Increased Likelihood of Falling in Older Cannabis Users vs. Non-Users

Cannabis is one of the most common drugs in the United States and is the third most prevalent substance consumed by adults aged 50 years and older. Normal aging is associated with physiological changes that make older adults vulnerable to impaired function and geriatric conditions (e.g., falls, cognitive impairment). However, the impact of medical cannabis use on fall risk in older adults remains unexplored. The purpose of this study was to investigate if cannabis use in older adults influences fall risk, cognitive function, and motor function. It was hypothesized that older chronic cannabis users would perform worse than non-users on gait, balance, and cognitive tests. Sixteen older adults, split into cannabis Users and age- and sex-matched Non-Users groups (n = 8/group), participated in the study. The results indicate a higher fall risk, worse one leg standing balance performance, and slower gait speed in Users vs. Non-Users. No significant differences in cognitive function were found. Thus, chronic cannabis use was purported to exacerbate the poorer balance control and slower gait velocity associated with normal aging. Future mechanistic (e.g., neuroimaging) investigations of the short- and long-term effects of using a variety of cannabis products (e.g., THC/CBD ratios, routes of administration) on cognitive function, motor function, and fall incidence in older adults are suggested.

Effects of Multicomponent Exercise on Cognitive Performance and Fall Risk in Older Women with Mild Cognitive Impairment

BACKGROUND

Emerging evidence suggests that multicomponent exercise provides greater benefits for physical and cognitive function than single component exercise. However, few studies have been conducted to determine these effects in older adults with mild cognitive impairment (MCI) and findings have been less conclusive. It has been reported that older women have a greater risk of falls and a higher incidence of dementia than men.

OBJECTIVES

To examine the effects of multicomponent exercise on cognitive performance and fall risk in older women with MCI.

DESIGN

An experimental design comparing the exercise and control groups.

SETTING AND PARTICIPANTS

Forty community-dwelling older women with MCI were allocated to the exercise (n = 20) and control (n = 20) groups.

INTERVENTION

Twelve weeks of multicomponent exercise program (aerobic, resistance, and balance exercise) 60 mins/day, 3 days/week.

MEASUREMENT

Cognitive performance including the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Trail Making Test (TMT) and fall risk including the Timed Up and Go (TUG) single-, dual-task, and Physiological Profile Assessment (PPA) were administered before and after the 12-week exercise program.

RESULTS

At the end of the 12-week training, participants in the exercise group had a significantly greater improvement in TMT part A (p < 0.05), TUG dual-task (p < 0.05), and PPA composite score (p < 0.05) when compared to the control group. The exercise group also demonstrated significant improvement in TUG dual-task, PPA composite score, PPA subcomponents including postural sway and reaction time when compared to baseline (p < 0.05). In contrast, at 12-week, the control group showed a decline in TUG dual-task performance as compared to baseline (p < 0.05).

CONCLUSION

The 12-week multicomponent exercise improved attention, dual-task ability, and reduced risk of falling in older women with mild cognitive impairment.

Galvanic vestibular stimulation with low intensity improves dynamic balance

Background

Dynamic balance is associated with fall risk. The aim of this study is to explore the effects of galvanic vestibular stimulation with very low intensity direct current (dcGVS) on dynamic balance.

Methodology

We used a rocker force platform for assessing the dynamic balance performance. Center-of-pressure (COP) coordinates were acquired and decomposed to rambling (RA) and trembling (TR). We measured sway parameters, including length, average speed, and average range, affected by dcGVS at 0.01 mA with eyes open (EO) and eyes closed (EC).

Results

We assessed 33 young healthy subjects and found that all sway parameters were shorter in the EO condition, indicating a better dynamic balance performance. dcGVS significantly improved the dynamic balance performance both in EO and EC conditions. All the sway parameters in COP in EO were significantly shorter than those in EC, indicating a better dynamic balance performance in EO. In EO, RA had greater improvement rates than TR. In EC, only average speed had a greater improvement rate in RA, whereas length and average range had greater improvement rates in TR. These results indicate a different modulation model between EO and EC.

