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Barbanchon C, Mouraux D, Baudry S. Repeated exposure to virtual reality decreases reliance on visual inputs for balance control in healthy adults. Hum Mov Sci 2024; 96:103236. [PMID: 38805764 DOI: 10.1016/j.humov.2024.103236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
Postural control may encounter acute challenges when individuals are immersed in a virtual reality (VR) environment, making VR a potential pertinent tool for enhancing balance capacity. Nonetheless, the effects of repeated exposure to VR on balance control remain to be fully elucidated. Fifty-five healthy participants stood upright for six bouts of 90 s each in an immersive virtual reality (VR) environment using a head-mounted display (repeated VR exposure). During these bouts, participants experienced simulated forward and backward displacements. Before and after the repeated VR exposure, the center of pressure mean velocity (VELCOP) was measured in response to simulated forward and backward displacement in VR, as well as during quiet upright standing with eyes open (EO) and closed (EC) in the real environment. The results revealed a significant decrease in VELCOP for forward and backward simulated displacements in both antero-posterior and medio-lateral directions (p < 0.01) after compared to before repeated VR exposure. Furthermore, VELCOP significantly decreased when participants stood upright in EC (-5%; p = 0.004), but not EO (+3%; p > 0.05) in the real environment after repeated VR exposure. The Romberg ratio (EC/EO) was reduced in both antero-posterior and medio-lateral directions (p < 0.05) after VR exposure. This study indicates that repeated exposure to VR induces changes in balance control in both virtual and real environments. These changes may be attributed, in part, to a reduction in the weighting of visual inputs in the multisensory integration process occurring during upright standing. Accordingly, these findings highlight VR as a potentially effective tool for balance rehabilitation. SIGNIFICANCE STATEMENT: This study indicates that repeated exposure to VR induces changes in balance control in both virtual and real environments that can rely, in part, on a reduction in the weighting of visual inputs in the multisensory integration process occurring during upright standing.
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Affiliation(s)
- Christophe Barbanchon
- Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, Belgium
| | - Dominique Mouraux
- Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, Belgium
| | - Stéphane Baudry
- Laboratory of Applied Biology, Research Unit in Applied Neurophysiology (LABNeuro), Université Libre de Bruxelles, Belgium.
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Wearable gait analysis systems: ready to be used by medical practitioners in geriatric wards? Eur Geriatr Med 2022; 13:817-824. [PMID: 35243600 PMCID: PMC9378320 DOI: 10.1007/s41999-022-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/16/2022] [Indexed: 11/06/2022]
Abstract
Aim To investigate the feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system. Findings Wearable gait analysis can be implemented into geriatric wards, showing its readiness for a transformation from a pure research tool to a practically usable gait analysis system. Message Despite good transferability into clinical practice, future research should aim to increase functionality and applicability of wearable gait analysis systems in clinical contexts. Purpose We assess feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system. Methods Gait parameters of 83 patients (83.34 ± 5.88 years, 58/25 female/male) were recorded at admission and/or discharge to/from two geriatric inpatient wards. Gait parameters were tested for statistically significant differences between admission and discharge. Walking distance measured by a wearable gait analysis system was correlated with distance assessed by physiotherapists. Examiners rated usability using the system usability scale. Patients reported acceptability on a five-point Likert-scale. Results The total distance measures highly correlate (r = 0.89). System Usability Scale is above the median threshold of 68, indicating good usability. Majority of patients does not have objections regarding the use of the system. Among other gait parameters, mean heel strike angle changes significantly between admission and discharge. Conclusion Wearable gait analysis system is objectively and subjectively usable in a clinical setting and accepted by patients. It offers a reasonably valid assessment of gait parameters and is a feasible way for instrumented gait analysis.
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Somasekhar PY, Wu N, Hung BY, Morley JE, Malmstrom TK. Validation of F3ALLS Assessment in Older Adults. J Nutr Health Aging 2022; 26:1042-1046. [PMID: 36519766 PMCID: PMC9470502 DOI: 10.1007/s12603-022-1841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/22/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The study aimed to evaluate the brief F3ALLS assessment's validity in screening fall risk. DESIGN This is a cross sectional and longitudinal study. SETTING Participants were recruited from outpatient primary care clinics. PARTICIPANTS Older ambulatory adults ages 65-90 volunteered for this study. MEASUREMENTS Falls risk was measured with TGBA and F3ALLS questionnaires. A 6-month follow-up period assessed for falls using falls diaries and chart review. RESULTS Participants (n=97) were older adults ages 73.91±6.4, 68% (n=66) female. 31% of participants reported at least one fall at 6-months. F3ALLS scores were higher in participants who reported 1 or more falls at 6-months follow-up (3.23±1.5). Higher F3ALLS scores were associated with 6-month fall risk (OR=1.463, 95% CI=1.098-1.949). A score > 3 stratified patients as at risk of falling (AUC=0.77, P<.001; Sensitivity=0.65, Specificity=0.71). CONCLUSION The F3ALLS questionnaire adequately classifies person at risk versus not at risk for falls, and higher (worse) F3ALLS scores are associated with falls over 6 months.
