Static and Dynamic Postural Balance After Successful Mobile-Bearing Total Ankle Arthroplasty

Lee KB, Park YH, Song EK, Yoon TR, Jung KI. Static and dynamic postural balance after successful mobile-bearing total ankle arthroplasty.

Objective

To investigate static and dynamic postural balance after successful total ankle arthroplasty by using dynamic posturography.

Design

A controlled trial study.

Setting

A national university orthopedic and rehabilitation hospital.

Participants

Patients (n=30, 21 men, 9 women; mean age, 58y) and age- and sex-matched healthy controls (n=30).

Interventions

Thirty patients who underwent unilateral total ankle arthroplasty with a cementless mobile-bearing ankle prosthesis and 30 age- and sex-matched healthy control subjects were included.

Main Outcome Measures

Using computerized dynamic posturography, sensory (sensory organization test [SOT]), and motor (limit of stability [LOS], rhythmic weight shift [RWS], and weight bearing) impairment assessments were performed at an average of 15 months after total ankle arthroplasty.

Results

In the SOT, results of the SOT-2 test reflecting mainly proprioception showed no significant difference between patients and controls, but patients demonstrated significantly lower scores for SOT-4, -5, and -6 as a measure of dynamic postural balance and required more hip movement to maintain balance. In the motor-control tests, patients showed significantly lower measures in indices of LOS test except the mean reaction time and the forward/backward directional control and on-axis velocity of the RWS test. Weight bearing was observed asymmetrically in patients.

Conclusions

Patients had a higher degree of dynamic postural imbalance and relied less on ankle strategy to maintain balance than controls. Also, patients showed the deficit of motor control ability as compared with age- and sex-matched healthy controls.     

Acute Effects of Static Stretching on Balance in Young Versus Elderly Adults

ABSTRACT

The purpose of this study was to investigate the acute effects of static stretching of the gastrocnemius muscles on the dynamic balance of healthy young and elderly adults. Thirty adults aged 18 to 35 years, and 18 elderly adults aged 65 years and older participated in this study. Utilizing the NeuroCom SMART Balance Master, each subject performed the limits of stability (LOS) test twice before implementing a 30-s static stretching protocol of the gastrocnemius muscles and once after the intervention. There was a significant difference between the young and elderly groups for all outcome measures on the LOS test after the first measurement (pretest 1) (p ≤ 0.004). Movement velocity for pretest 1 was significantly slower than pretest 2 (p ≤ 0.005), while endpoint excursion distance improved across all points (p ≤ 0.039). For the post-test, all the components of the LOS test, except endpoint excursion, showed no significant treatment effect (p ≥ 0.016) with the Bonferroni corrected alpha of 0.01. Although differences between young and elderly subjects were observed, these results indicate that short duration static stretching of the gastrocnemius muscles has little or no effect on dynamic balance in healthy young and elderly adults.     

Psychometric Properties of the Brief Fatigue Inventory in Community-Dwelling Older Adults

Objective

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

Design

Cross-sectional validation study.

Setting

Community based.

Participants

Subjects (N=302) were nondemented older adults (mean age, 76.44y; 54% women).

Interventions

Not applicable.

Main Outcome Measures

BFI total, severity, and interference summation scores.

Results

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

Conclusions

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.     

Comparison of Two Exercise Programs Using the Falls Efficacy Scale,Berg Balance Scale and Ankle Dorsiflexor Strength in Older Adults

The purpose of this study was to investigate the effectiveness of two exercise programs with three different measurements (Falls Efficacy Scale–FES, Berg Balance Scale–BBS, and bilateral ankle dorsiflexor strength–ADFS) and to determine if these measurements correlate to each other. Thirteen pairs of subjects residing in a senior living community were recruited and matched for age, gender, and assistive device. The matched subjects were randomly divided into one of two exercise groups–resistance group (RG) provided with the exercise combination of resistance strengthening, balance and gait or seated group (SG) provided with seated range of motion exercise. Eleven pairs completed the 12-week exercise program. The results revealed that subjects in the RG made more improvement in fear of falling, balance, and ankle dorsiflexor strength than those in the SG. The decrease of FES score (fear of falling) is moderately correlated with the increase of BBS (balance) and ADFS scores. The improved BBS is also moderately correlated with the increased ADFS.     