Conclusion

These findings indicate that very low intensity dcGVS improved the sway parameters of dynamic balance in young healthy subjects. Moreover, our results suggest different dynamic balance control models between having EO and EC. The mechanisms of these phenomena caused by very low intensity dcGVS require further investigation.

The effect of pain severity on balance, postural stability and fall risk in patients with shoulder pathologies

INTRODUCTION

The study aimed to investigate how pain severity in the shoulder region affects balance ability, postural stability and fall risk.

MATERIAL AND METHODS

Sixty participants with shoulder pain, aged 42.45 ±6.51 years, were assessed using a Visual Analog Scale (VAS); they were divided into 2 subgroups as a mild pain group (group 1) and a moderate/severe pain group (group 2). According to VAS-at rest the mild-pain group included 39 and the moderate/severe-pain group included 21 subjects. According to VAS-during movement, the mild-pain group included 19 and the moderate/severe-pain group included 41 subjects. Balance ability-postural stability, fall risk and fear of falling were assessed by the Sportkat System, Berg Balance Scale (BBS), and Fall Efficacy scale (FES) respectively. Differences of variables between mild pain and moderate/severe pain groups were analyzed by the independent groups t-test in groups conforming to a normal distribution and the Mann-Whitney U test for the variables that did not fit a normal distribution.

RESULTS

A positive relationship was found between VAS-at rest and double-foot static balance test score right-left (RL) ratio, while a negative relationship was found between VAS-at rest and BBS score (p < 0.05). Significant differences were found between right foot static balance left score and RL ratio according to pain at rest (p < 0.05).

CONCLUSIONS

The results indicated that shoulder pain severity affects balance parameters. As pain level at rest increases, postural sway increases in a medio-lateral direction, and towards the left while standing on the right foot. Approaches regarding increasing balance and postural instability should be included in physiotherapy and rehabilitation programs of patients with shoulder pain at an early phase to protect patients from balance problems and fall risk.

The perspectives of healthcare practitioners on fall risk factors in older adults

Background

Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners’ (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization’s globally accepted International Classification of Functioning, Disability and Health (ICF) was used.

Aim

This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF.

Setting

Eighteen HCPs participated in two focus groups.

Methods

Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF.

Results

The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely ‘muscle-power functions’ and ‘mobility-of-joint functions’, which directly relate to the ability to execute mobility activities. Combining HCPs’ perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.

Stair Gait in Older Adults Worsens With Smaller Step Treads and When Transitioning Between Level and Stair Walking

Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent p_A = 0.033, descent p_D = 0.003) and horizontal step clearance decreased (p_A = 0.001), while trunk rotation (p_D = 0.002) and foot overhang increased (p_A,D < 0.001). Compared to the younger group, older participants used the handrail more, were slower across all conditions (p_A < 0.001, p_D = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group (Group x Start interaction) showed a larger trunk rotation (p_A = 0.011, p_D = 0.015), and smaller lead foot horizontal (p_A = 0.046) and vertical clearances (p_D = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users.

A Postural Assessment Utilizing Machine Learning Prospectively Identifies Older Adults at a High Risk of Falling

Introduction: Falls are the leading cause of accidental death in older adults. Each year, 28.7% of US adults over 65 years experience a fall resulting in over 300,000 hip fractures and $50 billion in medical costs. Annual fall risk assessments have become part of the standard care plan for older adults. However, the effectiveness of these assessments in identifying at-risk individuals remains limited. This study characterizes the performance of a commercially available, automated method, for assessing fall risk using machine learning.

Methods: Participants (N = 209) were recruited from eight senior living facilities and from adults living in the community (five local community centers in Houston, TX) to participate in a 12-month retrospective and a 12-month prospective cohort study. Upon enrollment, each participant stood for 60 s, with eyes open, on a commercial balance measurement platform which uses force-plate technology to capture center-of-pressure (60 Hz frequency). Linear and non-linear components of the center-of-pressure were analyzed using a machine-learning algorithm resulting in a postural stability (PS) score (range 1–10). A higher PS score indicated greater stability. Participants were contacted monthly for a year to track fall events and determine fall circumstances. Reliability among repeated trials, past and future fall prediction, as well as survival analyses, were assessed.

