Avaliação multifatorial do risco de quedas em idosas com baixa densidade óssea

Introdução: a identificação de instrumentos de avaliação eficazes na predição de quedas, especificamente em idosas com baixa densidade mineral óssea (DMO) e mais susceptíveis a fraturas, permanece um desafio. Objetivo: avaliar os fatores de risco para quedas na linha de base, identificar a ocorrência de quedas em seis meses de acompanhamento e investigar a validade preditiva do teste Quickscreen Clinical Falls Risk Assessment para predizer quedas múltiplas em idosas com baixa DMO. Métodos: estudo metodológico com 110 idosas com diagnóstico de osteoporose ou osteopenia (70,26 ± 6,24 anos). O risco de queda (linha de base) foi caracterizado pela presença de dois ou mais dos oito fatores de risco avaliados no QuickScreen e a ocorrência de quedas nos seis meses posteriores identificada por meio de telefonemas mensais. Resultados: os fatores de risco para quedas mais frequentes foram o autorrelato de quedas prévias, a polifarmácia e o déficit de deslocamento de peso e instabilidade lateral. A maioria das idosas (67,3%) apresentou dois ou mais fatores de risco, 24,5% relataram uma queda e 13,6% quedas múltiplas nos seis meses. O QuickScreen (ponto de corte ≥ 2 fatores de risco) apresentou boa sensibilidade (73,3%) e alto valor preditivo negativo (88,89%) para predizer quedas múltiplas em idosas com baixa DMO. Conclusão: Os resultados indicaram alta frequência de quedas entre idosas com baixa DMO e apontaram que o instrumento QuickScreen foi capaz de prever quedas múltiplas em seis meses de acompanhamento nessas idosas.Introduction: identifying effective assessment instruments for predicting falls, specifically in older women with low bone mineral density (BMD) that are more susceptible to fractures remains a challenge. Objective: to evaluate risk factors for falls at baseline, to identify the falls occurrence over six months of follow-up and to investigate the predictive validity of the Quickscreen Clinical Falls Risk Assessment for predicting multiple falls among low BMD older women. Methods: a methodological study with 110 older women with diagnosis of osteoporosis or osteopenia (70.26 ± 6.24 years). The presence of two or more of the eight risk factors assessed by the QuickScreen characterized the risk of falling (baseline) and monthly phone calls identified the occurrence of falls during the six months of follow-up. Results: the most prevalent falls risk factors were self-reported previous falls, polypharmacy and impairment in shifting weight and lateral instability. Most of the older women (67.3%) had two or more risk factors, 24.5% reported a single fall and 13.6% reported multiple falls over the six months. The QuickScreen (cutoff ≥ 2 risk factors) showed good sensitivity (73.3%) and high negative predictive value (88.89%) for predicting multiple falls among low BMD older women. Conclusions: the results indicated a high frequency of falls among low BMD older women. Additionally, the results highlighted that the QuickScreen instrument was able to predict multiple falls in the six months of follow-up among these older women

Precisión de herramientas clinico-funcionales para identificar riesgo de caídas em ancianos comunitários

Introdução: A identificação dos idosos com maior chance de cair caracteriza o primeiro passo para a prevenção de quedas. Ferramentas clínicas têm se mostrado capazes de diferenciar idosos caidores de não caidores, porém suas validades preditivas permanecem controversas. Objetivo: Investigar a acurácia das ferramentas Short Physical Performance Battery (SPPB) e Quick Screen Clinical Fall Risk Assessment (QuickScreen) para identificação de risco de quedas em idosos comunitários. Método: Estudo metodológico prospectivo com 81 idosos (≥ 60 anos), avaliados na linha de base por meio da SPPB e da QuickScreen e monitorados após 1 ano para identificação de ocorrência de quedas. Calculou-se a sensibilidade, a especificidade, o valor preditivo positivo (VPP), o valor preditivo negativo (VPN) e a área abaixo da curva ROC (AUC). Resultados: 28,4% dos idosos relataram quedas. O QuickScreen apresentou sensibilidade de 52,2%, especificidade de 74,1%, VPP de 44,4%, VPN de 79,6% e AUC de 0,656. A AUC do SPPB não foi significativa (p = 0,087). Conclusão: A ferramenta QuickScreen apresentou fraca acurácia para prever quedas e o SPPB mostrou-se incapaz de identificar idosos comunitários em risco de cair. A ferramenta QuickScreen destacou-se por seu alto potencial de identificar verdadeiros negativos.Introduction: The identification of older adults who present greater chances of falling is the first step in the prevention of falls. Clinical instruments have been shown to be able to differentiate fallers from non-fallers, but their predictive validity remains controversial. Objective: To investigate the accuracy of the Short Physical Performance Battery (SPPB) and Quick Screen Clinical Fall Risk Assessment (QuickScreen) instruments to identify risk of falls in community-dwelling older adults. Method: This is a prospective methodological study with 81 older adults (≥ 60 years), assessed at baseline by SPPB and QuickScreen and monitored after one year to identify the occurrence of falls. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve (AUC) were calculated. Results: 28.4% of the sample reported falls. QuickScreen presented 52.2% sensitivity, 74.1% specificity, 44.4% PPV, 79.6% NPV and 0.656 AUC. The AUC for SPPB was not significant (p = 0.087). Conclusion: QuickScreen presented poor accuracy when predicting falls and SPPB was unable to identify community-dwelling older adults at risk of falls. The QuickScreen instrument stood out for its high potential to identify true negatives.Introducción: La identificación de los ancianos con mayor probabilidad de caídas caracteriza el primero paso para la prevención de caídas. Las herramientas clínicas se han mostrado capaces de diferenciar a los ancianos que caen de los que no caen, pero sus validez predictiva siguen siendo controvertidas. Objetivo: Investigar la prediccíon de las herramientas Short Physical Performance Battery (SPPB) y Quick Screen Clinical Fall Risk Assessment (QuickScreen) para identificar el riesgo de caídas en ancianos comunitarios. Método: Estudio metodológico prospectivo con 81 ancianos (≥ 60 años), evaluados en la línea de base por medio de la SPPB y de la QuickScreen y monitoreados después de 1 año para identificación de ocurrencia de caídas. Se calculó la sensibilidad, la especificidad, el valor predictivo positivo (VPP), el valor predictivo negativo (VPN) y el área debajo de la curva ROC (AUC). Resultados: 28,4% de los ancianos reportaron caídas. QuickScreen presentó una sensibilidad de 52,2%, especificidad de 74,1%, VPP de 44,4%, VPN de 79,6% y AUC de 0,656. El AUC del SPPB no fue significativo (p = 0,087). Conclusión: La herramienta QuickScreen presentó una débil precisión para prever caídas y el SPPB se mostró incapaz de identificar a los ancianos comunitarios en riesgo de caer. La herramienta QuickScreen se destacó por su alto potencial de identificar verdaderos negativos

Assessing auditory function in neonates using ipsilateral suppression of transient evoked otoacoustic emissions

The present study investigated suppression of transient evoked otoacoustic emissions (TEOAEs) in neonates with an ipsilateral noise suppressor method using a forward masking paradigm. Participants were 26 full-term neonates (36-42 weeks gestational age) with a mean gestational age of 39.7 weeks (SD = 1.4 weeks) and mean chronological age of 1.96 days (SD = 0.8 day). Their mean birth weight was 3.4 kg (SD = 0.5 kg). Only one ear in each neonate was tested. The TEOAE spectra obtained were analysed using the Kresge EchoMaster program comparing assessments with and without noise suppressor. The results show a prevalence of suppression in 85% of the neonates when suppression in at least one frequency band was counted. The mean suppression effect was small (< 0.5 dB) across all frequency bands from 1 to 4 kHz and time windows from 8 to 18 msec, with large variations in suppression amplitude (SD = 1.4-2.4 dB). Three different patterns of suppression were found, with 91% and 9% of neonates demonstrating suppression effects in the 1-3 kHz and 3.5-4 kHz frequency ranges, respectively. A significant negative correlation was found between suppression amplitude and birth weight. The suppression amplitude was negatively correlated to ambient noise, although the correlation was not significant at the 0.05 level. The presence of robust spontaneous otoacoustic emissions (SOAEs) could influence TEOAE suppression amplitude, resulting in reverse suppression. The present study found that males showed greater suppression in left ears and females showed greater suppression in right ears. However, this finding should be interpreted with caution in view of the small sample size of the study. Further research using a large sample size is required to confirm these findings and establish normative data for the neonatal population

The design of a purpose-built exergame for fall prediction and prevention for older people

Background Falls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system. Methods The system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components. Results The iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people. Conclusions The iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling

Effect of noise on transient-evoked otoacoustic emissions and pure-tone screening audiometry

Currently, the American Speech-Language Hearing Association (ASHA) recommends pure-tone audiometry as the preferred audiometric screening method of school-aged children; however, background noise is often present and can result in high referral rate. The current study\u27s goal was to examine the effect of noise on the pass rate on transient-evoked otoacoustic emissions (TEOAEs) and pure-tone audiometric screening measures. Twenty normal hearing adults (M = 22.85), eighteen females and two males, were screened with TEOAEs and pure-tone audiometry in quiet and in different levels of noise (i.e., 40 dB SPL, 50 dB SPL, 60 dB SPL) in a sound-treated booth. Pure-tone audiometry and TEOAEs were present at 40 dB SPL. At 50 dB SPL, a 90% pass rate was recorded for TEOAEs and 60% pass rate for pure-tone audiometry. In 60 dB SPL noise, a 70% pass rate was found for TEOAE screenings and a 15% pass rate was found for pure-tone screenings. The amplitude was not found to be significantly different for the right or left ear, suggesting participants had similar TEOAE amplitudes in all noise levels. A significant difference for the right ear TEOAE reproducibility was found for the quiet to 60 dB level, but no other noise level was found to be significant. The reproducibility for the left ear TEOAE was found to be significant at the 40 to 60 dB noise levels and the 50 to 60 dB noise conditions

Otoacoustic emission screening in neonates tester and seasonal factors on referral rate

Also available in print."A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, December 31, 2004."Thesis (B.Sc)--University of Hong Kong, 2004.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Correlação dos testes clínicos funcionais e a plataforma WII na identificação do risco de quedas em idosos comunitários

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Faculdade de Ceilândia, 2019.Introdução: Testes clínicos têm sido desenvolvidos para avaliar funcionalmente o equilíbrio e identificar idosos com maior risco de quedas, assim como a plataforma Nintendo Wii Balance Board (WBB). Objetivo: Analisar a correlação de um conjunto de testes clínicos funcionais com dados quantitativos obtidos a partir da plataforma do Nintendo Wii Balance Board, para identificação do risco de quedas em idosos comunitários. Metodologia: Tratou-se de um estudo transversal, observacional análitico e piloto, realizado com 15 idosos comunitários, hígidos, com idade igual ou superior a 60 anos. Foram utilizados testes clínicos funcionais, como Dynamic Gait Index (DGI), Short Physical Performance Battery (SPPB), QuickScreen Falls Risk, Time Up and Go (TUG) , além da avaliação de posturografia estática com a plataforma Wii. A análise dos dados se deu por meio do programa SPSS (Statistical Package for Social) e aplicação do coeficiente de correlação de Spearman (p), com nível de significância de 5% (p ≤ 0,05). Resultados: Verificou-se uma correlação positiva e moderada entre o teste QuickScreen e a condição olhos abertos em superfície firme, no eixo médio-lateral (ML), da plataforma Wii. Conclusão: Os achados deste estudo piloto, sugerem que o instrumento WBB possa ser utilizado em contexto clínico como ferramenta complementar ao QuickScreen, de acordo com estudos anteriores, já que o mesmo pode identificar aumento da velocidade de deslocamento no centro de pressão (COP) em idosos com maiores fatores de risco de quedas.Introduction: Tests clinical have been developed to functionally assess balance and identify older adults at greater risk of falls, as well as the Nintendo Wii Balance Board (WBB) platform. Objective: To analizy the correlation a set of functional clinical tests with quantitative data obtained from the platform of the Nintendo Wii Balance Board, to identify the risk of falls in community-dwelling elders. Methodology: This was a cross-sectional, observational analytical and pilot study of 15 healthy elderly individuals aged ≥ 60 years. We used functional clinical tests such as Dynamic Gait Index (DGI), Short Physical Performance Battery (SPPB), QuickScreen Falls Risk, Time Up and Go (TUG), and the evaluation of static posturography with the Wii platform. Data were analyzed using SPSS (Statistical Package for Social) and Spearman's correlation coefficient (p), with a significance level of 5% (p ≤ 0.05). Results: It was verified a positive and moderate correlation between the QuickScreen test and the open-eyes condition on the firm surface on the mid-lateral axis (ML) of the Wii platform. