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Evangelista RAGDT, Evangelista AL, Ernandes RDC, Brech GC, Silva RND, Lino MHDS, Bocalini DS, Graaf MD, Mochizuki L, Soares-Junior JM, Baracat EC, Greve JMD, Garcez-Leme LE, Alonso AC. Importance of muscle strength to maintain mobility, but not to maintain postural balance in older women: Cross-sectional study. Clinics (Sao Paulo) 2024; 79:100504. [PMID: 39321635 PMCID: PMC11462165 DOI: 10.1016/j.clinsp.2024.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/23/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Acknowledging the relationship between postural control and muscle strength in lower limbs is important to find persons with high fall risk and to design fall prevention exercise programs. OBJECTIVE To investigate the connection between knee muscle strength, semi-static postural balance, and functional mobility in irregularly active older women. METHODS One hundred and ten older women aged 60 to 85 years underwent a semi-static postural balance test in a force and functional mobility measured by Timed Up & Go (TUG) with and without Cognitive Tasks (CT). Muscle strength of the knee was assessed by isokinetic dynamometry at 60°/s. RESULTS A negative correlation between the functional mobility (TUG with and without CT) and the muscular strength of the knee was observed. Regarding semi-static balance, there was a low negative correlation with peak torque corrected for body weight of the extensors with the following variables with eyes open: Mean Velocity Dominant limb (D) (r = -0.19; p = 0.03); and anteroposterior range Non-Dominant limb (ND) (r = -0.19; p = 0.04); with eyes closed: mediolateral range ND limb (r = -0.21; p = 0.02) and Mean Velocity ND limb (r = -0.18; p = 0.05). CONCLUSIONS This study found that better functional mobility was associated with greater muscle strength in the knee in elderly women. There were weak negative correlations between knee extensor strength and some measures of semi-static postural balance, suggesting that different motor control actions are required to maintain semi-static balance and mobility. In the case of semi-static balance, a lower level of muscle response is required than in functional mobility.
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Affiliation(s)
| | - Alexandre Lopes Evangelista
- Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Guilherme Carlos Brech
- Program in Aging Science, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil; Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
| | | | | | - Danilo Sales Bocalini
- Laboratories of Exercise Physiology and Experimental Physiology, Biochemistry of Physical Education and Sport Center at Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | - Myriam de Graaf
- Institute of Sport and Exercise Sciences, Universität Münster: Westfalische Wilhelms-Universitat Munster, Germany
| | - Luis Mochizuki
- Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil; School of Arts, Sciences, and Humanities, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jose Maria Soares-Junior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Júlia Maria D'Andréa Greve
- Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Luiz Eugênio Garcez-Leme
- Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Angelica Castilho Alonso
- Program in Aging Science, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil; Laboratory for the Study of Movement, Institute of Orthopedics and Traumatology, Faculdade de Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Nicoli EM, Silva FVCE, Assad LG, Cardinelli CC, Alves RA, de Oliveira SG. Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review. Rev Bras Enferm 2024; 77:e20230180. [PMID: 39045975 PMCID: PMC11259443 DOI: 10.1590/0034-7167-2023-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/24/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.
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Affiliation(s)
- Esther Mourão Nicoli
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Raquel Azevedo Alves
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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Lučarević J, Gaunaurd I, Clemens S, Belsky P, Summerton L, Walkup M, Wallace SP, Yokomizo L, Pasquina P, Applegate EB, Schubert MC, Gailey RS. The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation. Phys Ther 2020; 100:1333-1342. [PMID: 32399552 DOI: 10.1093/ptj/pzaa091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/17/2018] [Accepted: 02/11/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. METHODS This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. RESULTS Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. CONCLUSIONS These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. IMPACT The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. LAY SUMMARY Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.
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Affiliation(s)
- Jennifer Lučarević
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida; and California State University Dominguez Hills, Department of Orthotics and Prosthetics, Carson, California
| | - Ignacio Gaunaurd
- Miami Veterans Affairs Healthcare System, Miami, Florida; and Department of Physical Therapy, Miller School of Medicine, University of Miami
| | - Sheila Clemens
- Department of Physical Therapy, Miller School of Medicine, University of Miami; and Department of Physical Therapy, Florida International University, Miami, Florida
| | - Paulina Belsky
- Department of Physical Therapy, Miller School of Medicine, University of Miami
| | - Lauren Summerton
- Department of Physical Therapy, Miller School of Medicine, University of Miami
| | - Melody Walkup
- Department of Physical Therapy, Miller School of Medicine, University of Miami
| | | | - Lori Yokomizo
- Department of Physical Therapy, Miller School of Medicine, University of Miami
| | - Paul Pasquina
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - E Brooks Applegate
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, Michigan
| | - Michael C Schubert
- Department of Otolaryngology Head Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Gailey
- Department of Physical Therapy, Miller School of Medicine, University of Miami, 5915 Ponce de Leon Boulevard, Coral Gables, FL 33146 (USA)
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Kristensen MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1841. [PMID: 32363803 DOI: 10.1002/pri.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. METHODS Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. RESULTS A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. CONCLUSION The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.
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Affiliation(s)
- Morten T Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Gerhardy T, Gordt K, Jansen CP, Schwenk M. Towards Using the Instrumented Timed Up-and-Go Test for Screening of Sensory System Performance for Balance Control in Older Adults. SENSORS 2019; 19:s19030622. [PMID: 30717202 PMCID: PMC6387355 DOI: 10.3390/s19030622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
Background: Decreasing performance of the sensory systems’ for balance control, including the visual, somatosensory and vestibular system, is associated with increased fall risk in older adults. A smartphone-based version of the Timed Up-and-Go (mTUG) may allow screening sensory balance impairments through mTUG subphases. The association between mTUG subphases and sensory system performance is examined. Methods: Functional mobility of forty-one community-dwelling older adults (>55 years) was measured using a validated mTUG. Duration of mTUG and its subphases ‘sit-to-walk’, ‘walking’, ‘turning’, ‘turn-to-sit’ and ‘sit-down’ were extracted. Sensory systems’ performance was quantified by validated posturography during standing (30 s) under different conditions. Visual, somatosensory and vestibular control ratios (CR) were calculated from posturography and correlated with mTUG subphases. Results: Vestibular CR correlated with mTUG total time (r = 0.54; p < 0.01), subphases ‘walking’ (r = 0.56; p < 0.01), and ‘turning’ (r = 0.43; p = 0.01). Somatosensory CR correlated with mTUG total time (r = 0.52; p = 0.01), subphases ‘walking’ (r = 0.52; p < 0.01) and ‘turning’ (r = 0.44; p < 0.01). Conclusions: Supporting the proposed approach, results indicate an association between specific mTUG subphases and sensory system performance. mTUG subphases ‘walking’ and ‘turning’ may allow screening for sensory system deterioration. This is a first step towards an objective, detailed and expeditious balance control assessment, however needing validation in a larger study.
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Affiliation(s)
- Thomas Gerhardy
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Katharina Gordt
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Carl-Philipp Jansen
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Michael Schwenk
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany.
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Middleton A, Fritz SL. Assessment of Gait, Balance, and Mobility in Older Adults: Considerations for Clinicians. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13670-013-0057-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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