1
|
Marshall K, Patterson F, Fleming J, Gustafsson L, Atresh S. "Be ready to learn": a qualitative study of the patient perspective of falls and fall prevention following discharge from a spinal injuries unit. Disabil Rehabil 2024; 46:3108-3115. [PMID: 37559389 DOI: 10.1080/09638288.2023.2245755] [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: 02/07/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Falls following a spinal cord injury (SCI) can have physical and psychological consequences, although some risk of falls may be acceptable to enable participation in meaningful activity. The study aimed to explore the patients' perspective of falls and fall prevention after discharge from a inpatient spinal injuries unit. METHODS An interpretive descriptive approach guided the study. Semi structured interviews were conducted in the 6-12 months post discharge period. Thematic analysis was used to analyze the data and identify themes. RESULTS Fifteen individuals with SCI, with a mean age of 57 years and varied fall experiences were included. Three themes were identified including: 1. Expectation of falling; 2. Learning from my own experience and the experience of others' and 3. How to prevent falls. Learning from their own experience and the experience of others was highly valued by persons with SCI and influenced expectations of falls. A variety of strategies were used to prevent falls. CONCLUSIONS Strategies that include learning from others, include activities that are individual and provide skills in self-reflection may aid to make fall prevention meaningful.
Collapse
Affiliation(s)
- Kathryn Marshall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Sridhar Atresh
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Butler Forslund E, Truong MTN, Wang R, Seiger Å, Gutierrez-Farewik EM. A Protocol for Comprehensive Analysis of Gait in Individuals with Incomplete Spinal Cord Injury. Methods Protoc 2024; 7:39. [PMID: 38804333 PMCID: PMC11130903 DOI: 10.3390/mps7030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden's largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.
Collapse
Affiliation(s)
- Emelie Butler Forslund
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Minh Tat Nhat Truong
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Ruoli Wang
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Åke Seiger
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Elena M. Gutierrez-Farewik
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
3
|
Wouda MF, Løtveit MF, Bengtson EI, Strøm V. The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury. Spinal Cord Ser Cases 2024; 10:7. [PMID: 38418466 PMCID: PMC10902359 DOI: 10.1038/s41394-024-00620-x] [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: 09/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI). SETTING Sunnaas Rehabilitation Hospital, Norway. METHODS Thirteen men and two women with iSCI and 15 healthy, matched controls were included. Performance of the Berg Balance Scale (BBS) short version (7 items) was used to indicate balance control. Maximal voluntary contraction (MVC) was performed to measure isometric muscle strength in thigh muscles (knee extension/flexion), while surface electromyography (EMG) was measured from M. Vastus Lateralis and M. Biceps Femoris. The relative activation of each muscle during each of the BBS tasks was reported as the percentage of the maximal activation during the MVC (%EMGmax). RESULTS The iSCI participants had a significantly lower BBS sum score and up to 40% lower muscle strength in knee- flexion and extension compared to the matched healthy controls. They also exhibited a significantly higher %EMGmax, i.e. a higher muscle activation, during most of the balance tests. Univariate regression analysis revealed a significant association between balance control and mean values of %EMGmax in Biceps Femoris, averaged over the seven BBS tests. CONCLUSIONS The participants with iSCI had poorer balance control, reduced thigh muscle strength and a higher relative muscle activation in their thigh muscles, during balance-demanding activities.
Collapse
Affiliation(s)
- Matthijs Ferdinand Wouda
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
| | - Marte Fosvold Løtveit
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| |
Collapse
|
4
|
Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:108001. [PMID: 38199138 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
Collapse
Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
5
|
Abou L, Rice LA. Functional balance assessment for predicting future recurrent falls in non-ambulatory individuals with spinal cord injury: a prospective pilot study. Physiother Theory Pract 2023:1-10. [PMID: 37801067 DOI: 10.1080/09593985.2023.2266741] [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: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Functional assessments easy to administer within the clinic to identify non-ambulatory individuals with spinal cord injury at risk of recurrent falls are needed. PURPOSE To examine the ability of functional balance and transfer quality to predict recurrent falls. METHODS This 6-month prospective study examined remote assessments of transfer quality using the Transfer Assessment Instrument and functional sitting balance with the Function in Sitting Test and the Trunk Control Test. Then, participants prospectively monitored their falls for 6-month using fall diaries. Frequency of falls was categorized as infrequent fallers (≤2 falls) and recurrent fallers (>2 falls). A multivariable logistic regression analysis was conducted. A Receiver Operating Characteristic curve was performed to determine the area under the curve, the sensitivity, and the specificity of the model. RESULTS Eighteen non-ambulatory individuals (mean age = 44 ± 16 years, mean time since injury = 7.8 ± 32.6 years) participated in the study. Poor balance (lower Function in Sitting Test score) was associated with higher odds of future recurrent falls (Odds Ratio = 0.70, 95% CI, 0.48 to 1.00, p = 0.05), area under the receiving operating curve = 0.87, sensitivity = 88%, and specificity = 70%. CONCLUSIONS A comprehensive sitting balance assessment that includes the static, proactive, and reactive components of balance with the integration of sensorial functions as evaluated within the Function in Sitting Test may be useful for predicting recurrent falls among non-ambulatory individuals with spinal cord injury. Replication of the findings in a larger sample is warranted.
Collapse
Affiliation(s)
- Libak Abou
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Center for Health, Aging and Disability, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| |
Collapse
|
6
|
Gopal A, Gelfand JM, Bove R, Block VJ. Fall Assessment and Monitoring in People With Multiple Sclerosis: A Practical Evidence-Based Review for Clinicians. Neurol Clin Pract 2023; 13:e200184. [PMID: 37720138 PMCID: PMC10503932 DOI: 10.1212/cpj.0000000000200184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Purpose of Review Falls occur in more than half of all people with multiple sclerosis (MS) but tend to be underdiagnosed and underreported in clinical encounters. This narrative review aims to summarize evidence-based approaches for evaluating fall risk and proven treatment strategies to reduce falling in people with MS to improve care for people with MS and to enhance interprofessional care coordination between treating neurologic and physical therapy (PT) teams. Recent Findings Screening not just for falls but for near-falls as well because fear of falling can improve fall assessment and identify patients who may benefit from fall prevention interventions. A number of barriers, including time constraints during visits and the fallacy that falling is inevitable in MS, can limit clinician awareness about patient falls and delay timely referral to PT. Consultation with physical therapists for individualized fall prevention treatment can reduce risk of falling. Interventional studies have also shown that PT-guided exercise programs improve balance confidence in people with MS. However, people with MS are often under-referred to PT by treating clinicians. Summary A clinical approach is provided to summarize practical, accessible, evidence-based, low-burden measurements and interventions likely to improve ascertainment of patients at risk of falling and optimize timely PT referral and treatment.
Collapse
Affiliation(s)
- Arpita Gopal
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Riley Bove
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| | - Valerie J Block
- UCSF Weill Institute for Neurosciences (AG, JMG, RB), MS and Neuroinflammation Clinic, Department of Neurology; and Department of Physical Therapy and Rehabilitation Science (VJB), University of California, San Francisco
| |
Collapse
|
7
|
Heffernan MG, Lee JW, Chan K, Unger J, Marzolini S, Welsh TN, Masani K, Musselman KE. Spatial characteristics of reactive stepping among people living with chronic incomplete spinal cord injury. J Spinal Cord Med 2023; 46:769-777. [PMID: 37037014 PMCID: PMC10446810 DOI: 10.1080/10790268.2023.2175575] [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] [Indexed: 04/12/2023] Open
Abstract
Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.Design: Cross sectional.Setting: Lyndhurst Centre.Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and kinetic data were recorded.Outcome measures: The length, width and height of the first reactive step of each trial were calculated. Standard deviation between trials was calculated to represent the variability in step length, width and height within a participant. Among participants with iSCI, correlation coefficients were used to explore the relationship between step length and width variability and (1) Lean-and-Release test behavioral responses, (2) 3-month fall history, and (3) lower extremity strength.Results: Step length (P = 0.94), width (P = 0.52) and height (P = 0.97), normalized for participant height, did not differ between groups. Participants with iSCI showed greater variability in step length (P = 0.02) and width (P = 0.01), but not height (P = 0.32). No correlation was found between step length or width variability and behavioral responses, 3-month fall history, or lower extremity strength.Conclusions: Individuals with iSCI showed increased variability in length and width of reactive stepping compared to AB individuals, which may contribute to their impaired ability to execute single-step reactive responses.Trial registration: ClinicalTrials.gov identifier: NCT02960178.