Results: Measurement reliability was found to be high (ICC(2,1) [95% CI]=0.78 [0.76–0.81]). Individuals in the high-risk range (1-3) were three times more likely to fall within a year than those in low-risk (7–10). They were also an order of magnitude more likely (12/104 vs. 1/105) to suffer a spontaneous fall i.e., a fall where no cause was self-reported. Survival analyses suggests a fall event within 9 months (median) for high risk individuals.

Conclusions: We demonstrate that an easy-to-use, automated method for assessing fall risk can reliably predict falls a year in advance. Objective identification of at-risk patients will aid clinicians in providing individualized fall prevention care.

[The effect of administration of dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation]

Elimination of vitamin D and calcium deficiencies is of particular importance in older patients undergoing medical rehabilitation after a serious illness, surgery or injury and having a high risk of fractures. Preventing falls and fractures, including during the course of rehabilitation, is an important challenge that can be addressed in these patients, in particular through improved nutrition and vitamin D and calcium supplementation. The aim of the study was to evaluate the effect of long-term intake of a complex dietary supplement with calcium and vitamins D₃ and B₆ on calcium homeostasis and the frequency of falls in patients with high fracture risk undergoing medical rehabilitation. Material and methods. The study enrolled 109 women and 10 men (mean age 65.5±7.9 years) with high fracture risk who were undergoing medical rehabilitation. After baseline examination, 41 patients have been receiving antiresorptive therapy already comprised group 1, and patients who didn't receive osteoporotic therapy were randomized into groups 2 (n=39) and 3 (control, n=39). Patients in groups 1 and 2 for 12 months were prescribed a dietary supplement containing calcium in a daily dose of 200 mg (in the form of citrate 1000 mg), 600 IU of vitamin D₃ and 2 mg of vitamin B₆. All patients underwent assessment of bone mineral density (BMD), calculation of absolute 10-year fracture risk according to FRAX, assessment of food calcium intake, etermination of biochemical parameters of calcium-phosphorus metabolism and bone remodeling (total calcium, inorganic phosphorus, alkaline phosphatase activity - by colorimetric method in blood serum; immunoreactive parathyroid hormone (PTH) and osteocalcin - by electrochemiluminescence immunoassay in blood serum; β-isomer of C-terminal telopeptide of type I collagen (CTx) and 25(OH)D in blood plasma - by immunochemiluminescence analysis), cases of falls and fractures were fixed. Results. Average daily intake of calcium in the studied sample (n=119) was 782.9±243.4 mg, and 67.2% of patients consumed less than 800 mg of calcium daily. Vitamin D deficit was detected in 38.4% of the examined, its insufficiency - in 32.8%. An increase in 25(OH)D concentration was noted in groups 1 and 2 after 6 and 12 months (p<0.01), while in group 3 there was no dynamics of 25(OH)D (p>0.05). Patients in group 1 showed an increase in the level of osteocalcin and total calcium after 6 and 12 months, as well as alkaline phosphatase activity after 6 months (p<0.05). In group 3, there was an increase of PTH levels after 6 (p<0.05) and 12 months (p<0.01), CTx and alkaline phosphatase activity after 12 months (p<0.05). In group 1, there was an increase in BMD in the spine (+4.2%, p=0.024), femoral neck (+3.0%, p=0.041), and total femur (+2.7%, p=0.045), in patients of group 2 - an increase in BMD in the spine (+1.8%, p=0.048). In group 1, there was also a decrease in proportion of patients who fell after 6 months (χ²=4.97, p=0.026) and a decrease in the total number of falls after 12 months (χ²=4.89, p=0.027). Group 2 showed a decrease in the number of patients who fell after 6 and 12 months (χ²=48.58, p=0.0034 at both stages of the study) and the number of falls in general after 6 months (χ²=6.02, p=0.0142). Conclusion. The obtained data allow us to recommend prescription of dietary supplements containing calcium and vitamin D₃ as a part of complex rehabilitation of patients with high fracture risk.

Weaker Braking Force, A New Marker of Worse Gait Stability in Alzheimer Disease

Background: Braking force is a gait marker associated with gait stability. This study aimed to determine the alteration of braking force and its correlation with gait stability in Alzheimer disease (AD).

