Fall risk in the aging population: fall prevention using smartphones technology and multiscale sample entropy

Falls are an important aspect of older people's health because they trigger major injuries and even death in one-third of fallen patients, making them  a major public health problem. Given the risk of physical and psychological injury, if serious injuries occur as a result of a fall, prevention is an important consideration in today's health care landscape, where the population is predominantly adult world wide. This paper presents the applicability ofa simple technique of analysis of gait signals capturedby mobile devices with the objective to the generation of early warnings on the risk of falls in older adults, which correlates with subjective scales. The technique is tested in a population of patients showing results of the significant risk of falls inpatients that the subjective scales could not detect, demonstrating that mobile devices and signal processing can become important tools in the service of elderly care in fall risk prevention

高齢者の健康管理におけるウェアラブルデバイスと中国伝統医学の役割

早大学位記番号:新8258早稲田大

Assessing the risk of falls of older people using specialized diagnostic tests

Background: The phenomenon of population aging, resulting in an increase in the number of elderly people in need of medical assistance, necessitated the development of geriatric medicine. Its key assumption is to improve the quality of life of older people through early recognition, prevention and treatment of diseases of old age. Material and methods: Analysis of available literature, articles in the Google Scholar and PubMed database using keywords: geriatrics, aging process, falls Results: The fall belongs to a group of great geriatric problems contributing to the phenomenon of senile disability. The result of disturbances in the balance and problems associated with the weakening of the musculoskeletal system is a fall, which has very serious consequences for the health and functioning of an older person. The most important diagnostic tests related to falls of older people include: Timed Up & Go Test (TUG), Dynamic Gait Index (DGI), The Step Test, Stop Walking When Talking (SWWT), Four Square Step Test (FSST) Conclusions: Falling older people is statistically one of the biggest problems of this age group, and at the same time causing a huge number of complications in the lives of geriatric patients, which is why their prevention is so important. There is a further need for research and discussion on the effectiveness of forms of diagnostic to prevent the falls of older peopl

Balance disturbance and orthostatic hypotension as risk factors for falls among older adults