Collapse
Affiliation(s)
- Matthew G. Heffernan
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jae Woung Lee
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Susan Marzolini
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Timothy N. Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Kei Masani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin E. Musselman
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Abou L, Rice LA. Frequency and characteristics of falls, fall-related injuries, and fear of falling among wheelchair users with spinal cord injury. J Spinal Cord Med 2023; 46:560-568. [PMID: 35943367 PMCID: PMC10274528 DOI: 10.1080/10790268.2022.2097995] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT/OBJECTIVE To investigate the frequency and characteristics of falls, fall-related injuries, and fear of falling (FOF) among non-ambulatory individuals with spinal cord injury (SCI). METHODS This is a cross-sectional study design that included 59 non-ambulatory individuals with SCI. Participants completed a survey on demographics, SCI characteristics (type of injury, level of injury, and time since injury), FOF, activities curtailment due to FOF, and frequency of falls and fall-related injuries in the past 6 months. Characteristics of the most recent falls and fall-related injuries were also collected. A directed content analysis was used to analyze qualitative data. RESULTS Overall, 63% of the study participants reported falling at least once, 46.7% reported injuries after falls, and 73% reported FOF during the previous 6 months. Participants commonly reported falling inside of the house (74.6%), during transfers (43.2%), and associated with obstacles on the way (54.5%) or surface conditions (36.4%). Almost half of the participants (42.3%) reported never received education on fall prevention from a healthcare professional. CONCLUSIONS The results confirm that falls, fall-related injuries, and FOF are a common concern in this population. These findings contribute to the knowledge base for the future development of fall prevention programs specific for non-ambulatory individuals with SCI.
Collapse
Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Laura A. Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
9
|
Dondin M, Baeza-Velasco C. Joint Hypermobility and Fatigue Are Associated With Injuries in a Group of Preprofessional Ballet Dancers. J Dance Med Sci 2023:1089313X231177173. [PMID: 37300373 DOI: 10.1177/1089313x231177173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Strenuous preprofessional ballet training places young students at an increased risk of injury. This represents a major concern for aspiring dancers since a link has been described between injury and dropping out. It is therefore important to identify physical and psychological factors related to injuries in dance for prevention purposes. METHODS In this cross-sectional study, we explored the frequency and characteristics of injuries, as well as their physical and psychological determinants in preprofessional ballet dancers. Seventy-three participants (women = 75.6%; mean age = 13.7; SD = 1.8) were evaluated with the Beighton criteria for joint hypermobility and self-questionnaires assessing injuries in the last 18 months, fatigue, fear of injury, and motivation. RESULTS Most of participants (61.6%) experienced injuries in the last 18 months, mainly in the lower limbs, and due to overuse. Multivariate analyses showed that joint hypermobility and fatigue predict injury status in this sample. CONCLUSION These results confirm previous reports suggesting that physical factors such as fatigue and joint hypermobility, that are frequent in ballet dancers, should be taken into account in order to prevent injuries.
Collapse
Affiliation(s)
- Morgan Dondin
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Boulogne Billancourt, France
| | - Carolina Baeza-Velasco
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Boulogne Billancourt, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| |
Collapse
|
10
|
Bay AA, Ramachandran S, Ni L, Prusin T, Hackney ME. Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults. J Geriatr Phys Ther 2023; 46:122-131. [PMID: 35981334 PMCID: PMC10189616 DOI: 10.1519/jpt.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. METHODS Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. RESULTS Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. DISCUSSION Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. CONCLUSION Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.
Collapse
Affiliation(s)
- Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers, Birmingham, Alabama
- Emory University Department of Rehabilitation Medicine, Atlanta, Georgia
- Emory University School of Nursing, Atlanta, Georgia
| |
Collapse
|
11
|
Sprague BN, Ross LA, Ball KK. Does Cognitive Training Reduce Falls across Ten Years?: Data from the ACTIVE Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4941. [PMID: 36981850 PMCID: PMC10048914 DOI: 10.3390/ijerph20064941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to examine the effect of cognitive training on the risk of experiencing a fall across 10 years. The study used data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial. Older adults aged 65-94 were randomly assigned to speed of processing, memory, or reasoning training or to a no-contact control group (n = 2802). The experience of a fall in the prior two months was assessed at baseline and at 1, 2, 3, 5, and 10 years posttest. Cox proportional hazards explored group differences in the total sample, as well as group differences for participants classified as low risk (n = 2360) and high risk (n = 442) for future falls. The data were censored at the first reported fall postbaseline. After baseline, 983 (35.08%) participants across the full sample reported a fall. There were no significant effects of the training in the full sample or in the low-risk sample of participants. However, the participants at greater risk for future falls in the speed of processing training group were 31% less likely (HR = 0.69; 95% CI = 0.48, 0.998, p = 0.049) to experience a subsequent fall across ten years compared to the control group. Reasoning and memory training did not reduce a future fall in the high-risk sample. The speed of processing training reduced the risk of future falls across ten years in the high-risk participants. Future work should examine moderators and mediators of training in at-risk samples.
Collapse
Affiliation(s)
- Briana N. Sprague
- Division of General Internal Medicine & Geriatrics, University of Indiana School of Medicine, Indianapolis, IN 46202, USA
- Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Lesley A. Ross
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Karlene K. Ball
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| |
Collapse
|
12
|
Is waist circumference associated with fear of falling in community-dwelling older adults? A cross-sectional study. Geriatr Nurs 2023; 50:203-207. [PMID: 36796144 DOI: 10.1016/j.gerinurse.2023.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Fear of falling (FOF) is a prevalent condition among older adults and several variables have been pointed out as risk factors. OBJECTIVES To identify the cut-off point on waist circumference (WC), capable of discriminating between older adults with and without FOF, and to test the association between WC and FOF. METHODS A cross-sectional observational study was carried out with older adults of both sexes from Balneário Arroio do Silva, Brazil. We used Receiver Operating Characteristic (ROC) curves to determine the cut-off point on WC and logistic regression adjusted for potential confounding variables to test the association. RESULTS Older women with WC >93.5 cm [area under the curve: 0.61 (95%CI 0.53; 0.68)] had 3.30 (95%CI 1.53; 7.14) greater chances of having FOF compared with older women with WC ≤93.5 cm. WC was not able to discriminate FOF in older men. CONCLUSION WC values >93.5 cm are associated with higher chances of FOF in older women.