Methods: A total of 32 AD patients and 32 healthy controls (HCs) were enrolled in this study. Gait parameters (braking force, gait variability, and fall risk) in the walking tests of Free walk, Barrier, and Count backward were measured by JiBuEn^® gait analysis system. Gait variability was calculated by the coefficient of variation (COV) of stride time, stance time, and swing time.

Results: The braking force of AD was significantly weaker than HCs in three walking tests (P < 0.001, P < 0.001, P = 0.007). Gait variability of AD showed significant elevation than HCs in the walking of Count backward (COV_stride: P = 0.013; COV_swing: P = 0.006). Fall risk of AD was significantly higher than HCs in three walking tests (P = 0.001, P = 0.001, P = 0.001). Braking force was negatively associated with fall risks in three walking tests (P < 0.001, P < 0.001, P < 0.001). There were significant negative correlations between braking force and gait variability in the walking of Free walk (COV_stride: P = 0.018; COV_swing: P = 0.013) and Barrier (COV_stride: P = 0.002; COV_swing: P = 0.001), but not Count backward (COV_stride: P = 0.888; COV_swing: P = 0.555).

Conclusion: Braking force was weaker in AD compared to HCs, reflecting the worse gait stability of AD. Our study suggests that weakening of braking force may be a new gait marker to indicate cognitive and motor impairment and predict fall risk in AD.

Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia

BACKGROUND

Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking.

OBJECTIVE

To analyze mismatch of objective and subjective fall risk and associated factors in PwD.

METHOD

Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables.

RESULTS

In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression.

CONCLUSION

The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.

Prediction of Falls in Acute Care Using The Morse Fall Risk Scale

The high number of patient falls occurring within acute care hospitals throughout the United States has led to increased patient impairment and contributed to rising healthcare costs. The Morse Fall Risk Scale is a commonly used assessment tool for prediction of a patient's potential for experiencing a fall while in a healthcare facility. This retrospective study reviewed the use of the Morse Fall Risk Scale in a 300+ bed acute care hospital setting to determine adequacy for patient fall predictions over a four-month period. Use of multivariate regressions and Chi-Square test statistics revealed the Morse Fall Risk Scale was a predictor of patients' fall risk in this setting with other significant predictors of fall risk potential including male gender and diagnosis (neurologic, cardiac, general medical/surgical conditions). Patients experiencing a fall had a statistically significant longer hospital stay. Occupational therapy practitioners play an important role on the interdisciplinary team by providing a comprehensive fall assessment, developing fall prevention programs, and providing discharge recommendations.

Design and Evaluation of an Augmented Reality-Based Exergame System to Reduce Fall Risk in the Elderly

Falls are a major public health concern in today’s aging society. Virtual reality (VR) technology is a promising method for reducing fall risk. However, the absence of representations of the user’s body in a VR environment lessens the spatial sense of presence. In terms of user experience, augmented reality (AR) can provide a higher degree of presence and embodiment than VR. We developed an AR-based exergame system that is specifically designed for the elderly to reduce fall risk. Kinect2.0 was used to capture and generate 3D models of the elderly and immerse them in an interactive virtual environment. The software included three functional modules: fall risk assessment, cognitive–motor intervention (CMI) training, and training feedback. The User Experience Questionnaire (UEQ-S) was used to evaluate user experience. Twenty-five elders were enrolled in the study. It was shown that the average scores for each aspect were: pragmatic quality score (1.652 ± 0.868); hedonic quality score (1.880 ± 0.962); and overall score was 1.776 ± 0.819. The overall score was higher than 0.8, which means that the system exhibited a positive user experience. After comparing the average score in a dataset product of UEQ-S Data Analysis Tool, it was found that the pragmatic quality aspect was categorized as good, while the hedonic quality aspect was categorized as excellent. It revealed a positive evaluation from users.

Characteristics of Voluntary-induced Stepping Response in Persons with Stroke compared with those of healthy Young and Older Adults

BACKGROUND

Impairment of protective steps to recover balance from external perturbation is evident after stroke. Voluntary-induced stepping response (VSR) can be used to practice protective steps by instructing an individual to voluntarily lean their whole body forward until they perceive a loss of balance and automatically induce a step. However, to improve protective stepping performance, detailed characteristics of VSR in healthy persons are required.

RESEARCH QUESTION

What is the difference in VSR between healthy and persons with stroke?

METHODS

An observational study was conducted in 30 participants, (10 young, 10 older, and 10 persons with stroke). All participants performed VSR for 10 trials. Step length, step width, step duration, CoM position, CoM velocity, trunk-hip displacement, and strategies of response were recorded using a motion capture system and analysed using Matlab software. Statistical analysis was performed using One-way ANOVA and Chi-square.

RESULTS

On average, participants with stroke had shorter step lengths and step durations than young and older adults. Step width of older adults and participants with stroke was wider than that of young adults (p < 0.05). While multiple steps and losing balance were reported more frequently in participants with stroke than the others, the percentage of trials in which participants grasped the handrails was not significantly different between older adults and participants with stroke. CoM position, CoM velocity, and trunk-hip displacement at foot liftoff were significantly smaller in older adults and participants with stroke than young adults (p < 0.05). Participants with stroke tended to use trunk bending rather than trunk leaning strategies to generate VSR in contrast to healthy participant. The prevalence of the trunk bending strategy was also greater in older adults than young adults.

SIGNIFICANCE

Values obtained from healthy groups can be used as guidelines to set realistic goals during VSR training to improve protective steps in patients with stroke.

Merging Yoga and Occupational Therapy for Parkinson's Disease: A Feasibility and Pilot Program

The purpose of this study was to assess feasibility and changes in outcome measures following the Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT for PD) program: a 14-session program which combined community-based yoga for PD, and fall-risk focused group occupational therapy sessions. Seventeen participants completed an 8-week control period consisting of their normal participation, and an 8-week intervention period (14 MY-OT for PD sessions). There were fewer self-reported falls in the intervention (6) vs. control periods (10). One fall risk factor management scale (the Fall Prevention and Management Questionnaire, p=.02), and balance (p<.01) showed significant improvement between the control and intervention. The MY-OT for PD program is an encouraging occupational therapist-led program, which may improve balance and reduce self-reported falls.

Impact of Psychological Distress and Sleep Quality on Balance Confidence, Muscle Strength, and Functional Balance in Community-Dwelling Middle-Aged and Older People

The objective was to evaluate the associations of psychological distress and sleep quality with balance confidence, muscle strength, and functional balance among community-dwelling middle-aged and older people. An analytical cross-sectional study was conducted (n = 304). Balance confidence (Activities-specific Balance Confidence scale, ABC), muscle strength (hand grip dynamometer), and functional balance (Timed Up-and-Go test) were assessed. Psychological distress and sleep quality were evaluated by the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index, respectively. Age, sex, physical activity level, nutritional status, and fatigue were included as possible confounders. Multivariate linear and logistic regressions were performed. Higher values of anxiety (OR = 1.10), fatigue (OR = 1.04), and older age (OR = 1.08) were associated with an increased risk of falling (ABC < 67%). Greater muscle strength was associated with male sex and improved nutritional status (adjusted R² = 0.39). On the other hand, being older and using sleeping medication were linked to poorer functional balance (adjusted R² = 0.115). In conclusion, greater anxiety levels and the use of sleep medication were linked to a high risk of falling and poorer functional balance, respectively. No associations were found between muscle strength and sleep quality, anxiety, or depression.

Balance assessment in people with COPD: An evidence-based guide

Balance problems and an increased rate and risk of falls are common in people with chronic obstructive pulmonary disease (COPD). Although a balance assessment is now recommended by clinical practice guidelines for pulmonary rehabilitation, specific tests have yet to be suggested. The purpose of this review is to provide an evidence-based synthesis of balance measurement in older adults and in people with COPD, to guide practice in this area. An overview of best practices for assessing balance and fall risk in older adults is provided along with a practical synthesis of evidence to date on common balance measures used in people with COPD such as the Timed Up and Go, Single Leg Stance, Berg Balance, and Mini and Full Balance Evaluation Systems Tests. Finally, two clinical scenarios are described to illustrate the process of evidence-based clinical decision-making with respect to balance assessment in people with COPD. Ultimately, the selection of balance test and its interpretation will depend on the purpose of the assessment, available data on psychometric properties, the patient’s individual characteristics, and the resources available to the clinician.

Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

Postural control and perturbation response in aging populations: fall risk implications

Falls are an increasing cause of mortality in an ever-growing aging population. The main factors to consider in reducing mortality rates due to falls are postural control, consisting of the vestibular, visual, and proprioceptive system, and perturbation response. This Neuro Forum article reviews recent literature highlighting the developmental changes that occur in aging populations and the possible avenues for interventions and training to mitigate fall risk.

Bathroom Modifications, Clutter, and Tripping Hazards: Prevalence and Changes after Incident Falls in Community-Dwelling Older Adults

Objectives: To describe the prevalence of bathroom modifications, clutter, and tripping hazards in the homes of US older adults and to examine changes after an incident fall. Methods: We used data from the 2015-2017 National Health and Aging Trends Study (n = 7499). Outcomes were the prevalence of bathroom modifications, clutter, and tripping hazards and changes after incident fall. Results: In 2015, 26.5% of community-dwelling older adults had clutter or tripping hazards in the home, and 69.3% had at least one bathroom modification. Compared to nonfallers, older adults with multiple falls were significantly more likely to modify the bathroom. The magnitude of hazard reduction was similar after multiple falls but was not statistically significant. Discussion: Bathroom modifications are common and increase after multiple falls. A single incident fall does not appear to lead to home environment changes to reduce fall risk. Targeting home hazards may be an opportunity to reduce fall risk.

Investigating the psychometric properties of the Carers' Fall Concern instrument to measure carers' concern for older people at risk of falling at home: A cross-sectional study

AIMS

This study aimed to investigate the psychometric properties of the Carers' Fall Concern Instrument (CFC-I) for measuring carers' concern for older people (care recipients) at risk of falling.

BACKGROUND

Family carers are crucial in preventing older people from falling at home. Their concerns for older people at risk of falling have severe implications on carers' psychological well-being and ability to prevent falls. However, there is no validated instrument measuring this concern.

METHODS

A cross-sectional study was used to examine the validity and reliability of the CFC-I. Carers looking after older people living at home completed the 17-item CFC-I and provided information about their care arrangements and the older people's fall history. Construct validity was tested using exploratory factor analysis and hypothesis testing. Internal consistency was determined by calculating Cronbach's alpha coefficient.

RESULTS

143 carers completed the survey either by face-to-face or by online. After deleting one item with an item-total correlation of below 0.3, the remaining 16-item CFC-I reported a Cronbach alpha of 0.93. Construct validity was supported by strong item-total correlations (0.51-0.76), mean inter-item correlations (0.47) and factor loadings (0.557-0.809). Factor analysis revealed three factors that include concerns about care recipients' health and function, living environment and carers' perception of fall and fall risk. The 16-item CFC-I can discriminate between carers of older people with and without recurrent (fallen 3/ more times) falls.

CONCLUSION

The 16-item CFC-I is a valid and reliable scale for measuring carers' concern for the older people's risk of falling. Future analysis of test-retest and inter-rater reliability of the instrument will further support its clinical use for carers.

IMPLICATIONS FOR PRACTICE

The newly developed multi-item CFC-I can be used to quantify the carers' level of fall concern and inform targeted interventions for carers when caring for older people who are at risk of falling.

Task-level regulation enhances global stability of the simplest dynamic walker

Much remains unknown about how considerations such as stability and energy minimization shape the way humans walk. While active neuromotor control keeps humans upright, they also need to choose from multiple stepping regulation strategies to achieve one or more task goals, such as maintaining a desired speed or direction. Experiments on human treadmill walking motivate an important question: why do humans prefer one task-level regulation strategy over another-perhaps to enhance their ability to reject large disturbances? Here, we study the relationship between task-level regulation and global stability in a powered compass walker on a treadmill, with added step-to-step speed and position regulators. For treadmill walking, we find that speed regulation greatly enlarges and regularizes the unregulated walker's stability region, i.e. its basin of attraction, much more than position regulation. Thus, our results suggest a possible explanation for the experimental finding that humans strongly prioritize regulating speed from one stride to the next, even as they walk economically on average. Furthermore, our work suggests a functional connection between task-level motor regulation and global stability-and, thus, perhaps even fall risk.