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Affiliation(s)
- P Y Somasekhar
- Theodore K. Malmstrom, PhD, 1438 South Grand Boulevard, St. Louis, MO 63104, USA, 314-977-4814 (office),
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Quijoux F, Nicolaï A, Chairi I, Bargiotas I, Ricard D, Yelnik A, Oudre L, Bertin‐Hugault F, Vidal P, Vayatis N, Buffat S, Audiffren J. A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code. Physiol Rep 2021; 9:e15067. [PMID: 34826208 PMCID: PMC8623280 DOI: 10.14814/phy2.15067] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
Postural control is often quantified by recording the trajectory of the center of pressure (COP)-also called stabilogram-during human quiet standing. This quantification has many important applications, such as the early detection of balance degradation to prevent falls, a crucial task whose relevance increases with the aging of the population. Due to the complexity of the quantification process, the analyses of sway patterns have been performed empirically using a number of variables, such as ellipse confidence area or mean velocity. This study reviews and compares a wide range of state-of-the-art variables that are used to assess the risk of fall in elderly from a stabilogram. When appropriate, we discuss the hypothesis and mathematical assumptions that underlie these variables, and we propose a reproducible method to compute each of them. Additionally, we provide a statistical description of their behavior on two datasets recorded in two elderly populations and with different protocols, to hint at typical values of these variables. First, the balance of 133 elderly individuals, including 32 fallers, was measured on a relatively inexpensive, portable force platform (Wii Balance Board, Nintendo) with a 25-s open-eyes protocol. Second, the recordings of 76 elderly individuals, from an open access database commonly used to test static balance analyses, were used to compute the values of the variables on 60-s eyes-open recordings with a research laboratory standard force platform.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- ORPEA GroupPuteauxFrance
| | - Alice Nicolaï
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Ikram Chairi
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Groupe MSDAUniversité Mohammed VI PolytechniqueBenguerirMaroc
| | - Ioannis Bargiotas
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Service de Neurologie de l’Hôpital d’Instruction des Armées de PercySSAClamartFrance
- Ecole du Val‐de‐GrâceEcole de Santé des ArméesParisFrance
| | - Alain Yelnik
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- PRM DepartmentGH Lariboisière F. WidalAP‐HPUniversité de ParisUMR 8257ParisFrance
| | - Laurent Oudre
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | | | - Pierre‐Paul Vidal
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
- Institute of Information and ControlHangzhou Dianzi UniversityZhejiangChina
| | - Nicolas Vayatis
- Centre Borelli UMR 9010/Université Paris‐SaclayENS Paris‐SaclayCNRSSSA, InsermUniversité de ParisParisFrance
| | - Stéphane Buffat
- Laboratoire d’accidentologie de biomécanique et du comportement des conducteursGIE Psa Renault GroupesNanterreFrance
| | - Julien Audiffren
- Department of NeuroscienceUniversity of FribourgFribourgSwitzerland
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Quijoux F, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study. Front Digit Health 2021; 2:604552. [PMID: 34713067 PMCID: PMC8521935 DOI: 10.3389/fdgth.2020.604552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/15/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- ORPEA Group, Puteaux, France
| | | | | | | | - Pierre-Paul Vidal
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Service de Neurologie de l'Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, Paris, France
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Croarkin E, Zampieri C. On the EDGE of Task Force Recommendations: Computerized Balance Assessment. REHABILITATION ONCOLOGY 2021; 39:64-67. [PMID: 38404645 PMCID: PMC10888498 DOI: 10.1097/01.reo.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Earllaine Croarkin
- Board Certified Neurological Clinical Specialist, Physical Therapist, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Research Physical Therapist, Functional and Applied Biomechanics Laboratory, Clinical Research Center, National Institutes of Health, Bethesda, MD
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Rodríguez-Rubio PR, Bagur-Calafat C, López-de-Celis C, Bueno-Gracía E, Cabanas-Valdés R, Herrera-Pedroviejo E, Girabent-Farrés M. Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217733. [PMID: 33105835 PMCID: PMC7660083 DOI: 10.3390/ijerph17217733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. METHODS A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test-retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. RESULTS The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. CONCLUSION The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.