Collapse
|
13
|
Marshall K, Fleming J, Atresh S, Scott JR, Gustafsson L, Patterson F. Falls on an inpatient rehabilitation spinal injuries unit: the characteristics, circumstances, and consequences. Spinal Cord 2023; 61:57-64. [PMID: 36273103 PMCID: PMC9836933 DOI: 10.1038/s41393-022-00861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/17/2023]
Abstract
STUDY DESIGN Retrospective audit OBJECTIVES: To describe the nature of falls and fallers in a spinal injuries unit (SIU) and identify factors associated with having more than one fall (recurrent fallers) and falls with physical or psychological consequences (consequential falls). SETTING An Australian inpatient rehabilitation SIU. METHODS Data were retrospectively extracted from falls incident reports and electronic medical records over a 5-year period. Data were analysed descriptively to summarise participant and fall details. Univariate analyses identified candidate variables for further investigation in a multivariate model for recurrent fallers and consequential falls. RESULTS Of the 566 persons admitted to the SIU, 132 (23%) participants experienced 207 falls over the 5 years. Of the fallers, 41 (31%) were recurrent fallers experiencing between 2 and 7 falls and 78 (59%) experienced a consequential fall. No significant variables were identified for recurrent fallers. For consequential falls, older age (OR = 1.038, 95% CI, 1.012 to 1.064, p = 0.004) and female gender (OR = 3.581, 95% CI, 1.269 to 10.103, p = 0.016) were significant, as well as falls that occurred on a Sunday (OR = 0.196, 95% CI, 0.061 to 0.630, p = 0.006). Falls while transferring were less likely to be consequential (OR = 4.100, 95% CI, 1.706 to 9.856, p = 0.002). CONCLUSIONS Nearly one quarter of SIU inpatients experienced a fall with almost a third of those who fell experiencing recurrent falls. Older age, female gender, and Sundays were risk factors for falls with consequence.
Collapse
Affiliation(s)
- Kathryn Marshall
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,grid.412744.00000 0004 0380 2017Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, QLD Australia
| | - Jennifer Fleming
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Sridhar Atresh
- grid.412744.00000 0004 0380 2017Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537School of Medicine, The University of Queensland, Brisbane, QLD Australia
| | - Justin, R. Scott
- grid.1003.20000 0000 9320 7537QCIF Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia
| | - Louise Gustafsson
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,grid.1022.10000 0004 0437 5432School of Health Sciences and Social Work, Griffith University, Brisbane, QLD Australia ,grid.1022.10000 0004 0437 5432The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Freyr Patterson
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| |
Collapse
|
14
|
Shao X, Wang Z, Luan L, Sheng Y, Yu R, Pranata A, Adams R, Zhang A, Han J. Impaired ankle inversion proprioception during walking is associated with fear of falling in older adults. Front Aging Neurosci 2022; 14:946509. [PMID: 36247986 PMCID: PMC9563849 DOI: 10.3389/fnagi.2022.946509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Ankle proprioception plays a critical role in lower limb movement control. However, the relationship between ankle proprioception and fear of falling (FOF) in older people is still unclear. Objective (1) This study aims to develop a new device for measuring ankle inversion proprioceptive discrimination sensitivity during walking, i.e., the Ankle Inversion Discrimination Apparatus–Walking (AIDAW), and assess the test–retest reliability of the AIDAW in both young and older adults; (2) to evaluate the discriminant validity of the measure by comparing ankle proprioception during walking between the two groups; and (3) to explore convergent validity by determining to what extent the AIDAW proprioceptive scores correlate with Fall Efficacy Scale-International (FES-I) scores. Materials and methods The AIDAW was purpose-built to test ankle inversion proprioceptive discrimination sensitivity during walking. The area under the receiver operating curve (AUC) was calculated as the proprioceptive discrimination score. In total, 54 adults volunteered. Test–retest reliability was evaluated in 12 young and 12 older adults, and another 15 young and 15 older adults completed the comparison study. FOF was assessed by using the FES-I. Results The test–retest reliability intraclass correlation coefficient ICC (3,1) value for the whole group was 0.76 (95% CI: 0.52–0.89). The ICC values of the young and older groups were 0.81 (95% CI: 0.46–0.94) and 0.71 (95% CI: 0.26–0.91), respectively. The Minimal Detectable Change with 90% confidence (MDC90) values for the young and older groups were 0.03 and 0.11, respectively. There was a significant difference between the AIDAW proprioceptive sensitivity scores for the young and older groups (0.78 ± 0.04 vs. 0.72 ± 0.08, F = 5.06, p = 0.033). Spearman’s correlation analysis showed that the FES-I scores were significantly and negatively correlated with the AIDAW scores (rho = −0.61, p = 0.015), with higher FOF associated with worse ankle proprioception. Conclusion The AIDAW is a reliable and valid device for measuring ankle proprioception during walking in both young and older adults. Ankle inversion proprioceptive discrimination sensitivity during walking was found to be impaired in the elderly compared to young adults. This impairment was found to be strongly associated with FOF, suggesting that assessment and intervention for ankle proprioception in this population are needed to reduce the risk of falls.
Collapse
Affiliation(s)
- Xuerong Shao
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zheng Wang
- Department of Rehabilitation Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijiang Luan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yilan Sheng
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Ruoni Yu
- School of Medicine, Jinhua Polytechnic, Jinhua, China
| | - Adrian Pranata
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Roger Adams
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Anren Zhang
- Department of Rehabilitation Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Anren Zhang,
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
- Research Institute for Sports and Exercise, University of Canberra, Canberra, ACT, Australia
- Jia Han,
| |
Collapse
|
15
|
Bendt M, Forslund EB, Hagman G, Hultling C, Seiger Å, Franzén E. Gait and dynamic balance in adults with spina bifida. Gait Posture 2022; 96:343-350. [PMID: 35820238 DOI: 10.1016/j.gaitpost.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Spina bifida (SB) is a complex congenital malformation, often causing impaired gait performance depending on the level and extent of malformation. Research regarding gait and balance performance in adults with SB, has not been sufficiently described yet. RESEARCH QUESTION What are the characteristics of spatiotemporal gait parameters and balance performance in adults with SB? Further, do persons with muscle function (MF) level 3 differ regarding gait and balance performance from those with MF level 1-2? METHODS Cross-sectional observational study at an outpatient clinic. 41 adults with SB (18-65 years), who walked regularly. Spatiotemporal parameters of gait was assessed with the APDM system and balance performance with the Mini Balance Evaluation Systems Test (Mini-BESTest). Muscle strength in the legs was assessed with 0-5 manual muscle test, and participants were classified according to level of MF into groups MF1, MF2, and MF3. Two-sided t-test was used for parametric independent variables, and Cohen's d was used for effect sizes. The Mann-Whitney U test was used for non-parametric independent data and effect size was calculated by the z value (r = z/√n). RESULTS Mean gait speed was 0.96 (SD 0.20) m/s and mean stride length 1.08 m (SD 0.17), individuals with MF3 showed significantly slower gaitspeed and shorter stride length (p < 0.05). Lumbar rotation was 21° (SD 11), and thoracic lateral sway 15° (IQR 15) with significantley difference (p < 0.001 and p < 0.05) for individuals in MF3. Mini-BESTest showed a mean score of 11.3 (SD 6.9), and individuals with MF3 showed significantly lower scores (p ≤ 0.001). SIGNIFICANCE Gait and balance performance was reduced compared to normative data in almost all parameters, especially in persons with less muscle function. Increased knowledge from advanced gait analysis may help healthcare professionals to design rehabilitation programmes, in order to achieve and maintain a sustainable gait and balance performance.