Clinical and Diffusion Tensor Imaging to Evaluate Falls, Balance and Gait Dysfunction in Leukoaraiosis: an Observational, Prospective Cohort Study

OBJECTIVE

To assess the correlation between leukoaraiosis (LA) and falls, to determine the risk factors for falls in patients with LA, and to detect specific white matter tracts are associated with the falls by using the diffusion tensor magnetic resonance imaging (DTI) screen.

METHODS

For the elderly patients with LA, we collected demographic information and scores for the Tinetti Balance and Gait Scale, Berg Balance Scale, Timed up-and-go test, and Cognitive, Emotional, Sleep-related Scale. All the patients underwent DTI scanning and were followed up for 1 year.

RESULTS

Ninety-four individuals were prospectively enrolled. After multivariable analyses, age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were reported to be risk factors for falls. In patients with severe LA, the fall incidence was higher than in those with mild LA. Tract-Based Spatial Statistics showed that fractional anisotropy values of the corpus callosum, cingulate gyrus, anterior limb of internal capsule, cerebral peduncle, anterior corona, and fronto-occipital fasciculus were significantly reduced in the patients who fell. The body of the corpus callosum and anterior corona radiate were significantly related to balance and gait function.

CONCLUSIONS

Our findings indicated that age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were risk factors for falls in elderly patients with LA. Leukoaraiosis was relevant for falls, but LA severity had a threshold effect with falls. The loss of integrity of some white matter tracts might influence balance and gait function. The DTI had preeminent clinical application prospects for identifying fall risk in patients with LA.

Older Adults' Perspectives on Fall Risk: Linking Results to the ICF

The aim of this study is to establish the perceptions of older adults in the South African context regarding falls and to link these perceptions to the International Classification of Functioning, Disability and Health (ICF). Data were analyzed by a summative, conventional, and deductive approach. The analysis indicated that the Body Function and Structure codes were most frequently used during the discussions, but the contextual analysis of the most frequently used categories indicated that Activities and Participation were the participants' main focus. The main focus of fall assessment in older adults should therefore be on Activities and Participation, as this can assist them in decreasing their fall risk, irrespective of whether they had a previous fall. Contrary to the majority of current literature on falls, this study included both participants who had fallen and those who hadn't, resulting in richer data and themes gathered from the focus groups.

Immediate effect of voluntary-induced stepping response training on protective stepping in persons with chronic stroke: a randomized controlled trial

Purpose: To compare the immediate effects of voluntary-induced stepping response training (VSR) and DynSTABLE perturbation training (DST) on protective stepping in patients with stroke.Methods: A randomized controlled trial (registration number: TCTR20170827001) was conducted in 34 patients with chronic stroke who were randomly allocated to the VSR (n = 17) or DST (n = 17) group. The VSR group was instructed to lean forward to induce protective stepping, while the DST group experienced support surface translation. All participants received one session of training (3 set, 10 min for each set with 10-minute rest in between). Step length, step width, number of steps and center of mass (CoM) position during protective stepping were assessed using a computer-assisted rehabilitation environment (CAREN) system prior to and immediately after training. Two-way ANOVA was used to compare between groups and times.Results: Both types of training resulted in an increase in step width, but step length increased and there was a more positive COM position exhibited following DST (p < .05) than following VSR. Single-step incidence increased, whereas multiple-step incidence decreased significantly in both groups. Only participants in the VSR group generated protective stepping with the affected leg in a larger percentage of trials (27%) after training than before training.Conclusion: Both DST and VSR led to changes in protective stepping parameters after a single session of training. VSR may be a feasible alternative to equipment-based training but requires further study.Implication for RehabilitationVSR and DST trainings improved protective stepping in stroke.Step length and CoM control at foot touchdown increased after DST training.VSR training for 50 minutes led to increase affected stepping and reduce grasping.Step width, affected step length, and single step increased after both trainings.Without instrument, VSR increased steps execution and performance similar to DST.