Effects of Conservative Interventions on Static and Dynamic Balance in Individuals With Chronic Ankle Instability: A Systematic Review and Meta-analysis

ObjectiveTo determine which conservative interventions are effective for static and dynamic balance in patients with chronic ankle instability (CAI).Data SourcesPubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to March 20, 2022.Study SelectionRandomized controlled trials investigating the effects of conservative interventions on static and/or dynamic balance in patients with CAI compared with those of different conservative interventions or controls were included.Data ExtractionTwo independent reviewers extracted the data. Certainty of the evidence was assessed using the GRADE approach.Data SynthesisForty-eight studies (1906 participants) were included. Whole-body vibration training (WBVT) was significantly more effective than controls for both static (standardized mean difference, 1.13; 95% confidence interval [CI], 0.58-1.68; moderate-certainty evidence) and dynamic balance (0.56; CI, 0.24-0.88; low-certainty evidence). Balance training (BT) and joint mobilization were significantly more effective than controls for dynamic balance (0.77; CI, 0.41-1.14; and 0.75; CI, 0.35-1.14, respectively), but not for static balance (very low to low-certainty evidence). Adding other interventions to BT had no significant effect on either type of balance compared with that of BT alone (moderate to low-certainty evidence). Strength training (ST) and taping had no significant effect on either type of balance (very low- to low-certainty evidence). Multimodal interventions were significantly effective in improving dynamic balance (0.76; CI, 0.32-1.20; low-certainty evidence). Adding transcranial direct current stimulation to ST was significantly more effective for dynamic balance than ST (0.81; CI, 0.08-1.53; moderate-certainty evidence). The effects on balance were not significantly different among BT, ST, and WBVT (very low- to low-certainty evidence).ConclusionsThe significantly effective interventions reviewed may be treatment options for balance impairments associated with CAI. However, interventions should be chosen carefully, as much of the certainty of evidence is very low to low.     

脑卒中患者坐位站起速度与动静态平衡的相关性研究

目的探讨脑卒中患者坐位站起速度与静、动态平衡的相关性。方法测量脑卒中患者5次坐立时间(Five Ti mes Sitto Stand Performance,FTSTS),用重心动摇仪(GS-10A)测量静态平衡能力及重心左右移动的能力,并测量坐位时功能性前伸的距离。分别计算FTSTS得分与各测量指标的相关性,并做回归分析。结果 FTSTS得分分别与偏瘫侧、重心摆动的外周面积、坐位时功能性前伸相关(r=-0.512,P<0.05;r=0.632,P<0.05;r=-0.662,P<0.01),多元回归分析显示,影响坐位站起速度的主要因素是坐位时功能性前伸距离和静态平衡参数外周面积。结论从平衡方面来看,外周面积和坐位下功能性前伸距离是影响坐位站起速度的主要因素,两者可以作为预测性指标评价脑卒中患者坐位站起速度。     

Fatigue and Fatigability in Older Adults

Fatigue is believed to be a common complaint among older adults; however, multiple studies of self-reported fatigue across the lifespan have found this may not be the case. To explain this paradox, this article considers “fatigability”–a phenotype characterized by the relationship between an individual's perceived fatigue and the activity level with which the fatigue is associated. Fatigability may be measured by combining self-report measures of fatigue with performance of physical or cognitive activities, provided that the work of the activity is known or can be standardized. Doing so prevents self-pacing and allows meaningful comparisons across subjects and between studies. Increased fatigability with aging may arise from a variety of factors including age-related changes in energy production or utilization, and inflammatory mechanisms. A few published intervention studies have targeted fatigue in older adults, though none have examined fatigability specifically. Because fatigue may represent a physiologic warning system, future clinical studies may benefit from a focus on fatigability, where both symptoms and function are considered.     

Effect of Acute Fatigue of the Hip Abductors on Control of Balance in Young and Older Women

Bellew JW, Panwitz BL, Peterson L, Brock MC, Olson KE, Staples WH. Effect of acute fatigue of the hip abductors on control of balance in young and older women.

Objective

To examine the effects of acute fatigue of the hip abductors on the control of balance in young and older women.

Design

Pretest-posttest.

Setting

University research laboratory.

Participants

Healthy young women (n=20; age, 23.0±1.5y; height, 166.52±4.5cm; mass, 65.33±10.5kg) and community-dwelling older women (n=20; age, 71.65±7.2y; height, 162.31±3.8cm; mass, 71.16±11.6kg) without a fall history.

Intervention

Measurements of control of single-limb balance before and after fatiguing the hip abductors of the dominant leg.