Collapse
Affiliation(s)
- Martina Bendt
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Aleris Rehab Station, Stockholm, Sweden.
| | - Emelie Butler Forslund
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Aleris Rehab Station, Stockholm, Sweden.
| | - Göran Hagman
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Karolinska University Hospital, Stockholm, Sweden.
| | - Claes Hultling
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Spinalis Foundation, Sophiahemmet University College, Stockholm, Sweden.
| | - Åke Seiger
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Clinical Geriatrics, Aleris Rehab Station, Stockholm, Sweden.
| | - Erika Franzén
- Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Physiotherapy, Allied Health Professionals, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholms Sjukhem R and D Unit, Stockholm, Sweden.
| |
Collapse
|
16
|
Chan K, Habib Perez O, Singh H, Marinho-Buzelli AR, Hitzig SL, Musselman KE. Impact of Falls and Fear of Falling on Participation, Autonomy and Life Satisfaction in the First Year After Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:903097. [PMID: 36188963 PMCID: PMC9397684 DOI: 10.3389/fresc.2022.903097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
IntroductionIndividuals with spinal cord injury (SCI) experience reduced participation in meaningful activities, leading to reduced social engagement and negative psychological impact. Two factors that may affect participation post-SCI are fall status (e.g., having experienced a fall) and having a fear of falling. Our objective was to examine if and how fall status and fear of falling impact participation, autonomy and life satisfaction in the first year post-injury.MethodsAdult inpatients of a SCI rehabilitation hospital were recruited. Following discharge, falls were tracked for 6 months and participants who fell at least once were categorized as “fallers”. At the end of the 6-month period, the Impact on Participation and Autonomy Questionnaire and Life Satisfaction Questionnaire 9 were administered, and participants were asked if they had a fear of falling (i.e., an ongoing concern about falling leading to the avoidance of activities they are capable of doing). Falls were reported using descriptive statistics. Ordinary least squares regression was used to evaluate the relationships between the independent variables (i.e., fall status and fear of falling) and each dependent variable (i.e., questionnaire scores).ResultsSeventy-one individuals were enrolled in the study; however, 11 participants were lost to follow-up. The included participants (n = 60) were 58.4 ± 14.6 years old and 99 ± 60.3 days post-injury. Over one third (38.3%) of participants fell over the 6-month tracking period. Twenty-seven participants (45%) reported a fear of falling and 14 (51.9%) of these participants were fallers. Fear of falling significantly predicted scores of autonomy indoors (β = 3.38, p = 0.04), autonomy outdoors (β = 2.62, p = 0.04) and family role (β = 3.52, p = 0.05).ConclusionIndividuals with subacute SCI and a fear of falling experienced reduced participation and autonomy, but with no differences in life satisfaction compared to those without a fear of falling. In contrast, having experienced a fall did not impact participation, autonomy or life satisfaction. In the first year after SCI, rehabilitation programs should place specific attention on the presence of fear of falling to help individuals with SCI prepare for everyday mobility challenges.
Collapse
Affiliation(s)
- Katherine Chan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Olinda Habib Perez
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hardeep Singh
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andresa R. Marinho-Buzelli
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sander L. Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Kristin E. Musselman
| |
Collapse
|
17
|
Habib Perez OD, Martin S, Chan K, Singh H, Yoshida KK, Musselman KE. A qualitative photo-elicitation study exploring the impact of falls and fall risk on individuals with subacute spinal cord injury. PLoS One 2022; 17:e0269660. [PMID: 35671304 PMCID: PMC9173606 DOI: 10.1371/journal.pone.0269660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a time when fall prevention initiatives are delivered. Hence, we explored the impact of falls and fall risk in individuals with subacute SCI/D as they transitioned from inpatient rehabilitation to community living.
Methods
This qualitative photo-elicitation study used an inductive thematic analysis. Eight individuals (7 male) undergoing inpatient rehabilitation at a Canadian tertiary rehabilitation hospital due to a new SCI/D participated. Six months following discharge, photo-elicitation interviewing was used to understand the impact of falls and fall risk. Over 7–14 days, participants completed a photo-assignment that involved taking photographs in response to questions, such as what increases/decreases your likelihood of falling? A semi-structured interview followed, in which participants described their photographs and discussed their experiences with falls, fall risk and fall prevention training.
Results
Four themes were identified. 1) Risk factors and strategies identified through lived experience. Participants discovered their fall risk factors and fall prevention strategies through “trial and error”. 2) Influences on the individual’s perception of their fall risk. Prior experience with falls, including falls experienced by themselves as well as friends and family, influenced their perception of fall risk. 3) Experiencing life differently due to increased fall risk. A high fall risk reduced participation, increased negative emotions and decreased independence and quality of life. 4) Falls training in rehabilitation can be improved. Prior experiences with falls training varied; however, participants expressed a desire for comprehensive and individualized training.
Conclusion
Although participants’ experiences with falls and fall prevention varied, falls and the risk of falling can have a significant impact on the first year of living with a SCI/D.
Collapse
Affiliation(s)
| | - Samantha Martin
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Katherine Chan
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
| | - Hardeep Singh
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Karen K. Yoshida
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health (Social Science Division), University of Toronto, Toronto, ON, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab–University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- * E-mail:
| |
Collapse
|
18
|
Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults. Aging Clin Exp Res 2022; 34:1341-1347. [PMID: 35050494 DOI: 10.1007/s40520-021-02058-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies. AIMS To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls. METHODS This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls. RESULTS The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition. CONCLUSIONS The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.
Collapse
|
19
|
Evans NH, Suri C, Field-Fote EC. Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury. Front Hum Neurosci 2022; 16:849297. [PMID: 35634208 PMCID: PMC9130633 DOI: 10.3389/fnhum.2022.849297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCSsham) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.
Collapse
Affiliation(s)
- Nicholas H. Evans
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Cazmon Suri
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, GA, United States
- Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Edelle C. Field-Fote,
| |
Collapse
|
20
|
Frechette ML, Abou L, Rice LA, Sosnoff JJ. Relationship Between Lower Limb Function and Fall Prevalence in Ambulatory Adults With Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2022; 28:153-175. [PMID: 35521058 PMCID: PMC9009199 DOI: 10.46292/sci21-00026] [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] [Indexed: 11/19/2022]
Abstract
Background Falls are common, detrimental events among ambulatory individuals with spinal cord injury (SCI). Following SCI, changes to lower limb function are probable and likely to impact an individual's fall risk, yet no comprehensive review has been completed on the topic. Objectives This study systematically reviewed data on the relationship between lower limb function and fall prevalence in ambulatory individuals with SCI. Methods A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL. Two independent reviewers screened abstracts/titles and then full articles. Study details, participants' characteristics, lower limb function assessed, and fall-related data were extracted from the studies. A qualitative analysis of the relationship between lower limb function and fall prevalence was performed. The risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Results The search yielded 1553 articles. Eight prospective, two retrospective, and three cross-sectional studies met the eligibility criteria. These studies ranged from low to high risk of bias. Overall, the qualitative analysis provided little evidence to support the relationship between lower limb function recorded by clinical measures and fall prevalence. Conclusion This review highlights the inconsistent relationship between lower limb function and falls prevalence in ambulatory adults with SCI. Greater uniformity in methodology and consistent categorization of fallers and nonfallers among researchers is necessary to move the field forward. Investigating additional factors such as behavior traits, assistive device use, and environmental risk factors may be appropriate in understanding fall prevalence in this population.
Collapse
Affiliation(s)
- Mikaela L. Frechette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Libak Abou
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Laura A. Rice
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
- Center on Health, Aging, and Disability, University of Illinois at Urbana-Champaign
| | - Jacob J. Sosnoff
- Department of Physical Therapy, Rehabilitation Science and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
21
|
Singh H, Cheung L, Chan K, Flett HM, Hitzig SL, Kaiser A, Musselman KE. Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis. J Spinal Cord Med 2021; 44:S193-S202. [PMID: 34779733 PMCID: PMC8604457 DOI: 10.1080/10790268.2021.1956252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the occurrence of falls and fall-related injuries, and the circumstances of falls among individuals with spinal cord injury (SCI) who ambulate full-time, use a wheelchair full-time and ambulate part-time. DESIGN A secondary analysis. SETTING Community. PARTICIPANTS Adults with SCI. INTERVENTION None. OUTCOME MEASURES The occurrence and circumstances of falls and fall-related injuries were tracked over six-months using a survey. Participants were grouped by mobility and fall status. A chi-square test compared the occurrence of falls and fall-related injuries, and the time and location of falls, and a negative binomial regression was used to predict the likelihood of falls by mobility status. Kaplan-Meier analysis was used to determine differences in the time to first fall based on mobility status. Group characteristics and causes of falls were described. RESULTS Data from individuals who ambulated full-time (n = 30), used a wheelchair full-time (n = 27) and ambulated part-time (n = 8) were analyzed. Mobility status was a significant predictor of falls (P < 0.01); individuals who used a wheelchair full-time had a third of the likelihood of falling than those who ambulated full-time (P < 0.01). Type of fall-related injuries differed by mobility status. Those who ambulated full-time fell more in the daytime (P < 0.01). Individuals who ambulated full-time and part-time commonly fell while walking due to poor balance, and their legs giving out, respectively. Those who used a wheelchair full-time typically fell while transferring when rushed. CONCLUSION Mobility status influences the likelihood and circumstances of falls. Mobility status should be considered when planning fall prevention education/training for individuals with SCI.