Falls present common serious clinical problems among older adults. To detect older adults with a high risk to fall, there is a need to develop clinically usable tools. For clinicians, balance is an important aspect of fall risk, but no proper, short, validated tool is available that measures balance reliably among community-dwelling older adults with quite good physical function. Therefore, a standardized tool that measures balance is needed. Orthostatic hypotension (OH) is a common, yet under diagnosed disorder. The association between falls and OH is unclear, particularly because of poor measurement methods of previous longitudinal studies. The purpose of this thesis was to validate an easy-to-use tool to measure balance. The thesis aimed to create a shorter version of the original Berg Balance Scale (BBS) and to assess the adequacy and predicting value of the nine-item Berg Balance Scale (BBS-9) to predict fall risk among older adults. In addition, it aimed to assess the prevalence of OH and the association of OH with the risk of falls. The subjects were participants in fall prevention conducted in Pori. Homedwelling older adults ≥65 years, who had fallen during the previous year, were included in the study. Falls were recorded by fall diaries during 12-month. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. OH was defined according to the consensus by the Consensus Committee of the American Autonomic Society and the American Academy of Neurology and European Federation of Neurological Societies. The blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. BBS-9 correlated significantly with the original BBS and had moderate correlations with static and dynamic aspects of balance. The cut-off score 32/33 of BBS-9 together with data of vision and the number of regularly used drugs predicted quite poorly the risk of falling among older adults. The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. 30 seconds BP measurement is more reliable to detect the risk than the 3 minutes measurement. Results showed BBS-9 alone is not specific and sensitive enough to be used as a screening tool. BBS-9 together with the data of vision and the number of regularly used drugs predicted falls rather poorly. The results support the usability of 30 seconds measurement in determining OH and the risk for falling among older adults.Tasapainohäiriö ja ortostaattinen hypotonia kaatumisten riskitekijöinä iäkkäillä Kaatumiset ja niistä aiheutuvat vammat ovat yleisiä iäkkäillä. Kaatumisten ehkäisemiseksi kaatumisvaarassa olevien iäkkäiden tunnistaminen on tärkeää. Tasapainohäiriö on keskeisiä kaatumisen vaaratekijöitä. Kaatumisriskin arviointiin ja tasapainon tutkimiseen tarvitaan kliiniseen työhön soveltuvaa tasapainotestiä. Validoitua tasapainotestiä melko hyväkuntoisille kotona asuville iäkkäille ei ole olemassa. Ortostaattinen hypotonia (OH) on yleinen ja alidiagnosoitu ongelma iäkkäillä. Aikaisemmat pitkittäistutkimukset ovat olleet menetelmällisesti heikkoja ja vakioinnit puutteellisia. OH:n ja kaatumisten välinen yhteys on jäänyt epäselväksi. Tämän tutkimuksen tavoitteena oli kehittää helppokäyttöinen, validoitu ja lyhennetty versio Berg Balance Scalesta (BBS) sekä selvittää lyhennetyn tasapainotestin (BBS-9) soveltuvuutta ja ennustearvoa kaatumisriskin arvioinnissa iäkkäillä. Lisäksi tavoitteena oli arvioida OH:n yleisyyttä ja yhteyttä kaatumisriskiin. Tutkimuksen aineiston muodostivat Porissa kaatumisten ehkäisyohjelmaan osallistuneet ≥65-vuotiaat, jotka olivat kaatuneet vähintään kerran edeltäneen 12 kuukauden aikana. Kaatumispäiväkirjoista saatiin tiedot kaatumisista 12 kuukauden ajalta. Tiedot hoitoa vaatineista kaatumisista kerättiin terveyskeskuksen ja sairaalan rekistereistä 12 ja 36 kuukauden ajalta. OH määritettiin The American Autonomic Societyn and the American Academy of Neurology and European Federation of Neurological Societyn konsensuksen mukaan. OH mittaukset tehtiin makuulla ja 30 sekuntia sekä 3 minuuttia seisomaan nousun jälkeen. BBS-9 korreloi vahvasti alkuperäisen BBS:n ja kohtalaisesti staattisen ja dynaamisen tasapainon kanssa. BBS-9 (katkaisupisteellä 32/33) yhdistettynä tietoon näkökyvystä ja säännöllisesti käytettyjen lääkkeiden lukumäärästä ennusti huonosti kaatumisriskiä. OH:n prevalenssi oli 23,4 % (30 sekuntia) ja 7,3 % (3 minuuttia). OH 30 sekunnin tai 3 minuutin kohdalla seisomaan nousun jälkeen oli yhteydessä suurentuneeseen kaatumisriskiin 12 kuukauden seurannassa. Kaatumisriskin arvioinnissa verenpaineen (BP) mittaus 30 sekunnin kohdalla ennusti kaatumisriskiä paremmin kuin 3 minuutin mittaus. Tutkimustulosten perusteella BBS-9 ei ole riittävä kaatumisriskin seulontaa. BBS-9 yhdessä näön ja säännöllisesti käytettävien lääkkeiden lukumäärän kanssa ennustaa melko huonosti kaatumisrikiä. BP mittaus 30 sekuntia seisomaan nousun jälkeen on suositeltavaa arvioitaessa iäkkäiden OH:ta ja kaatumisriskiä

Interdisciplinary Fall Risk Screening and Assessment: An Evidence-Based Practice Project

This project sought to answer the following Evidence-Based Practice (EBP) question: What occupational therapy and interdisciplinary assessments have the best psychometric characteristics and are most effective for screening or evaluating person and environment fall risk factors and measuring the outcomes of fall prevention programs

Motor patterns evaluation of people with neuromuscular disorders for biomechanical risk management and job integration/reintegration