Main Outcome Measure

Performance on 3 clinical assessments of control of balance: the modified Functional Reach Test in the forward, left, and right directions; the Lower-Extremity Reach Test in forward and lateral directions; and the Single-Limb Stance Time Test (SLSTT).

Results

Although the younger subjects showed a significantly greater control of balance than the older women in most tests, control of balance after acute fatigue failed to show a significant decline in either age group. The only exception to this was the SLSTT in the younger women in whom a significant 26% decline was noted (P<.05).

Conclusions

Acute fatigue of the hip abductors did not result in a decreased control of balance in healthy young or older women without fall history. Despite considerable changes in movement strategies used to complete the postfatigue tests of balance, quantitative measures of balance did not decrease.     

Using the Wii to Improve Balance in Older Adults: A Systematic Review

ABSTRACT

Aims: The purpose of this systematic review was to evaluate the effectiveness of the Wii at improving balance in older adults without documented neurologic or orthopedic deficits. Methods: A thorough investigation of the CINAHL Plus with Full Text, ProQuest Medical Library, and SPORTDiscus with Full Text databases was completed. The search terms utilized while analyzing the databases were “Wii” AND “randomized” AND “balance” OR “postural control” AND “elderly” OR “older adults”. Results: Eight studies were included in the qualitative analysis. Participants in the Wii therapy groups generally demonstrated more improvement in postural control compared to participants in the control groups. Although there were no significant differences in postural control between the Wii therapy groups and the conventional therapy groups following the respective intervention, the Wii participants generally expressed greater enjoyment, interest, and motivation. Conclusions: Wii balance training may be considered an effective alternative intervention for individuals with impaired postural control.     

静态平衡仪用于预测老年人跌倒风险的有效性

目的探讨静态平衡仪预测老年人跌倒风险的有效性。方法 2014年3月至2015年3月,便利抽样法选取上海市某三级甲等医院住院老年患者401例为研究对象,运用静态平衡仪(Tetrax)监测既往有跌倒史和无跌倒史两组老年人的跌倒风险是否有差异,随访患者1年并评价静态平衡仪用于预测老年人跌倒危险的有效性。结果平衡仪的3个指标中,跌倒指数(fall index,FI)受试者工作特征曲线下面积比为0.762,稳定性系数(stability index,SI)为0.720;体质量分布系数(weight distribution index,WDI)为0.524。根据Youden指数,FI对跌倒的预测值为41,敏感性为80.5%,特异性为60.2%;SI对跌倒的预测值为1.5~6,敏感性为72%,特异性为63.3%;WDI预测值为-1~3。结论静态平衡仪可以预测老年人的跌倒风险,而且3个参考指标中,FI的敏感性和特异性最好。     

Pain Management in Older Adults

Background

Chronic pain is prevalent among older adults but is underrecognized and undertreated. The approach to pain assessment and management in older adults requires an understanding of the physiology of aging, validated assessment tools, and common pain presentations among older adults.

Objective

To identify the overall principles of pain management in older adults with a specific focus on common painful conditions and approaches to pharmacologic treatment.

Methods

We searched PubMed for common pain presentations in older adults with heart failure, end-stage renal disease, dementia, frailty, and cancer. We also reviewed guidelines for pain management. Our review encompassed 2 guidelines, 10 original studies, and 22 review articles published from 2000 to the present. This review does not discuss nonpharmacologic treatments of pain.

Results

Clinical guidelines support the use of opioids in persistent nonmalignant pain. Opioids should be used in patients with moderate or severe pain or pain not otherwise controlled but with careful attention to potential toxic effects and half-life. In addition, clinical practice guidelines recommend use of oral nonsteroidal anti-inflammatory drugs with extreme caution and for defined, limited periods.

Conclusion

An understanding of the basics of pain pathophysiology, assessment, pharmacologic management, and a familiarity with common pain presentations will allow clinicians to effectively manage pain for older adults.     

Effects of Combined Balance and Resistance Exercise on Reducing Knee Pain in Community-Dwelling Older Adults

ABSTRACT

The effects of a combined balance and resistance exercise program on knee joint pain (KJP) in community-dwelling older adults were determined. Twenty-eight participants with KJP were divided into an exercise group (EXG: n = 14, 77 ± 4 year) and a control group (n = 14, 77 ± 4 year). The EXG participated in 12 weeks of community-based training. The training program consisted of balance exercise and lower body resistance exercise using body weight. The EXG demonstrated significant improvements in KJP (46%), lower extremity muscular strength (5–26%), Chair Stand (27%), Up and Go (9%), and Functional Reach (17%).     

