Obstacle course training can improve mobility and prevent falls in people with intellectual disabilities

Risk factors associated with history of falls in adults with intellectual disability

BACKGROUND

Adults with intellectual disability (ID) have a higher risk for falls than the general population.

AIM

The purpose of this study was to identify risk factors for falls in adults with ID using objective measurements.

METHODS

Eighty adults with ID (men 36 women 44 age 43 ± 13 years) provided data on falls history, health problems or limitations in daily life, physical activity (PA), and physical performance. We conducted independent-samples t-tests, and Chi-square (χ²) tests to examine the difference between fallers and non-fallers. Multivariate logistic regressions were performed to identify the independent effects of risk factors for falls in adults with ID.

RESULTS

Fallers had significantly lower SPPB, mobility, and moderate PA than non-fallers (p <  .05). Fallers were more likely to be older, need support with activities of daily living (ADLs), and have arthritis or rheumatism, walking problem, and limitations to participating in PA than non-fallers (p <  .05). Among these variables, only needing support with ADLs remained a significant independent predictor of falls in a multivariate model.

CONCLUSION

Support need for ADLs can predict falls in individuals with ID. Caregivers may need to closely monitor adults with ID who need support for ADLs.

Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review

OBJECTIVE

The objective of the review was too synthesize the best available evidence on the incidence and prevalence of falls among adults with intellectual disability (ID).

INTRODUCTION

Falls among adults with ID frequently cause physical injury and may negatively impact on their quality of life. Studies investigating falls among people with ID have used differing methods and populations, making it difficult to determine the scope and extent of this problem.

INCLUSION CRITERIA

This review considered all studies that included adults with ID aged 18 years and over and which reported percentage/numbers of individuals who fell, and the total number of falls and injurious falls sustained from a fall. Studies were included if they were conducted within community or residential settings. Studies that were conducted in hospitals were excluded. Cohort studies, case-control and cross-sectional studies were included. Studies that used an experimental design, both randomized controlled and quasi experimental design, were also included.

METHODS

A three-step search strategy was undertaken for published and unpublished literature in English from 1990 to 2017. An initial search of MEDLINE and CINAHL was undertaken before a more extensive search was conducted using keywords and index terms across 11 electronic databases. Two independent reviewers assessed the methodological quality of the included studies using the Joanna Briggs Institute standardized critical appraisal instrument for prevalence studies (Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data).Data was extracted using the Joanna Briggs Institute's standardized extraction tool. Data that directly reported or could be used to calculate the incidence and prevalence of falls were extracted. Quantitative data for the number (proportion) of people who fell were pooled in statistical meta-analysis using STATA version 14 (Stata Corp LLC, Texas, USA). Data measuring incidence of falls (rate of falls for the duration of the study) and incidence of injurious falls (rate of falls resulting in one or more injuries for the duration of the study) could not be pooled in meta-analysis, hence results have been presented in a narrative form including tables. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes is also reported.

RESULTS

Nine studies were eligible for inclusion in this review. Eight articles were observational cohort studies which reported on the incidence/prevalence of falls as outcome measures, and one article was a quasi-experimental study design. Overall the methodological quality of the included studies was considered moderate. The pooled proportion of people with ID who fell (four studies, 854 participants) was 39% (95% CI [0.35%-0.43%], very low GRADE evidence). The rate of falls (eight studies, 782 participants) ranged from 0.54 to 6.29 per person year (very low GRADE evidence). The rate of injurious falls (two studies, 352 participants) ranged from 0.33 to 0.68 per person year (very low GRADE evidence).

CONCLUSIONS

Synthesized findings demonstrate that people with ID, who live in community or residential settings, may fall more frequently, and at a younger age, compared to general community populations. Studies should take a consistent approach to measuring and reporting falls outcomes. Further research is recommended to identify the impact of falls on health related outcomes for people with ID and subsequently evaluate falls interventions for their efficacy.

Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability

BACKGROUND

Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations.

METHOD

A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method.

RESULTS

Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways.

CONCLUSION

There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.

[Effects of a physical exercise programme on the risk of falls, balance, and walking speed in older people with intellectual disabilities]

INTRODUCTION

People with intellectual disabilities (ID) have balance disturbances and risk of falls, which are aggravated with ageing. This study aimed to provide information on the effects of an exercise programme on fall risk, balance, and walking speed in a group of older people with ID.