Collapse
Affiliation(s)
- Hardeep Singh
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Bridgepoint Collaboratory for Research & Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Lovisa Cheung
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Katherine Chan
- KITE, Toronto Rehab-University Health Network, Toronto, Canada
| | - Heather M. Flett
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anita Kaiser
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Canadian Spinal Research Organization, Toronto, Canada
| | - Kristin E. Musselman
- KITE, Toronto Rehab-University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Kristin E. Musselman, SCI Mobility Lab, KITE, Toronto Rehab-University Health Network, 520 Sutherland Drive, TorontoM4G 3V9, Canada.
| |
Collapse
|
22
|
Plooij M, Apte S, Keller U, Baines P, Sterke B, Asboth L, Courtine G, von Zitzewitz J, Vallery H. Neglected physical human-robot interaction may explain variable outcomes in gait neurorehabilitation research. Sci Robot 2021; 6:eabf1888. [PMID: 34550719 DOI: 10.1126/scirobotics.abf1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- M Plooij
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Demcon Advanced Mechatronics, Delfttechpark 23, Delft, Netherlands.,Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands
| | - S Apte
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Laboratory of Movement Analysis and Measurement, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - U Keller
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
| | - P Baines
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands
| | - B Sterke
- Motek, a DIH brand, Hogehilweg 18-C, 1101 CD Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
| | - L Asboth
- Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - G Courtine
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - J von Zitzewitz
- ONWARD, EPFL Innovation Park, Lausanne, Switzerland.,Center for Neuroprosthetics (CNP) Valais, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - H Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
| |
Collapse
|
23
|
Lee D, Tak SH. Fear of Falling and Related Factors in Older Adults With Spinal Diseases. J Gerontol Nurs 2021; 47:29-35. [PMID: 34309452 DOI: 10.3928/00989134-20210624-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].
Collapse
|
24
|
Bendt M, Seiger Å, Hagman G, Hultling C, Franzén E, Forslund EB. Adults with spina bifida: ambulatory performance and cognitive capacity in relation to muscle function. Spinal Cord 2021; 60:122-128. [PMID: 34262127 DOI: 10.1038/s41393-021-00658-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3. SETTING Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden. METHODS A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis. RESULTS In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity. CONCLUSIONS Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.
Collapse
Affiliation(s)
- Martina Bendt
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden. .,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Åke Seiger
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Göran Hagman
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hultling
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Spinalis, Foundation, Stockholm, Sweden.,Sophiahemmet, University College, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden.,Allied Health Professionals, Medical Unit Occupational Therapy and Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem R & D Unit, Stockholm, Sweden
| | - Emelie Butler Forslund
- Aleris Rehab Station, Spinalis Outpatient Clinic, Solna, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
25
|
Damar HT, Bilik Ö, Baksi A, Akyil Ş. Examining the relationship between elderly patients' fear of falling after spinal surgery and pain, kinesiophobia, anxiety, depression and the associated factors. Geriatr Nurs 2021; 42:1006-1011. [PMID: 34256148 DOI: 10.1016/j.gerinurse.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023]
Abstract
This study aimed to examine the relationship between fear of falling in elderly patients who underwent spinal surgery and pain, kinesiophobia, anxiety, depression, and associated factors. The study was a descriptive, cross-sectional design. The research sample consisted of 211 elderly patients who had undergone spinal surgery. The average age of the patients was 66.68 ± 5.57. Of the sample, 83.4% were afraid of falling, and 21.3% were severely afraid of falling. In the study, age (β = 0.115, p = 0.005), being a woman (β = -0.182, p < 0.001), pain (β = 0.269, p < 0.001), risk of falling (β = 0.084, p = 0.49), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) (β = 0.135, p = 0.044), Hospital Anxiety and Depression Scale Anxiety-Depression (HADS-D) (β = 0.382, p < 0.001), and kinesiophobia (β = 0.722, p < 0.001) were statistically significant predictors of fear of falling. This study provided important information about the variables that surgical nurses should pay attention to while evaluating the fear of falling in elderly patients who underwent spinal surgery.
Collapse
Affiliation(s)
- Hale Turhan Damar
- Elderly Care Program, Health Services Vocational School, İzmir Demokrasi University, Izmir, Turkey.
| | - Özlem Bilik
- Department of Surgical Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey.
| | - Altun Baksi
- Department of Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey.
| | - Şirin Akyil
- Dokuz Eylül University Hospital, Izmır, Turkey.
| |
Collapse
|
26
|
Marshall K, Gustafsson L, McKittrick A, Fleming J. Falls Occurring After a Spinal Cord Injury: A Scoping Review. Am J Occup Ther 2021; 75:12500. [PMID: 34781344 DOI: 10.5014/ajot.2021.043695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life. OBJECTIVE To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population. DATA SOURCES We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person's experience of falls, and strategies to prevent falls. FINDINGS Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person's experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically. CONCLUSIONS AND RELEVANCE Research on participants' experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.
Collapse
Affiliation(s)
- Kathryn Marshall
- Kathryn Marshall, BOccThy, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Queensland, Australia;
| | - Louise Gustafsson
- Louise Gustafsson, PhD, BOccThy(Hons), is Professor, School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia, and Honorary Professor, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea McKittrick
- Andrea McKittrick, BSc(Hons) CurrOcc, is PhD Student, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia, and Occupational Therapist, Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy(Hons), FOTARA, is Professor and Head of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Investigating proactive balance control in individuals with incomplete spinal cord injury while walking on a known slippery surface. Neurosci Lett 2021; 749:135744. [PMID: 33610664 DOI: 10.1016/j.neulet.2021.135744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Up to 83 % of individuals with incomplete spinal cord injury (iSCI) experience ≥ 1 fall/year. Individuals with iSCI employ more cautious walking strategies than able-bodied (AB) individuals during normal walking. Whether individuals with iSCI can use proactive balance strategies to adapt to expected slip perturbations/reduce slip severity while walking has not been previously assessed. METHODS 19 individuals with iSCI (AIS D; 14 males; 61 ± 18 years) and 17 AB individuals (13 males; 61 ± 18 years) completed 3 walking conditions: normal walking trials, an unexpected slip trial, and expected slip trials. Steel rollers induced a slip in the antero-posterior (AP) direction. Outcome variables included step length, center of mass velocity, foot-floor angle, AP margin of stability, and maximum post-slip velocity (PSV). RESULTS The iSCI group used a greater magnitude of cautious strategies (i.e. walking slower with shorter, flatter steps) than AB individuals in all conditions. However, the lack of significant interaction effects indicate that the proactive adaptations compared to normal walking (i.e. walking slower with shorter, flatter steps, and a more anterior xCOM-position) were similar between the two groups (AB & iSCI). Both groups showed a similar rate of adaptation (after just 1 slip) and these feedforward changes were maintained throughout the remaining slip trials which was effective at reducing maximum PSV. CONCLUSIONS Individuals with iSCI use proactive balance strategies to adapt to a known slippery surface in a similar manner to AB individuals both in terms of the proportion and timing of adaptation.