Psychological Well-being in Older Adults Suffering From Chronic Headache

Objective.—The aim of this study was to examine two components of psychological well-being—life satisfaction and effective well-being—in community-dwelling elderly with (n=321) and without chronic headache (n=4955).
Methods.—A checklist of chronic medical conditions was used to determine whether respondents were suffering from headache. Cantril's ladder was employed to measure life satisfaction. The subscale, Mental Health, from the MOS SF-20 was used to assess affective well-being.
Results.—Headache sufferers reported lower life satisfaction as well as lower affective well-being. However, the difference in life satisfaction between the two groups disappeared after controlling for comorbidity. The difference in affective well-being disappeared after controlling for neuroticism.
Conclusions.—Lower life satisfaction in patients with chronic headache is caused by more comorbid diseases in the headache group. Lower affective well-being in headache sufferers is due to higher levels of neuroticism in the headache group.     

Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study

Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.

Objective

To determine whether fear of falling (FoF) and balance improved after a 12-week yoga intervention among older adults.

Design

A 12-week yoga intervention single-armed pilot study.

Setting

A retirement community in a medium-sized university town in the Midwest.

Participants

A convenience sample of adults (N=14) over the age of 65 years who all endorsed an FoF.

Intervention

Each participant took part in a biweekly 12-week yoga intervention. The yoga sessions included both physical postures and breathing exercises. Postures were completed in sitting and standing positions.

Main Outcome Measures

We measured FoF with the Illinois FoF Measure and balance with the Berg Balance Scale. Upper- and lower-body flexibility were measured with the back scratch test and chair sit and reach test, respectively.

Results

FoF decreased by 6%, static balance increased by 4% (P=.045), and lower-body flexibility increased by 34%.

Conclusions

The results indicate that yoga may be a promising intervention to manage FoF and improve balance, thereby reducing fall risk for older adults. Rehabilitation therapists may wish to explore yoga as a modality for balance and falls programming; however, future research is needed to confirm the use of yoga in such programming.     

膝骨关节炎患者动静态跌倒风险测试的临床应用价值

目的探讨膝骨关节炎(KOA)患者的平衡功能状况和动静态跌倒风险测试在KOA患者中的临床应用价值。方法对无膝痛的KOA患者(对照组,n=30)给予静态姿势稳定性(PS)、姿势稳定极限性(LOS)、动态跌倒风险指数(DFI)和静态跌倒风险指数(SFI)测试。对有膝痛的KOA患者(治疗组,n=30)给予10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入和6次推拿手法联合治疗,并于治疗前后给予西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及上述4种平衡功能测试。结果对照组与治疗组治疗前在PS总分、前后摆动系数、侧向摆动系数存在显著性差异(P<0.05);LOS完成时间、LOS总分和DFI存在非常显著性差异(P<0.01),而SFI无显著性差异(P>0.05)。治疗组治疗前后的WOMAC得分、PS总分、前后摆动系数、LOS完成时间、LOS总分和DFI存在显著性差异(P<0.05);侧向摆动系数、SFI无显著性差异(P>0.05)。结论有膝痛的KOA患者与年龄相匹配的无膝痛KOA受试者相比,平衡功能更差,跌倒风险更大。经有效治疗后,KOA患者的平衡功能明显改善,跌倒风险降低。与SFI测试相比,DFI测试对KOA患者平衡功能改善更加敏感。     

Effects of a Community-Based Tai Chi Program on Balance,Functional Outcomes,and Sensorimotor Function in Older Adults

Abstract

Aims: Examine effects of a community Tai Chi program on measures of balance and sensorimotor function.

Methods: In a pretest and post-test design, balance was measured in older adults (N?=?344; 73.4?±?7.4?years) with 30-s chair stand, timed-up-and-go, and 4-stage balance test following a 12-week community-based Tai Chi intervention. Balance and sensorimotor measures, including hip abductor electromechanical delay and hip proprioception, were measured in a smaller sample of older adults (n?=?11; 67.3?±?3.7?years).

Results: Balance improved (p?<?0.0001) following intervention compared to pretest. Similarly, participants in the smaller sample showed improvements at post-test (p?<?0.05) in electromechanical delay and lower extremity proprioception, but no bone density or muscle mass changes.

Conclusions: These preliminary results suggest that a community-based Tai Chi program improves balance in older adults. In a smaller sample, Tai Chi resulted in additional sensorimotor changes, specifically faster hip abductor muscle contraction speed and improved hip proprioception.     