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Affiliation(s)
- Pere Ramón Rodríguez-Rubio
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
| | - Caritat Bagur-Calafat
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
| | - Carlos López-de-Celis
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Elena Bueno-Gracía
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Correspondence:
| | - Ernesto Herrera-Pedroviejo
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, UIC Barcelona, Sant Cugat del Vallès, 08195 Barcelona, Spain; (P.R.R.-R.); (C.B.-C.); (C.L.-d.-C.); (E.H.-P.)
- Department of Physiotherapy, Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain
| | - Montserrat Girabent-Farrés
- Department of Physiotherapy, School of health Sciencies, Tecnocampus-pompeu Fabra University, Mataró, 08302 Barcelona, Spain;
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Quijoux F, Vienne-Jumeau A, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. Ageing Res Rev 2020; 62:101117. [PMID: 32565327 DOI: 10.1016/j.arr.2020.101117] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.
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Health, Functional and Nutritional Determinants of Falls Experienced in the Previous Year-A Cross-Sectional Study in a Geriatric Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134768. [PMID: 32630725 PMCID: PMC7369737 DOI: 10.3390/ijerph17134768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
Falls are a serious health problem in older adults. A limited number of studies assessed their multifactorial nature in geriatric ward patients. The aim of this study is to explore health, functional and nutritional correlates of experiencing fall(s) in the previous year by older inpatients. A cross-sectional study of patients admitted to the department of geriatrics was conducted. A "faller status" was defined based on positive history of falls in the previous 12 months. Health, functional and nutritional factors associated with falls were evaluated, and multivariable logistic regression analysis models were built. A total of 358 patients (median age 82 (IQR 76-86) years, 77.9% women) were recruited, 43.9% of whom reported falls. The "fallers" presented with a significantly higher number of chronic diseases, higher prevalence of Parkinson's disease, peripheral arterial disease, chronic osteoarthritis, more frequently reported urinary incontinence and were dependent on others for daily living activities. They had significantly worse results for the assessment of gait, balance and frailty status. The Mini Nutritional Assessment-Short Form scores and the mean value of serum albumin were significantly lower in the fallers' group. Parkinson's disease (OR = 2.82, CI-1.07-7.45; p = 0.04) and osteoarthritis (OR = 2.08, CI-1.02-4.23; p = 0.04) were the main variables for the outcome prediction, according to the direct multivariable logistic regression analysis. Our findings suggest that Parkinson's disease and osteoarthritis are the main predictors independently associated with a history of falls in patients admitted to the geriatric ward, although the influence of some factors may be underestimated due to the tendency of not taking the history of falls in very frail, functionally dependent and bedridden individuals.
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Evaluation of Self-reported Symptoms in 1,457 Dizzy Patients and Associations With Caloric Testing and Posturography. Otol Neurotol 2020; 41:956-963. [DOI: 10.1097/mao.0000000000002670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Piano L, Geri T, Testa M. Raising and stabilization phase of the sit-to-stand movement better discriminate healthy elderly adults from young subjects: a pilot cross-sectional study. Arch Physiother 2020; 10:7. [PMID: 32318274 PMCID: PMC7161000 DOI: 10.1186/s40945-020-00078-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background The sit-to-stand (STS) test is usually included in the clinical assessment of balance and its instrumented analysis may support clinicians in objectively assessing the risk of falling. The aim of the present study was to assess if kinetic parameters of STS collected using a force platform, with particular focus on the raising and stabilization phase, could discriminate between young and older adults. Methods Twenty-four adults (age ranging from 18 to 65 years old) and 28 elderly adults (older than 65 years old) performed STS on a force platform. Data on ground reaction forces, sway, displacement and velocity of the center of pressure were gathered during the raising and the stabilization phases. Results elderly subjects showed significant greater global sway (146.97 vs 119.85; p < 0.05) and a higher velocity (vs 40.03 vs 34.35 mm/s; p < 0.05) of execution of STS. Between-group comparisons highlighted a greater postural sway in the raising phase (21.63 vs 13.58; p < 0.001) and a doubled sway during the stabilization phase (12.38 vs 4.98; p < 0.001). Conclusions The analysis of STS performed on a force platform provides further information about the age-specific pattern of STS execution. The stabilization phase of STS seems to be the more challenging for functional independent older adults and should be considered during balance assessment.Further studies are needed to confirm findings and improve generalizability of this study.