Neurological diseases are now the most common pathological condition and the leading cause of disability, progressively worsening the quality of life of those affected. Because of their high prevalence, they are also a social issue, burdening both the national health service and the working environment. It is therefore crucial to be able to characterize altered motor patterns in order to develop appropriate rehabilitation treatments with the primary goal of restoring patients' daily lives and optimizing their working abilities. In this thesis, I present a collection of published scientific articles I co-authored as well as two in progress in which we looked for appropriate indices for characterizing motor patterns of people with neuromuscular disorders that could be used to plan rehabilitation and job accommodation programs. We used instrumentation for motion analysis and wearable inertial sensors to compute kinematic, kinetic and electromyographic indices. These indices proved to be a useful tool for not only developing and validating a clinical and ergonomic rehabilitation pathway, but also for designing more ergonomic prosthetic and orthotic devices and controlling collaborative robots

Gait, mobility, and falls in older people

My doctoral thesis contributes to the understanding of gait, mobility, and falls in older people. All presented projects investigated the most prominent and sensitive markers for fall-related gait changes, that is gait velocity and gait variability. Based on the measurement of these spatio-temporal gait parameters, particularly when using a change-sensitive dual task paradigm, it is possible to make conclusions regarding walking, balance, activities of daily living, and falls in older people. The research summarized in my doctoral thesis will help in the detection of early fall risk and modulation of therapeutic interventions to improve gait and consequently reduce fall risk in older people. To identify modifiable fall risk factors, such as gait disorders, the GAITRite electronic walkway system was used for objective spatio-temporal gait analysis. The simplicity and feasibility of the administration of single and dual task gait analysis make it a desirable clinical and research measurement tool. Gait analysis with walking as a single task condition alone is often insufficient to reveal underlying gait disorders present during everyday activities. However, measuring gait with a dual task paradigm can detect subtle gait deficits. Dual-tasking, walking while simultaneously performing an additional task, was used to assess the effects of divided attention on motor performance and gait control. The presented publications in this doctoral thesis investigated the association between gait parameters and several hypothesized fall-related modalities: (a) Our first review article highlighted the association between gait disorders and falls, and how related motor and cognitive impairments can be detected by measuring gait while dual-tasking. (b) A second review looked at how the dual task paradigm can be used for gait assessment in older people and how spatio-temporal gait parameters are associated with increased fall risk. (c) Our systematic literature review provided evidence about effective fall prevention interventions (exercise, home modifications, footwear, and walking aids) to reduce the risk of falls in vulnerable older people. (d) To evaluate which exercise modalities are effective in modifying risk factors for falls, we conducted an eight-week salsa intervention trial and measured the effect of dancing on static and dynamic balance, and leg muscle power in older people. (e) Besides exercise, inadequate nutritional intake is another modifiable risk factor for falls in older people, and therefore our most recent cross-sectional study examined how serum 25-hydroxvitamin D levels are associated with functional mobility in older people assessed in a memory clinic. (c) Walking aids are commonly prescribed for older people with a high risk of falls which is why we examined the influence of walking aids on spatio-temporal gait parameters in older people who used a cane, a crutch or a walker. (g) Finally, besides predominantly investigating fall risk factors for motor abilities, our prolonged and ongoing randomized, double-blind, and placebo-controlled intervention trial explores the potential influence of ginkgo biloba on the cognitive domain relevant for dual-tasking in older people with mild cognitive impairment

Effects of Generic Group-Based Versus Personalized Individual-Based Exercise Programs on Balance, Gait, and Functional Performance of Older Adults with Mild Balance Dysfunction and Living in Residential Care Facilities - A Randomized Controlled Trial