大学生动静态平衡能力与形态指标的相关性研究

目的:分析人体形态学各指标与大学生平衡能力间的相关性,并以此为大学生平衡能力的提高提供依据。方法:对133名受试者进行动静态平衡能力及身高、体重、柔韧性等人体形态指标进行测试,对男女两组平衡能力进行T检验,对受试者的平衡能力与各指标进行pearson分析。结果:男女受试者的动静态平衡能力均无差异性(P>0.05),静态平衡测试值与柔韧性、全身反应时、背肌力、身高、体重、BMI指数、踝关节背屈活动度之间的相关系数均小于0.2,无相关性。动态平衡测试值与身高、体重、BMI均呈负相关,与柔韧性及踝关节背屈活动度之间成正相关。结论:大学生的动态平衡能力与柔韧性及踝关节的灵活程度密切相关,但该文所测各项数据与静态平衡能力均无关联。     

不同血压状态老年2型糖尿病患者静态平衡功能特征分析

目的:分析不同血压水平下老年2型糖尿病患者静态平衡功能的变化特征。方法:选择2013年11月—2020年8月于福建中医药大学附属第二人民医院进行体检的60~80周岁受试者体检信息共2179例,按血糖及血压状态分为健康人群(对照组)、血压正常2型糖尿病组(T2DM组)及血压异常升高2型糖尿病组(T2DM-HTN组),其中对照组使用倾向性评分匹配的方法挑选281例,T2DM组273例,T2DM-HTN组281例。比较3组空腹血糖(FBG)、糖化血红蛋白(GHbA1c)、血脂[三酰甘油(TG)、总胆固醇(TC)、高/低密度脂蛋白(HDL/LDL)]等血液生化指标;血压(BP)和每分钟脉搏数等健康相关指标;睁眼和闭眼状态下动摇总轨迹长(LNG)、轨迹图面积(SSKG)、单位面积轨迹长(LNG/area)、X方向轨迹长(LNG-X)、Y方向轨迹长(LNG-Y)、Romberg商(RQ)和重心偏移幅度(DA)等静态平衡功能参数的差异。结果:(1)血液生化指标:与对照组比较,T2DM组和T2DM-HTN组FBG、GHbA1c、TG、总胆固醇、LDL等血液生化代谢指标明显升高(P<0.05);与T2DM组比较,T2DM-HTN组FBG水平升高(P<0.05)。(2)健康相关指标:与对照组比较,T2DM组和T2DM-HTN组BMI、每分脉搏数和血压明显升高(P<0.05);与T2DM组比较,T2DM-HTN组的BMI、每分脉搏数和血压水平升高(P<0.05)。(3)静态平衡功能参数:在睁眼状态下,与对照组比较,T2DM组LNG/area升高(P<0.05),T2DM-HTN组LNG、SSKG、LNG/area、LNG-X、LNG-Y均升高(P<0.05);与T2DM组比较,T2DM-HTN组LNG、LNG/area、LNG-X、LNG-Y均升高(P<0.05)。在闭眼状态下,与对照组比较,T2DM组SSKG和LNG-X升高,T2DM-HTN组的LNG、SSKG、LNG/area、LNG-X、LNG-Y均升高(P<0.05);与T2DM组比较,T2DM-HTN组LNG、LNG/area、LNG-X、LNGY均升高(P<0.05)。与对照组和T2DM组比较,T2DM-HTN组RQ和DA均明显升高(P<0.05)。结论:老年2型糖尿病患者维持静态姿势稳定性的能力较同龄非糖尿病者下降,需要更多的视觉代偿以维持平衡,其中X轴方向的平衡控制能力受视觉影响更明显。血压异常升高将导致老年2型糖尿病患者的静态平衡能力进一步下降,且身体重心偏移幅度更大。     

Challenges with Diagnosing and Managing Sepsis in Older Adults

Sepsis in older adults has many challenges that affect rate of septic diagnosis, treatment, and monitoring parameters. Numerous age-related changes and comorbidities contribute to increased risk of infections in older adults, but also atypical symptomatology that delays diagnosis. Due to various pharmacokinetic/pharmacodynamic changes in the older adult, medications are absorbed, metabolized, and eliminated at different rates as compared to younger adults, which increases risk of adverse drug reactions due to use of drug therapy needed for sepsis management. This review provides information to aid in diagnosis and offers recommendations for monitoring and treating sepsis in the older adult population.