lumbar stabilization exercise and Nintendo Wii^TM Sports in elderly at risk for falls. [Subjects and Methods] Twenty-four elderly women with at risk for falls were randomly divided into the control, lumbar stabilization exercise, and Nintendo Wii Sports groups. Static balance was measured by the Berg Balance Scale and functional reach test, dynamic balance by the timed up-and-go test, and obstacle negotiation function by crossing velocity and maximum vertical heel clearance. [Results] Both the lumbar stabilization exercise and Nintendo Wii Sports groups showed significant improvements in obstacle negotiation function after the exercise compared to the control group. Berg Balance Scale and functional reach test scores were greater in the lumbar stabilization exercise group, while the timed up-and-go test time was significantly better in the Nintendo Wii Sports groups. [Conclusion] Lumbar stabilization exercises and Nintendo Wii Sports improve falling related balance and obstacle negotiation function in elderly women at risk for falls.Key words: Elderly women, Falls, Nintendo Wii Sports     

Implementation of a patient fall prevention program.

Falls among hospitalized patients are common occurrences and can have detrimental effects on patient outcomes. Identifying high-risk patients and taking measures to prevent patient falls have been successful. The purpose of this project was to decrease the fall rate in adult neuroscience patients. This was accomplished through implementation of a patient fall prevention program. Patients were assessed for risk factors associated with patient falls. Risk factors were identified through the use of the patient's history, nursing data base and patient classification system. Patients with identified risk factors were placed on fall precautions which included interventions specifically designed to prevent patient falls. This project resulted in a decrease in the number of patient falls and increased staff awareness of the risk factors associated with falls among adult neuroscience patients.     

Effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis

[Purpose] This study aimed to elucidate the effects of a novel walking training program with postural correction and visual feedback on walking function in patients with post-stroke hemiparesis. [Subjects] Sixteen subjects were randomly allocated to either the experimental group (EG) or the control group (CG), with eight subjects in each. [Methods] EG and CG subjects performed a 30-min treadmill walking training exercise twice daily for 2 weeks. EG subjects also underwent postural correction using elastic bands and received visual feedback during walking. The 10-m walk test was performed, and gait parameters were measured using a gait analysis system. [Results] All parameters showed significant main effects for the group factor and time-by-group interactions. Significant main effects for the time factor were found in the stride length and stance phase ratios. [Conclusion] The novel walking training program with postural correction and visual feedback may improve walking function in patients with post-stroke hemiparesis.Key words: Postural correction, Stroke, Walking function     

国外预防老年住院病人跌倒的研究进展

从国外预防老年住院病人跌倒的研究现状入手,介绍国外预防跌倒的有效干预措施,以期拓展我国预防院内跌倒的思路,有效减少住院病人跌倒的发生。     

Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients

[Purpose] This study aimed to assess the effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. [Subjects] Twenty stroke patients were randomly assigned to two groups 10 to an experimental group that performed a virtual reality exercise program accompanied by cognitive tasks and 10 to a control group. The control group performed a proprioceptive neuromuscular facilitation exercise program. Balance was measured with the Berg Balance Scale. Gait was assessed using the Timed Up and Go Test. The paired t-test was used to compare groups before and after the experiment. The independent t-test was conducted to assess differences in the degree of change between the two groups before and after the experiment. [Results] Within-group comparison in the experimental group showed significant differences in the Berg Balance Scale and Timed Up and Go Test. In a comparison between groups, the differences in the Berg Balance Scale and Timed Up and Go Test in the experimental group appeared significant compared with the control group. [Conclusion] The results of the experiment indicate that a virtual reality exercise program accompanied by cognitive tasks has a positive effect on the balance and gait of stroke patients.Key words: Virtual reality exercise program accompanied by cognitive tasks, Balance, Gait     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

住院病人跌倒预防措施效果的系统评价

[目的]评价住院病人跌倒预防措施效果.[方法]计算检索数据库后筛选出相关临床随机对照研究,由2名研究者对文献的质量进行严格评价、提取,对符合质量标准的使用RevMan4.04软件对结局指标进行了分析及描述.[结果]共纳入19项临床随机对照研究,有10/14项研究的结果显示,实施跌倒预防措施后实验组中发生跌倒的人数所占比例低于对照组,但差异无统计意义;有5/7项研究的结果显示,实施跌倒预防措施后实验组中发生跌倒导致骨折人数所占比例低于对照组,但仅1项研究结果提示差异有统计意义;实验组有4项研究报道实施干预措施后病人第1次发生跌倒所用的时间长于对照组,但差异无统计意义.[结论]尚无证据显示,跌倒预防措施能有效降低住院病人中跌倒及跌倒所致骨折人数所占比例.住院病人跌倒预防干预措施需要针对性、个体化和持续地进行.     