Collapse
|
28
|
Kumprou M, Amatachaya P, Sooknuan T, Arayawichanon P, Thaweewannakij T, Amatachaya S. The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury. Hong Kong Physiother J 2021; 41:55-63. [PMID: 34054257 PMCID: PMC8158402 DOI: 10.1142/s1013702521500050] [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: 03/29/2020] [Accepted: 12/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability. Objective: This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily (n=49). Methods: All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance. Results: The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability (p<0.05). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance (ρ=−0.351 to −0.493, p<0.05). Conclusion: The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.
Collapse
Affiliation(s)
- Makamas Kumprou
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pipatana Amatachaya
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,School of Mechanical Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima 30000, Thailand
| | - Thanat Sooknuan
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Electronics Engineering, Faculty of Engineering and Architecture Rajamangala University of Technology Isan, Nakhon Ratchasima 30000, Thailand
| | - Preeda Arayawichanon
- Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.,Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thiwabhorn Thaweewannakij
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.,Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|
29
|
Predicting falls and injuries in people with multiple sclerosis using machine learning algorithms. Mult Scler Relat Disord 2021; 49:102740. [PMID: 33450500 DOI: 10.1016/j.msard.2021.102740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022]
Abstract
Falls in people with Multiple Sclerosis (PwMS) is a serious issue. It can lead to a lot of problems including sustaining injuries, losing consciousness and hospitalization. Having a model that can predict the probability of these falls and the factors correlated with them and can help caregivers and family members to have a clearer understanding of the risks of falling and proactively minimizing them. We used historical data and machine learning algorithms to predict three outcomes: falling, sustaining injuries and injury types caused by falling in PwMS. The training dataset for this study includes 606 examples of monthly readings. The predictive attributes are the following: Expanded Disability Status Scale (EDSS), years passed since the diagnosis of MS, age of participants in the beginning of the experiment, participants' gender, type of MS and season (or month). Two types of algorithms, decision tree and gradient boosted trees (GBT) algorithm, were used to train six models to answer these three outcomes. After the models were trained their accuracy was evaluated using cross-validation. The models had a high accuracy with some exceeding 90%. We did not limit model evaluation to one-number assessments and studied the confusion matrices of the models as well. The GBT had a higher class recall and smaller number of underestimations, which make it a more reliable model. The methodology proposed in this study and its findings can help in developing better decision-support tools to assist PwMS.
Collapse
|
30
|
Musselman KE, Arora T, Chan K, Alavinia M, Bone M, Unger J, Lanovaz J, Oates A. Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers. Arch Rehabil Res Clin Transl 2020; 3:100096. [PMID: 33778471 PMCID: PMC7984974 DOI: 10.1016/j.arrct.2020.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). Design Prospective cohort study. Setting Community. Participants Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome Measures Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant's number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. Results Median follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers (P<.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. Conclusions There are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients' fall risk.
Collapse
Affiliation(s)
- Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tarun Arora
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Chan
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mohammad Alavinia
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Mackenzie Bone
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janelle Unger
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
31
|
Wettasinghe AH, Dissanayake DWN, Allet L, Katulanda P, Lord SR. Falls in older people with diabetes: Identification of simple screening measures and explanatory risk factors. Prim Care Diabetes 2020; 14:723-728. [PMID: 32473990 DOI: 10.1016/j.pcd.2020.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
Abstract
AIMS To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool. METHODS Older adults with DM (n = 103; age = 61.6 + 6.0 years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction time, balance, mobility and gait parameters were assessed using validated methods. Falls were prospectively recorded over six months. RESULTS Past falls and female gender were identified as significant predictors of falls: history of falls and female gender increased fall rates by 4.62 (95% CI = 2.31-9.27) and 2.40 (95% CI = 1.04-5.54) respectively. Fall rates were significantly associated with Diabetic Neuropathy scores, HbA1c level, contrast sensitivity, quadriceps strength, postural sway, tandem balance, stride length and Timed Up and Go Test times. A multi-variable fall risk tool derived using five measures, revealed that absolute risk for multiple falls increased from 0% in participants with zero or one factor to 83% in participants with all five risk factors. CONCLUSIONS Simple screening items for fall risk in people with DM were identified, with parsimonious explanatory risk factors. These findings help guide tailored interventions for preventing falls in DM.
Collapse
Affiliation(s)
- Asha H Wettasinghe
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | | | - Lara Allet
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland; Department of Physiotherapy, School for Health Sciences, HES-SO, University of Applied Sciences & Arts of Western Switzerland, Geneva, Switzerland
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia
| |
Collapse
|
32
|
Mat S, Kamaruzzaman SB, Chin AV, Tan MP. Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above. Front Public Health 2020; 8:571196. [PMID: 33163471 PMCID: PMC7591456 DOI: 10.3389/fpubh.2020.571196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013–2015) and follow-up (2015–2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question “Are you afraid of falling?” Results: Data were available for 605 participants, mean (SD) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02–3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13–0.97)]. Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
Collapse
Affiliation(s)
- Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai-Vyrn Chin
- Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Innovation in Medical Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Subang Jaya, Malaysia
| |
Collapse
|
33
|
Singh H, Shibi Rosen A, Bostick G, Kaiser A, Musselman KE. Exploring the causes and impacts of falls among ambulators with spinal cord injury using photovoice: a mixed-methods study. BMJ Open 2020; 10:e039763. [PMID: 32868369 PMCID: PMC7462239 DOI: 10.1136/bmjopen-2020-039763] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES This study explored: (1) fall circumstances experienced by ambulators with spinal cord injury (SCI) over a 6-month period, (2) the impacts of falls-related injuries and fall risk and (3) their preferences/recommendations for fall prevention. DESIGN A sequential explanatory mixed-methods design with two phases. SETTING A Canadian SCI rehabilitation hospital and community setting. PARTICIPANTS Thirty-three ambulators with SCI participated in phase 1 and eight participants that fell in phase 1 participated in phase 2. METHODS In phase 1, fall circumstances were tracked using a survey that was completed each time a participant fell during the 6-month tracking period. Phase 2 involved photovoice; participants took photographs of factors that influenced their fall risk and how their fall risk impacted their work/recreational activities. Participants discussed the photographs and topics related to fall prevention in an individual interview and a focus group. RESULTS Of the 33 participants, 21 fell in 6 months. Falls commonly occurred in the home while participants were changing positions or walking. Most falls occurred in the morning or afternoon. In phase 2, interviews and focus group discussion revealed three themes: (1) falls are caused by bodily impairments (eg, impaired reactive response during slips and trips and weakness and altered sensation in legs/feet), (2) impacts of fall-related injuries and fall risk (eg, psychosocial effects of fall-related injuries, limiting community participation due to the risk of falling and activity-dependent concern of falling) and (3) approaches to fall prevention (eg, fall prevention strategies used, components of fall prevention and utility of professional fall prevention strategies/interventions). CONCLUSIONS Fall prevention interventions/strategies should focus on minimising a person's fall risk within their home as most falls occurred in the home environment. Ambulators with SCI would benefit from education and awareness about common fall circumstances that they may encounter in their daily lives.