MATERIALS AND METHODS

Eight people with mild to moderate ID (mean age: 56.37±7.08 years) participated in a 12-week programme based on a weekly session that included exercises aimed at strengthening stabilising muscles, stimulating proprioception, and enhancing reflexes in unstable situations. The effects of the programme on the risk of falling and on balance and walking speed were assessed using the Tinetti scale and the Timed Up and Go test, respectively.

RESULTS

The programme was feasible and no adverse effects were registered. At the end of the programme, the risk of falls remained unchanged, while balance and gait speed improved significantly.

CONCLUSIONS

A three-month weekly programme based on muscle strengthening and proprioceptive re-education exercises was feasible and had a positive impact on balance and walking speed in a group of older people with ID. These results lay the foundation for future randomised clinical trials aiming to confirm the effects of such programmes on the risk of falls in this population.

Incidence and associated risk factors for falls in adults with intellectual disability

BACKGROUND

People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community.

METHODS

A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling.

RESULTS

Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)].

CONCLUSIONS

People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.

Feasibility and acceptability of Otago Exercise Programme and Prevention of Falls for Adults with Intellectual Disability: a multiple case study design

Background/Aims

Many people with intellectual disability fall frequently. Understanding fall prevention intervention characteristics will assist efficacy trials to target appropriate people. An exploration of two exercise-based fall prevention interventions is reported, focusing on viability and acceptability.

Methods

A multiple case study of adults with intellectual disability completing either the group Otago Exercise Programme or the Prevention of Falls for Adults with Intellectual Disability intervention was performed. Integrated data sources were used: semi-structured interviews with participants and support workers, observations, attendance/adherence, falls, adverse events and balance measures.

Results

In total, seven adults with varying intellectual disability levels participated. Overall, three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants.

Conclusions

Educating adults with intellectual disability and their support workers of the importance of regular exercise is key to participation. Both programmes required high levels of support and prioritisation to ensure exercises occurred and were carried out safely.

The Game of Life soccer program: Effect on skills, physical fitness and mobility in persons with intellectual disability and autism spectrum disorder

BACKGROUND

Soccer is the world's most popular sport. The present authors evaluated the effect of the Game of Life (GOL) soccer initiative on soccer skills, fitness and mobility of adults with intellectual disability (ID) and autism spectrum disorder (ASD).

METHODS

The programme is comprised of once-weekly sessions.

OUTCOMES

soccer skills, fitness and mobility. Effectiveness was evaluated using within-/between-group analyses (e.g. effect size, ES).

RESULTS

Fifty adults with intellectual disability and 19 with ASD (age = 31.80 ± 10.11) participated in this study. From pre-test to post-test, the intellectual disability group improved their soccer skills (ES = 0.437); physical fitness-the intellectual disability group presented trivial ESs, whereas the ASD group showed moderate-to-large ESs; Mobility-only the ASD group presented a significant improvement (ES=-0.435), and the intellectual disability group presented better ability in most outcomes in pre- and post-tests.

CONCLUSION

The findings indicated differences in entry-level performance and training impact between the two groups. This should be considered when developing training programmes for soccer players.

Falls resulting in health care among older people with intellectual disability in comparison with the general population

BACKGROUND

Falls are common among older people with intellectual disability (ID) and are also a major contributor to injuries in this population. Yet, fall characteristics have only been sparsely studied, and the results are inconsistent. The aim of the present study was to investigate type of falls, places where they occurred and activities that caused them, as well as health outcomes and health utilisation patterns after falls, among older people with ID in comparison with their age peers in the general population.

METHODS

We established an administrative cohort of people with ID aged 55 years, or more, and alive at the end of 2012 (ID cohort; n = 7936). A cohort from the general population, one-to-one matched by sex and year of birth, was used as referents. Data regarding fall-induced health care episodes in inpatient and outpatient specialist care were collected from the National Patient Register for the period 2002-2012.