The effect of gait training with shoe inserts on the improvement of pain and gait in sacroiliac joint patients

[Purpose] The purpose of the current research was to identify how gait training with shoe inserts affects the pain and gait of sacroiliac joint dysfunction patients. [Subjects and Methods] Thirty subjects were randomly selected and assigned to be either the experimental group (gait training with shoe insert group) or control group. Each group consisted of 15 patients. Pain was measured by Visual Analogue Scale, and foot pressure in a standing position and during gait was measured with a Gateview AFA-50 system (Alpus, Seoul, Republic of Korea). A paired sample t-test was used to compare the pain and gait of the sacroiliac joint before and after the intervention. Correlation between pain and walking after gait training with shoe inserts was examined by Pearson test. The level of significance was set at α=0.05. [Results] It was found that application of the intervention to the experimental group resulted in a significant decrease in sacroiliac joint pain. It was also found that there was a significant correlation between Visual Analogue Scale score and dynamic asymmetric index (r= 0.796) and that there was a negative correlation between Visual Analogue Scale score and forefoot/rear foot peak pressure ratio (r=-0.728). [Conclusion] The results of our analysis lead us to conclude that the intervention with shoe inserts had a significant influence on the pain and gait of sacroiliac joint patients.Key words: Sacroiliac joint, Shoe inserts, Gait     

住院病人跌倒预防措施效果的系统评价

[目的]评价住院病人跌倒预防措施效果.[方法]计算检索数据库后筛选出相关临床随机对照研究,由2名研究者对文献的质量进行严格评价、提取,对符合质量标准的使用RevMan4.04软件对结局指标进行了分析及描述.[结果]共纳入19项临床随机对照研究,有10/14项研究的结果显示,实施跌倒预防措施后实验组中发生跌倒的人数所占比例低于对照组,但差异无统计意义;有5/7项研究的结果显示,实施跌倒预防措施后实验组中发生跌倒导致骨折人数所占比例低于对照组,但仅1项研究结果提示差异有统计意义;实验组有4项研究报道实施干预措施后病人第1次发生跌倒所用的时间长于对照组,但差异无统计意义.[结论]尚无证据显示,跌倒预防措施能有效降低住院病人中跌倒及跌倒所致骨折人数所占比例.住院病人跌倒预防干预措施需要针对性、个体化和持续地进行.     

The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation

OBJECTIVE: To assess in amputee patients the relationship between having fallen in the past 12 months, fear of falling, and balance confidence on mobility capability, mobility performance, and social activity. DESIGN: Population-based survey and chart review. SETTING: Two university-affiliated outpatient amputee programs in southwestern Ontario. PARTICIPANTS: Community-living individuals (n = 435) with a unilateral lower limb amputation. INTERVENTIONS: Patient chart review and a survey questionnaire. MAIN OUTCOME MEASURES: Self-report assessment of prosthetic capability and performance and social activity participation was assessed with the Prosthetic Evaluation Questionnaire mobility subscale, the Houghton Scale, and the Frenchay Activities Index. RESULTS: Falling experiences in the past 12 months were not significantly associated with any outcomes. Fear of falling was important in univariate relationships in all 3 outcomes, but not when balance confidence was included in multivariable modeling. Balance confidence was statistically significant with each of the outcomes and remained significant with inclusion of the covariates. There was statistical interaction (balance confidence x automatism; balance confidence x medication count) in modeling mobility capability and in modeling mobility performance (balance confidence x pain + balance confidence x amputation level). The final models accounted for 70%, 60%, and 55% of the variation in mobility capability, mobility performance, and social activity, respectively. CONCLUSION: Balance confidence was the only factor associated with mobility capability and performance and social activity in the final adjusted models. Clinicians and researchers should consider this variable in the rehabilitation of amputee patients.     

Influence of pain and depression on fear of falling, mobility, and balance in older male veterans

This study determined the extent to which pain and depression influenced changes in fear of falling, mobility, and balance in older veterans with mobility disorders. Data were reviewed from 95 consecutive patients (aged 60 to 95 yr) who attended the Geriatric Gait and Balance Disorders Clinic at the Malcom Randall Department of Veterans Affairs Medical Center between 1998 and 2000. All subjects performed an individualized exercise program and were assessed four times over 12 weeks with a standardized evaluation battery. We used separate hierarchical regression models to examine the influence of measures of bodily pain and depression on outcomes (Berg Balance Test, Dynamic Gait Index, and Falls Efficacy Scale). Approximately half of the patients attended all evaluation sessions. Attendance at follow-up visits was a significant predictor of improvement in all outcome measures. Pain was a significant predictor of a decrease in balance and mobility outcome scores but not fear of falling. Thus, completing the program increased the amount of improvement, while having pain decreased the amount of improvement. These data suggest that targeted interventions for pain and improving adherence to rehabilitation recommendations should be included in the rehabilitation of older veterans with balance or mobility disorders to maximize potential improvements in balance and mobility.