[Postural strategies and falls in elderly and in parkinsonism]

Postural Sway and Effect of Levodopa in Early Parkinson's Disease

Objective:

To characterize postural stability control and levodopa responsiveness in early Parkinson's disease (PD).

Methods:

Postural sway was studied during quiet stance in ten patients within six years of PD onset, both before (OFF) and after (ON) regular oral levodopa dosing. Postural sway was recorded using a force platform during 30 sec with eyes open, and six dependent variables were examined.

Results:

Mild baseline subclinical changes in postural sway were recorded in our patients. Clear benefit was observed in five out of six characteristics (mean sway, transversal sway, sagittal sway, sway intensity, and sway area) in the ON condition.

Conclusion:

Postural control mechanisms are affected early in PD and modulated by dopamine.

[Study of the postural profile and spinal static for menopausal-women with chronic low back pain]

OBJECTIVES

To study postural and spinal static modifications associated with chronic low back pain in menopausal women.

METHODS

Clinical appreciation of static spinal profile in sagittal plane; postural evaluation on the Balance Master Neurocom force platform by the modified clinical test for the sensory interaction on balance (modified CTSIB test); Radiological evaluation of spinal and pelvic parameters as well as the sagittal profile according to the Roussouly classification.

RESULTS

Spinal curves clinical measurement and the sway velocity of the pressure center on the Balance Master Neurocom do not show significant difference between the two groups. While the pressure center position in the anteroposterior axis shows significant difference between the two groups (p=0.02) with a more backwards projection found in chronic low back pain subjects. Radiological evaluation shows sagittal shelter significantly superior, sacral slope significantly lower and the type 1 of lumbar lordosis more frequent in chronic low back pain women compared to healthy women.

DISCUSSION-CONCLUSION

In menopausal women, chronic low back pain seems to be associated with lower sacal slope, the type 1 of lumbar lordosis more frequent and behindly projection of pressure center.

Rôle du Neurocom Balance Master® dans l'évaluation des troubles de l'équilibre et du risque de chute chez le sujet âgé

INTRODUCTION

Falls in elderly people is currently a health service problem because of the multiple consequences. Numerous teams have been interested in predicting the risk of falling with clinical and instrumental tests. Our study investigated instrumental evaluation by use of the Neurocom Balance Master in the global assessment of gait problems and risk of falling in elderly people.

PATIENTS AND METHODS

Transverse study concerning 60 subjects older than 65 years distributed in 2 groups of 30 subjects each according to the existence or not of falling incidents during the past year. Evaluation by the Balance Master involved the following items: 1) the modified Clinical Test for the Sensory Interaction on Balance (CTSIB), which estimates balance by measuring the speed of oscillation of the center of pressure (CP) with open then closed eyes and firm then mossy ground; 2) support monopodal 5" to the left then to the right, eyes open then closed in moderated speeds of oscillation of the CP; 3) passage from standing to sitting, in moderated speeds of oscillation of the CP; 4) limits of stability: the possibilities of moving the CP towards a predetermined target without moving the feet in moderated time and speed; 5) study of the step: determine length and width of the step as well as speed; 6) most about-turn: measure of speed of oscillation of the CP during the right then left about-turn; 7) clearing: the force of the impact and the oscillations of the CP during the clearing of an obstacle 10 cm high to measure leverage.

RESULTS

The oscillation speed of the CP in the 2 groups during modified CTSIB, support monopodal 5", passage from standing to sitting, about-turn and clearing were significantly improved the group of the patients with falls (P < 0.05). The step, length and speed of these patients were significantly reduced, with no difference in width of the step between the 2 groups. In the evaluation of the limits of stability, only time necessary to reach the target was significantly increased in the group with falls. Finally, the indication of leverage and the force of impact on the ground measured by the test of clearing were more important in the group of fallers than in non-fallers.

CONCLUSION

The Neurocom Balance Master estimates not only postural balance, but also the vestibulary system and reproduces the physiological conditions of daily life. It has a certain role in the early assessment of gait problems and the risk of falling. This system also allows for rehabilitation of the impaired balance and offers a profit with the biofeedback.

Undisturbed upright stance control in the elderly: Part 2. Postural-control impairments of elderly fallers

A common way of predicting falling risks in elderly people can be to study center of pressure (CP) trajectories during undisturbed upright stance maintenance. By estimating the difference between CP and center of gravity (CG) motions (CP - CGv), one can estimate the neuromuscular activity. The results of this study, which included 34 sedentary elderly persons aged over 75 years (21 fallers and 13 nonfallers), demonstrated significantly increased CGh and CP - CGv motions in both axes for the fallers. In addition, the fallers presented larger CGh motions in the mediolateral axis, suggesting an enlarged loading-unloading mechanism, which could have reflected the adoption of a step-initiating strategy. As highlighted by fractional Brownian motion modeling, the distance covered by the CP - CGv motions before the successive control mechanisms switched was enhanced for the fallers in both axes, therefore increasing the risk that the CG would be outside of the base of support.

Évaluation posturale à domicile chez la personne âgée : comparaison chuteurs–non chuteurs

OBJECTIVES

To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal.

MATERIALS AND METHODS

The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center.

RESULTS

From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz).

CONCLUSIONS

To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.

Incidence, circonstances et conséquences des chutes chez les patients en rééducation après un premier accident vasculaire cérébral

OBJECTIVES

To describe the incidence, circumstances, and consequences of falls in patients admitted in a rehabilitation ward after a stroke.

METHODS

Prospective monitoring of falls over four years in a neurological rehabilitation unit. Use of fall registry.

INCLUSION CRITERIA

age < 75 years, admission < 45 days after stroke onset, single stroke of 1 cerebral hemisphere (nonlacunar) or of the brain stem. Only falls due to loss of balance were considered; falls caused by a seizure or syncope were not considered.

RESULTS

Of 217 consecutive patients with the inclusion criteria, 34 had fallen at least once (15.7%) and 10 twice (4.1%). Fall incidence, defined as the number of falls per patient per day was 2.2 per thousand. Half of the patients fell the first three weeks after admission. Most falls involved getting to or from the wheelchair or the bed; 1 patient had recovered minimal postural abilities at the gym but was not independent. Traumatic lesions were noted in 13 patients: they were minor in nine and severe in four, including three fractures.

CONCLUSION

Falls due to loss of balance are a major problem in patients undergoing rehabilitation after a stroke. Getting to and from wheelchairs in the bedroom and bathroom by patients who are not allowed to do so play a key role in many falls. Prevention programs should consider this information.