Suppression of the Vertical Vestibulo-ocular Reflex in Older Persons at Risk of Falling

A case-control design was used to assess eye-head-trunk coordination for community-dwelling elders performing a stand-walk task. Eighteen elders with a high risk of falling were matched to 18 subjects with low risk on the basis of age, living status (living alone or with someone) and category of residence (independent living or assisted living facility). Standard electro-oculography was used in conjunction with an electromagnetic tracking device to measure eye and head-trunk motion, respectively. For the low-risk group, the mean slope of gaze-head and gaze-trunk relationships was significantly greater than zero (0.91 and 0.64, respectively), whereas high-risk elders did not demonstrate slope magnitudes significantly different from zero (0.52 and 0.16, respectively) due to large inter-subject variations. While the majority of subjects showed some counter-rotation of the eyes with head pitch, a greater percentage of subjects in the high-risk group did not suppress this response and consequently gaze and gaze velocity overcompensated for head pitch. These findings suggest that the vertical vestibulo-ocular reflex is not adequately suppressed during the stand-walk task in elders who are at a high risk of falling. Possible mechanisms contributing to these findings are discussed.     

针对性健康教育对防止下肢手术术后患者跌倒的影响

目的探讨针对性健康教育对防止下肢手术术后患者跌倒的影响。方法将200例下肢手术术后患者按病房不同分为观察组和对照组各100例,对照组采用常规方法预防跌倒,观察组在此基础上进行针对性健康教育,比较两组跌倒发生情况;并在常规与针对性健康教育前后分别对两组采用MEFS改良跌倒功效评估表和平衡测评量表BBS测评,比较分析两组教育前后得分差值。结果观察组：无发生跌倒者,9例险些跌倒;对照组1例发生跌倒,12例险些跌倒。两量表对研究对象具有较好的信度和效度;两组患者在常规与针对性健康教育前后MEFS差值和BBS差值均有统计学意义（P〈0．05）。结论针对性健康教育能够增强患者自信。更好地控制身体平衡,能够更显著减少患者术后跌倒的发生。     

系铃铛法在预防老年痴呆住院患者坠床跌倒中的应用效果

目的：探讨系铃铛法在预防老年痴呆住院患者坠床跌倒中的应用效果。方法选择2013年6月－2014年3月入住我院老年科的轻中度老年痴呆患者110例,随机分为观察组和对照组各55例,两组均实施常规评估预防措施,观察组患者加用系铃铛法进行比较。结果阻止下床次数观察组243次,对照组155次,两组在阻止下床次数上差异有统计学意义（Mann‐Whitney U＝719,P＜0．001）。结论系铃铛法能有效预防轻中度老年痴呆住院患者坠床跌倒事件的发生,同时也能明显提高患者的满意度。     

Effect of Dynamic Neuromuscular Stabilization on Balance,Trunk Function,Falling, and Spasticity in People With Multiple Sclerosis: A Randomized Controlled Trial

ObjectiveTo compare the effects of core stabilization (CS) and dynamic neuromuscular stabilization (DNS) on balance, trunk function, mobility, falling, and spasticity, in people with multiple sclerosis (PWMS).DesignTwo-group randomized controlled trial.SettingGeneral community and referral center.ParticipantsA total of 64 PWMS, between 30 and 50 years old, and an expanded disability status scale between 2 and 5, participated in this study (N=64).InterventionsParticipants were randomly assigned to CS (n=32) and DNS (n=32) groups. Both groups received a total of 15 sessions of CS or DNS exercises, 60 minutes per session, 3 times a week during the 5 weeks.Outcome MeasuresBalance function was measured as the primary outcome measure. Trunk function, postural stability, falling rate, fear of falling, falling index, mobility, and spasticity were measured as secondary outcomes.ResultsDNS group had significant improvement in Berg balance scale, trunk impairment scale, postural stability, activities-specific balance confidence, reduced falling rate, the timed Up and Go (TUG), multiple sclerosis walking scale-12, and multiple sclerosis spasticity scale in PWMS compared with the CS group, (P<.0001) after 5 weeks of intervention and 17 weeks of follow-up. Except for the modified Ashworth scale (MAS), significant improvements were seen in all outcome measures in both groups after 5 weeks of intervention.ConclusionThis is the first clinical evidence to support the importance of DNS exercise in improving balance, trunk function, and fall prevention in PWMS. This study provides clinical evidence that DNS may be more effective for PWMS than CS.     