RESULTS

With the exception of falls from one level to another (i.e. fall on and from stairs and steps, ladder and scaffolding; fall from, out of or through building or structure; fall from tree or cliff and diving or jumping into water; or other fall from one level to another), people in the ID cohort were more likely to fall and fall more often than those in the general population cohort. Falls during a vital activity (e.g. attending to personal hygiene or eating) were twice as common among people with ID compared with the general population. When falling, people with ID were more likely to injure their head and legs but less likely to sustain injuries to the thorax and elbow/forearm. They were more likely to have superficial injuries, open wounds and fractures but less likely to have dislocations, sprain and strains. Fall-related health care visits among people with ID were more likely to be in inpatient care and be unplanned. People with ID were also more likely than those in the general population to have a readmission within 30 days.

CONCLUSIONS

People with ID are more likely to require specialist care after a fall and also more likely to obtain injuries to the head, compared with the general population. This is important to consider when taking preventive measures to reduce falls and fall-related injuries.

Insight into falls prevention programmes for people with visual impairments and intellectual disabilities: A scoping review

The aim of this study was to review the current literature on falls prevention in people with visual impairment and to estimate the applicability of methods of fall prevention for people with visual impairment and intellectual disability. A scoping review was performed according to the Arksey and O’Malley framework. Relevant studies were collected from PubMed, Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL). All records covering the time span from January 1980 until November 2017 were collected. Studies were included if the participants had a visual impairment according to objective ophthalmic assessments, the article described interventions to reduce falls or risk factors for falls, and the study was written in English and published in a peer-reviewed journal. The methodological quality of the studies were determined by consensus of the authors on the PEDro scale. Fifteen articles were included in this scoping review. Three articles focused on screening and intervention programmes, five articles addressed the effectiveness of environmental adjustments, and seven articles involved training programmes for physical improvement. Environmental adjustments emerged as having the best evidence for falls prevention for people with a visual impairment. Physical training programmes improved balance in those with a visual impairment but could not reduce the number of falls. Environmental adjustments also may be effective for persons with a visual impairment and intellectual disability. In addition, multifactorial screening and intervention programmes are recommended as an important new research direction with important clinical implications.

The association between gait and physical fitness in adults with intellectual disabilities

BACKGROUND

Gait deviations are often seen in adults with intellectual disabilities (ID). Their low physical fitness levels may be associated with these deviations. Understanding the impact of fitness on gait in this population is important for developing interventions to improve gait. In a cross-sectional study, we assessed the association between multiple physical fitness components and spatiotemporal gait parameters in adults with ID.

METHOD

Gait characteristics of 31 adults (42.77 ± 16.70 years) with ID without Down syndrome were assessed with the GAITRite at comfortable (CS) and fast speed (FS), along with fitness assessments (body composition, muscular endurance, strength, balance, Short Physical Performance Battery).

RESULTS

At CS, adults with ID with higher BMI and/or waist circumference spent more time in double support. At FS, those with better muscular endurance took steps faster, those with better balance took bigger steps and strides and those with better Short Physical Performance Battery scores took bigger steps and strides at higher velocity.

CONCLUSIONS

Body composition was mostly associated with gait at CS, while the other physical fitness components were mostly associated with gait at FS. Better fitness may therefore be more important in more challenging conditions. These insights are useful for developing interventions to improve gait in adults with ID.

Age-related and obstacle height-related differences in movements while stepping over obstacles

Background

This study aims to examine age-related and obstacle height-related differences in movements while stepping over obstacles.

Methods

The participants included 16 elderly and nine young women. Obstacles that were either 5 or 20 cm high were positioned at the center of a 4-m walking path. The participants were instructed to walk along the path as quickly as possible. The participants’ movements were analyzed using a three-dimensional motion analysis system that recorded their movements as they walked and stepped over the obstacles.

Results and conclusions

Seven joint angles and the distances between the ground and six markers were examined in the initial contact and swing instants of the leading and trailing limbs. In the initial contact instant, the elderly women prepared for stepping with a lower toe height than the young women when stepping over the 20-cm obstacle. Trunk rotation was greater in the young women than in the elderly women. In the swing instant, the elderly women showed greater ankle dorsiflexion and hip adduction angles for the leading limb when stepping over the 20-cm obstacle. They moved the trailing limb with increased ankle dorsiflexion, knee flexion, hip flexion, and foot inversion to ensure that they did not touch the obstacle as they stepped over it. These movement patterns are characteristic of elderly individuals who cannot easily lift their lower limbs because of decreased lower-limb strength.