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Affiliation(s)
- Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Casa di Cura "La Residenza", via Roma 1, 12050, Rodello, CN Italy
| | - Tommaso Geri
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
| | - Marco Testa
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
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Rasche P, Nitsch V, Rentemeister L, Coburn M, Buecking B, Bliemel C, Bollheimer LC, Pape HC, Knobe M. The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison. JMIR Aging 2019; 2:e12114. [PMID: 31518273 PMCID: PMC6715018 DOI: 10.2196/12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Fall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment. Objective The aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews. Methods Sensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS. Results Sensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool. Conclusions It could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Lars Rentemeister
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Mark Coburn
- Klinik für Anästhesiologie, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Leo Cornelius Bollheimer
- Department of Geriatrics, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Zurich Medical Center, University of Zurich, Zurich, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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Watt AA, Clark C, Williams JM. Differences in sit-to-stand, standing sway and stairs between community-dwelling fallers and non-fallers: a review of the literature. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1470748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Andrew A. Watt
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
| | - Carol Clark
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
| | - Jonathan M. Williams
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
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14
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Sensor-Based Balance Measures Outperform Modified Balance Error Scoring System in Identifying Acute Concussion. Ann Biomed Eng 2017; 45:2135-2145. [PMID: 28540448 DOI: 10.1007/s10439-017-1856-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/17/2017] [Indexed: 01/20/2023]
Abstract
Balance assessment is an integral component of concussion evaluation and management. Although the modified balance error scoring system (mBESS) is the conventional clinical tool, objective metrics derived from wearable inertial sensors during the mBESS may increase sensitivity in detecting subtle balance deficits post-concussion. The aim of this study was to identify which stance condition and postural sway metrics obtained from an inertial sensor placed on the lumbar spine during the mBESS best discriminate athletes with acute concussion. Fifty-two college athletes in the acute phase of concussion and seventy-six controls participated in this study. Inertial sensor-based measures objectively detected group differences in the acutely concussed group of athletes while the clinical mBESS did not (p < 0.001 and p = 0.06, respectively). Mediolateral postural sway during the simplest condition of the mBESS (double stance) best classified those with acute concussion. Inertial sensors provided a sensitive and objective measure of balance in acute concussion. These results may be developed into practical guidelines to improve and simplify postural sway analysis post-concussion.
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15
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Howcroft J, Lemaire ED, Kofman J, McIlroy WE. Elderly fall risk prediction using static posturography. PLoS One 2017; 12:e0172398. [PMID: 28222191 PMCID: PMC5319679 DOI: 10.1371/journal.pone.0172398] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
Maintaining and controlling postural balance is important for activities of daily living, with poor postural balance being predictive of future falls. This study investigated eyes open and eyes closed standing posturography with elderly adults to identify differences and determine appropriate outcome measure cut-off scores for prospective faller, single-faller, multi-faller, and non-faller classifications. 100 older adults (75.5 ± 6.7 years) stood quietly with eyes open and then eyes closed while Wii Balance Board data were collected. Range in anterior-posterior (AP) and medial-lateral (ML) center of pressure (CoP) motion; AP and ML CoP root mean square distance from mean (RMS); and AP, ML, and vector sum magnitude (VSM) CoP velocity were calculated. Romberg Quotients (RQ) were calculated for all parameters. Participants reported six-month fall history and six-month post-assessment fall occurrence. Groups were retrospective fallers (24), prospective all fallers (42), prospective fallers (22 single, 6 multiple), and prospective non-fallers (47). Non-faller RQ AP range and RQ AP RMS differed from prospective all fallers, fallers, and single fallers. Non-faller eyes closed AP velocity, eyes closed VSM velocity, RQ AP velocity, and RQ VSM velocity differed from multi-fallers. RQ calculations were particularly relevant for elderly fall risk assessments. Cut-off scores from Clinical Cut-off Score, ROC curves, and discriminant functions were clinically viable for multi-faller classification and provided better accuracy than single-faller classification. RQ AP range with cut-off score 1.64 could be used to screen for older people who may fall once. Prospective multi-faller classification with a discriminant function (-1.481 + 0.146 x Eyes Closed AP Velocity-0.114 x Eyes Closed Vector Sum Magnitude Velocity-2.027 x RQ AP Velocity + 2.877 x RQ Vector Sum Magnitude Velocity) and cut-off score 0.541 achieved an accuracy of 84.9% and is viable as a screening tool for older people at risk of multiple falls.
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Affiliation(s)
- Jennifer Howcroft
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
| | - Edward D Lemaire
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Canada
| | - Jonathan Kofman
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Canada
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