健康行为训练对学龄期癫痫患儿心理及自我概念的影响

目的探讨健康行为训练对学龄期癫痫患儿心理状态及自我概念水平的影响。方法将学龄期癫痫患儿112例随机分为研究组和对照组。对照组给予健康教育,研究组在健康教育的基础上实施健康行为训练,采用Piers-Harris儿童自我概念量表进行训练前后比较,在患儿出院1年时进行效果评价。结果研究组患儿干预后在行为、智力与学校情况、躯体外貌、焦虑、合群、幸福与满足6个分量表及总分方面,与对照组比较,差异有统计学意义（均P〈0．01）。研究组患儿对患病态度、对药物副作用、情绪、社会适应能力、健康状况、生活满意度均明显优于对照组（P〈0．01）。结论通过健康行为训练作为干预手段,可帮助患儿消除自卑心理,提高自我概念水平。     

Relationships between physical activity,ADL capability and fall risk in community-dwelling Japanese elderly population

Objective The purpose of this study was to clarify the relationships among fall risk, physical activity habits, and ADL capability in a community-dwelling Japanese elderly population. Methods The subjects were 1,407 Japanese aged 65 or older (604 males, 803 females). Fall risk was evaluated using the Falling Assessment Chart of Suzuki et al. (2003). Physical activity habits such as the frequency of leaving the house, the use of transportation, the frequency of physical exercise, and interests were evaluated. ADL capability was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Results Approximately 25% of the subjects had a high fall risk (score of 5 or more). Fall risk increased with age and ADL capability decreased with age. The group with a low fall risk (score<5) had a significantly higher ADL capability than the group with a high fall risk (score≥5). From results of two-way ANCOVA (gender×physical activity habits) with age as the covariate, the fall risk of people who regularly go on leaving the house, exercise, and have interests tended to be low. Further more, the relationships between the scores and physical activity habits were examined by two-way ANCOVA with age and ADL capability as the covariates. There were significant differences in the frequency of leaving the house, and elderly persons who leaved regularly the house, had a low fall risk. Conclusions This study showed that fall risk is closely related to ADL capability, and that the frequency of leaving the house is very important for reducing fall risk.     

Recovery responses to surrogate slipping tasks differ from responses to actual slips

Slipping and slip-related falls are a common and potentially dangerous problem, especially for older adults. We believe that it is possible to train compensatory stepping responses of older adults to reduce the incidence of slip-related falls. However, such an approach requires further understanding of the causal biomechanical distinctions between a successful and an unsuccessful recovery effort. Surrogate tasks are often used to study complex biomechanical events associated with large postural disturbances. Although surrogate tasks enhance experimental control over one or more elements of a generally more complex event, such control may change the task of interest by imposing biomechanical constraints that reduce the validity of the surrogate. The purpose of the present study was to quantify the differences in lower extremity and trunk kinematics following a simulated slip versus an actual slip. We hypothesized that the simulated slips would be less variable than real slips and would result in significantly different, and less realistic recovery kinematics. Twenty-two healthy young adults were subjected to unexpected slips using a custom slipping platform and artificial ice. Biomechanical variables associated with the slipping foot were significantly less variable in those slips induced with the platform compared to slips induced with the artificial ice. Significant differences between successful and unsuccessful recovery efforts were found for lower extremity and trunk kinematics on both types of slipping surface. Notably, 40% of the variables for which between surface differences were significant were also those variables that distinguished successful and unsuccessful recovery efforts on the two surfaces. The results suggest that slips induced using artificial ice more accurately reflect the type of slips that occur in the community.     

骨科住院患者意外跌倒风险因素评估及护理对策

目的：探讨骨科住院病人意外跌倒的风险因素,分析并制定有效的护理对策,以防止住院病人意外跌倒的发生。方法：采用统计学分析方法,调查2007年7月至2008年12月骨科住院病人发生意外跌倒例数和相关风险因素构成比。2009年1月至2010年7月对评估有意外跌倒风险的骨科病人实施安全护理,预防意外跌倒发生。结果：实施护理对策后目标人群防跌倒意识加强,意外跌倒病人发生率显著下降,P〈0.05。结论：对骨科病人意外风险因素进行评估,并对目标人群实施安全护理对策,可有效预防骨科住院病人意外跌倒的发生。     

预防长期住院高龄患者跌倒的护理干预

目的探讨长期住院高龄患者跌倒的危险因素及预防对策。方法对我院老年病区258例患者采取预防跌倒知识的宣教等干预,并对其效果进行分析总结。结果98．5％的患者或家属不同程度掌握了跌倒相关危险因素及预防措施的知识,老年患者在住院期间无跌倒发生。结论护理干预能有效地预防老年人跌倒,对提高老年人生活质量有重要意义。