Background and Purpose: To investigate the effect of an individualized exercise program versus a generic group-based exercise program on balance, gait, and functional performance of older adults categorized as having mild balance dysfunction and living in residential care facilities. Methods: Single blind randomized control design. One hundred-twenty residents fulfilled screening criteria for mild balance dysfunction based on the BioSwayTM balance and the Multi-Directional Reach Test (MDRT) primary outcome measures. Secondary assessment was completed using the Modified Physical Performance Test (PPT), hand-held dynamometer (lower-limb muscle strength testing), and gait speed analysis. Sixty subjects received individualized treatment from physical therapists (8 weeks). Another sixty subjects received generic group-based exercises (8 weeks). All outcome measures were collected at baseline and post-intervention (ninth week); and BioSwayTM and PPT measures at follow-up (thirteenth week) for the individualized group. Results: Individualized group (n=60) showed significant improvement compared to the group-based group (n=60) on the two BioSwayTM scores (limits of stability, p \u3c .001; and postural stability, p = .016), the MDRT scores (forward reach, p \u3c .001; backward reach, p = .007; right lateral reach, p \u3c .001; and left lateral reach p \u3c .001), the strength scores (hip flexors, p = .010; knee extensors, p = .002; hip abductors, p = .009; and ankle dorsiflexors, p = .025), the PPT outcomes (p \u3c .001), and the gait scores (p = .012). Effect sizes ranged from small to large, with the largest sizes for limits of stability and MDRT. There were no significant differences between groups for the mCTSIB (p = .538). However, 96.7% of subjects in the individualized group scored within one SD of the reference mean, relative to 75% in the group-based group. At follow-up, the individualized group showed significant differences over time with medium to large effect sizes on the PPT (p \u3c .001), limits of stability (p \u3c .001), postural stability (p \u3c .001), and mCTSIB (p = .005) measures. Post-hoc analysis revealed retention of gains for all measures at follow-up, except the mCTSIB. Conclusion: The individualized group showed significant improvements in the areas of balance, strength, mobility, and functional outcomes

Fall risk in older adults with hip osteoarthritis : decreasing risk through education and aquatic exercise

Purpose: The primary purpose of this project was to determine the effect of aquatic exercise and aquatic exercise combined with an education group program on decreasing both psychosocial and physical fall risk factors in community-dwelling older adults with hip osteoarthritis (OA). Secondary purposes were to 1) describe fall risk, history and nature of falls and near-falls in older adults with hip OA, 2) determine the association of the timed up and go test (TUG) to history of falls and near-falls, 4) explore the relationship of both psychosocial and physical factors to history of falls and near-falls, and 5) evaluate the role of falls-efficacy in predicting balance performance. Methods: Participants were recruited from the community and screened for presence of hip osteoarthritis and fall risk. Baseline fall history and a battery of measures for balance, muscle strength, functional ability and falls-efficacy were administered. Participants were then randomly assigned to one of three groups: Aquatic Exercise, Aquatic Exercise and Education or a Control Group. The interventions were twice per week for 11 weeks. Fall risk factors were measured after 11 weeks. Study 1 described history of falls and near-falls and evaluated the association of the TUG screening test with fall and near-fall history. Study 2 summarized the relationships of physical and psychosocial fall risk factors and identified the primary predictors of fall risk, based on associations with fall history. Study 3 evaluated the randomized controlled clinical trial comparing the impact of the interventions (aquatic exercise and education) on fall risk outcomes. Results: Older adults with hip OA reported a high frequency of falls and near-falls. The TUG, using a cut-off score of 10 sec., was associated with frequent near-fall history. There was a strong association of frequent near-falls to history of actual falls, with the association increasing 7-fold if lower falls-efficacy was present. Falls-efficacy was also an independent predictor of balance impairment. Screening for history of near-falls and falls-efficacy may be important in predicting risk of future falls. The combination of Aquatic Exercise and Education improved falls-efficacy and functional mobility compared to Aquatic Exercise only or no intervention. Aquatic Exercise on its own was not effective in decreasing fall risk factors or improving falls-efficacy. Significance of Findings: The accumulation of both physical and psychosocial risk factors in older adults with hip OA increases their vulnerability to falls and injury. Fall prevention programs for this population should be designed to include both exercise and education to address falls-efficacy and physical fall risk factors