Collapse
Affiliation(s)
- Hardeep Singh
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Arielle Shibi Rosen
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Neuroscience Program (interdepartmental), Department of Biology, Physiology, and Psychology, McGill University, Montreal, Québec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Anita Kaiser
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Kristin E Musselman
- Rehabilitation Sciences Institute, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Arora T, Musselman KE, Lanovaz JL, Linassi G, Arnold C, Milosavljevic S, Oates A. Reactive balance responses to an unexpected slip perturbation in individuals with incomplete spinal cord injury. Clin Biomech (Bristol, Avon) 2020; 78:105099. [PMID: 32653743 DOI: 10.1016/j.clinbiomech.2020.105099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/05/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frequent falls while walking among individuals with incomplete spinal cord injury may suggest impairments in reactive balance control; however, reactive balance control during walking has not been studied in this population. The objective was to compare reactive balance control with respect to changes in margin of stability, onset of arm and heel responses, and onset and magnitude of muscle activity following an unexpected slip perturbation in individuals with incomplete spinal cord injury and able-bodied individuals. METHODS Kinematic and electromyography data were obtained during normal walking and one unexpected slip. Changes in margin of stability following a compensatory or aborted step, onset of arms and trail heel responses, and onset and magnitude of activation of the tibialis anterior, soleus and gluteus medius were calculated. Multivariate analyses compared responses between incomplete spinal cord injury and able-bodied groups. FINDINGS Data from 16 participants with incomplete spinal cord injury (all American Spinal Injury Association Impairment Scale Grade D, 8 with tetraplegia) and 13 age-and-sex matched able-bodied individuals were included. Individuals with incomplete spinal cord injury demonstrated limited ability to increase margin of stability in the lateral direction during a compensatory or aborted step, and a smaller magnitude of soleus activity compared to able-bodied individuals. INTERPRETATION There are limitations in reactive balance control of individuals with incomplete spinal cord injury, which may be a reason for the high frequency of falls in this population. Reactive balance assessment should be included as a component of routine balance assessment and fall avoidance strategies in this population.
Collapse
Affiliation(s)
- Tarun Arora
- Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; College of Medicine, University of Saskatchewan, Saskatoon, Canada; School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada.
| | - Kristin E Musselman
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Dept. of Physical Therapy, Faculty of Medicine, University of Toronto, Canada
| | - Joel L Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| | - Gary Linassi
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Catherine Arnold
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Stephan Milosavljevic
- College of Medicine, University of Saskatchewan, Saskatoon, Canada; School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatchewan, Canada
| |
Collapse
|
35
|
Abou L, Alluri A, Fliflet A, Du Y, Rice LA. Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 102:132-154. [PMID: 32745544 DOI: 10.1016/j.apmr.2020.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected. DATA EXTRACTION Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence. RESULTS Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSIONS Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
Collapse
Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiting Du
- Department of Interdisciplinary Health Sciences, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
| |
Collapse
|
36
|
Choobsaz H, ShahAli S, Salehi R, Noorizadeh Dehkordi S, Shanbehzadeh S. Discriminative ability of fall efficacy scale international in Iranian people with multiple sclerosis. Mult Scler Relat Disord 2020; 42:102083. [DOI: 10.1016/j.msard.2020.102083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
|
37
|
Axén I, Jensen I, Butler Forslund E, Grahn B, Jørgensen V, Opava CH, Bodin L. Frequently repeated measurements -our experience of collecting data with SMS. BMC Med Res Methodol 2020; 20:124. [PMID: 32429834 PMCID: PMC7236444 DOI: 10.1186/s12874-020-01013-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background As technology is advancing, so are the possibilities for new data collection methods in research, potentially improving data quality and validity of the results. In Sweden, a system using frequent repeated data collection using text messages, SMS Track, has been used in clinical research for more than a decade. In this paper, compliance with repeated text message questions was examined across five different studies, i.e. if compliance was 1: associated with study-specific factors (age or gender of the subjects, the condition, its’ severity or course, i.e. improvement, relapse or steady state) and/or. 2: associated with the methodology itself (the question being asked, the frequency and number of questions, duration of data collection, initial compliance or the management of the system). Methods Descriptive comparisons were done across five studies. Three studies were collecting weekly responses over at least 52 weeks (“Weekly studies”) and were used to investigate the effect of age, sex and pain severity on compliance, the effect of early compliance for late compliance, and finally the early occurrence of two successive weeks with non-compliance. Result Compliance was excellent across all five studies, and only influenced somewhat by age, sex and pain-level. The factor “study” remained significant in the final model thus the observed differences may be a result of the conditions studied but does not seem to be attributable to severity or development of these conditions. Number and frequency of questions did not influence compliance, nor did study duration. Conclusions Compliance was excellent in the included studies and was not affected by population factors. However, differences in compliance were observed that cannot be easily explained and warrant further investigation. In particular, the nature of the variables or the management of the study are potential areas for further investigations.
Collapse
Affiliation(s)
- I Axén
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden.
| | - I Jensen
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden
| | - E Butler Forslund
- Rehab Station Stockholm, Research and Development Unit, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - B Grahn
- Department of Clinical Sciences Lund, Orthopedics, Faculty of medicine, Lund University, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - V Jørgensen
- Research Departement, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, N-1453, Bjørnemyr, Norway
| | - C H Opava
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - L Bodin
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Nobels väg 13, S- 171 77, Stockholm, Sweden
| |
Collapse
|
38
|
Kulkarni S, Gadkari R, Nagarkar A. Risk factors for fear of falling in older adults in India. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
39
|
Do clinical balance measures have the ability to predict falls among ambulatory individuals with spinal cord injury? A systematic review and meta-analysis. Spinal Cord 2019; 57:1001-1013. [PMID: 31477809 DOI: 10.1038/s41393-019-0346-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN Systematic review and meta-analysis. BACKGROUND AND PURPOSE Fall prevalence is high among individuals with spinal cord injury (SCI) and falls may lead to serious consequences. The objective of this study was to investigate the ability of clinical balance measures to predict falls among ambulatory individuals with SCI. METHODS We searched the online databases MEDLINE, Web of Science, Scopus, SportDiscuss, and CINAHL. Two reviewers independently selected prospective and cross-sectional studies of ambulatory adults with SCI, with a method of falls tracking and a clinical balance evaluation. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. A meta-analysis of prospective and cross-sectional studies was performed using Review Manager 5.3. RESULTS Ten studies from the 2672 studies identified were included in the qualitative synthesis. Nine studies were included in the meta-analyses. The Berg Balance Scale (BBS) and the Timed Up and Go Test demonstrate ability to differentiate between fallers and non-fallers, mean difference 5.25 (95% CI, 0.29 to 10.20) and 6.65 (95% CI, 0.17 to 13.12) respectively. The BBS presents moderate predictive ability (area under the receiver operating characteristic curve of 0.61 and sensitivity of 65%). Individuals with a BBS score ≥ 40 are likely at risk of falls. CONCLUSION The BBS is the most appropriate and specific clinical balance measure with the ability to discriminate between ambulatory fallers and non-fallers. However, the fall predictive abilities of the measure need to be further explored and improved for this population.
Collapse
|
40
|
Jørgensen V, Slettahjell HB, Skavberg Roaldsen K, Kostovski E. Carboxy terminal collagen crosslinks as a prognostic risk factor for fall-related fractures in individuals with established spinal cord injury. Spinal Cord 2019; 57:985-991. [PMID: 31308468 PMCID: PMC6892418 DOI: 10.1038/s41393-019-0322-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 11/09/2022]
Abstract
Study design Prospective cohort study. Objective To study associations between specific bone turnover markers and fall-related fractures in individuals with spinal cord injury (SCI). Setting Rehabilitation Hospital. Methods Carboxy terminal collagen crosslinks (CTX), type-1 procollagen N-terminal (P1NP), albumin-corrected calcium (Ca2+), parathyroid hormone (PTH) and vitamin D were examined in a cohort of 106 participants with SCI at least 1 year post injury. The participants were followed for 1 year monitoring fall-related fractures. Results In total, 29 out of 106 reported having experienced a fall-related fracture post-injury at baseline, and 5 out of 100 had experienced a fall-related bone fracture during the 1 year follow-up. Our main findings were that high levels of serum CTX increased the odds of being in the fracture group, and that 25-hydroxy vitamin D (25 OHD) levels, Ca2+, PTH or P1NP were not associated with being in the fracture group. Conclusions We here present an association between high-CTX plasma levels at baseline and fall-related fractures reported during a 1-year follow-up among individuals with established SCI. We recommend studies with larger SCI populations before further clinical implications can be drawn.
Collapse
Affiliation(s)
- Vivien Jørgensen
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway
| | | | - Kirsti Skavberg Roaldsen
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Emil Kostovski
- Department of Research, Sunnaas Rehabilitation Hospital, University of Oslo, Oslo, Norway
| |
Collapse
|
41
|
Khan A, Pujol C, Laylor M, Unic N, Pakosh M, Dawe J, Musselman KE. Falls after spinal cord injury: a systematic review and meta-analysis of incidence proportion and contributing factors. Spinal Cord 2019; 57:526-539. [PMID: 30967602 DOI: 10.1038/s41393-019-0274-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Falls are detrimental to the well-being of individuals with spinal cord injury (SCI). To establish effective fall prevention initiatives, a comprehensive understanding of falls after SCI is needed. OBJECTIVES To report the incidence proportion of falls and summarize the factors contributing to falls in individuals with SCI. STUDY DESIGN Systematic review and meta-analysis. METHODS Eight databases were searched. Abstracts/full articles were screened by two researchers independently. Data concerning study design, participant characteristics, and the incidence proportion, factors, and consequences of falls were extracted. Risk of bias was assessed using a domain-based approach that considered sampling and measurement bias. The incidence proportions of falls were pooled for ambulators and wheelchair users separately using random-effects meta-analyses, and compared descriptively for inpatients and community-dwelling individuals. Fall-related factors were organized according to the Biological, Behavioral, Social & Economic and Environmental Model of fall risk. RESULTS The search resulted in 1706 articles; 24 unique studies were included. The risk of sampling bias was high. All but one study focused on community-dwelling individuals; 78% (95% confidence interval 73-83%, I2 = 0%) of ambulators and 69% (95% confidence interval 60-76%, I2 = 59%) of wheelchair users fell ≥1 over 12 months. In contrast, only 13% of inpatients fell. Most fall-related factors were categorized as biological (e.g., muscle weakness), behavioral (e.g., inattentiveness) or environmental (e.g., uneven surfaces). CONCLUSIONS Falls are frequent among community-dwelling individuals with SCI. A variety of biological, behavioral, and environmental factors contribute to falls, some of which are modifiable and may be addressed through SCI-specific fall prevention initiatives.
Collapse
Affiliation(s)
- Alia Khan
- SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Clara Pujol
- SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Laylor
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Nikola Unic
- SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jaclyn Dawe
- SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin E Musselman
- SCI Mobility Lab, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. .,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
42
|
Vitorino LM, Marques‐Vieira C, Low G, Sousa L, Cruz JP. Fear of falling among Brazilian and Portuguese older adults. Int J Older People Nurs 2019; 14:e12230. [DOI: 10.1111/opn.12230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/27/2019] [Accepted: 02/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Luciano M. Vitorino
- Faculty of Medicine of Itajubá Itajubá Brazil
- Faculty of Medicine Federal University of Juiz de Fora – UFJF Juiz de Fora Brazil
| | - Cristina Marques‐Vieira
- School of Nursing of Lisbon, Institute of Health Sciences Universidade Católica Portuguesa Lisbon Portugal
- CIIS Lisbon Portugal
| | - Gail Low
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Luís Sousa
- Nurse at Curry Cabral Hospital Central Lisbon Hospital Center Lisbon Portugal
- Atlântica Higher School of Health Sciences Atlântica University Barcarena Portugal
| | - Jonas P. Cruz
- Nursing Department, College of Applied Medical Sciences Shaqra University Al Dawadmi Saudi Arabia
| |
Collapse
|
43
|
Walking Stability During Normal Walking and Its Association with Slip Intensity Among Individuals with Incomplete Spinal Cord Injury. PM R 2019; 11:270-277. [DOI: 10.1016/j.pmrj.2018.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/11/2018] [Indexed: 11/20/2022]
|
44
|
Predictors of falls in persons with spinal cord injury—a prospective study using the Downton fall risk index and a single question of previous falls. Spinal Cord 2018; 57:91-99. [DOI: 10.1038/s41393-018-0175-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/08/2022]
|
45
|
Arora T, Oates A, Lynd K, Musselman KE. Current state of balance assessment during transferring, sitting, standing and walking activities for the spinal cord injured population: A systematic review. J Spinal Cord Med 2018; 43:10-23. [PMID: 29869951 PMCID: PMC7006707 DOI: 10.1080/10790268.2018.1481692] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Comprehensive balance measures with high clinical utility and sound psychometric properties are needed to inform the rehabilitation of individuals with spinal cord injury (SCI). OBJECTIVE To identify the balance measures used in the SCI population, and to evaluate their clinical utility, psychometric properties and comprehensiveness. METHODS Medline, PubMed, Embase, Scopus, Web of Science, and the Allied and Complementary Medicine Database were searched from the earliest record to October 19/16. Two researchers independently screened abstracts for articles including a balance measure and adults with SCI. Extracted data included participant characteristics and descriptions of balance measures. Quality was evaluated by considering study design, sampling method and adequacy of description of research participants. Clinical utility of all balance measures was evaluated. Comprehensiveness was evaluated using the modified Systems Framework for Postural Control. RESULTS 2820 abstracts were returned and 127 articles included. Thirty-one balance measures were identified; 11 evaluated a biomechanical construct and 20 were balance scales. All balance scales had high clinical utility. The Berg Balance Scale and Functional Reach Test were valid and reliable, while the mini-BESTest was the most comprehensive. CONCLUSION No single measure had high clinical utility, strong psychometric properties and comprehensiveness. The mini-BESTest and/or Activity-based Balance Level Evaluation may fill this gap with further testing of their psychometric properties.
Collapse
Affiliation(s)
- Tarun Arora
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - Kaylea Lynd
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Kristin E. Musselman
- Health Sciences, College of Medicine, University of Saskatchewan, Saskatoon, Canada,School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada,Toronto Rehabilitation Institute-University Health Network, Toronto, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada,Correspondence to: Kristin E. Musselman PT, PhD, SCI Mobility Lab, Lyndhurst Centre, Toronto Rehabilitation Institute-University Health Network, 520 Sutherland Drive, Toronto, ON, Canada, M4G 3V9; Ph: (416) 597-3422 x6190.
| |
Collapse
|
46
|
Marquez MA, De Santis R, Ammendola V, Antonacci M, Santilli V, Berardi A, Valente D, Galeoto G. Cross-cultural adaptation and validation of the “Spinal Cord Injury-Falls Concern Scale” in the Italian population. Spinal Cord 2018; 56:712-718. [DOI: 10.1038/s41393-018-0070-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/10/2022]
|
47
|
Abstract
This chapter covers balance, gait, and falls in individuals with spinal cord injury (SCI) from a clinical perspective. First, the consequences of an SCI on functioning are explained, including etiology, clinical presentation, classification, and epidemiologic data. Then, the specific aspects of balance disorders, gait disorders, and falls are discussed with respect to motor complete (cSCI) and incomplete (iSCI) SCI. Typically, these activities are affected by impaired afferent and efferent nerves, but not by central nervous processing. Performance of daily life activities in cSCI depends on the ability to control the interaction between the center of mass and the base of support or limits of stability. In iSCI, impaired proprioception and muscle strength are important factors for completing balancing tasks and for walking. Falls are common in patients with SCI. Subsequent sections describe therapy approaches aimed at modifying balance, gait, and the risk for falls by means of therapeutic exercises, assistive devices like robots or functional electric stimulation, and environmental adaptations. The last part covers recent developments and future directions. These encompass interventions for maximizing residual neural function and regeneration of axons, as well as technical solutions like epidural or intraspinal electric stimulation, powered exoskeletons, and brain computer interfaces.
Collapse
Affiliation(s)
- Markus Wirz
- Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland.
| | - Hubertus J A van Hedel
- Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
| |
Collapse
|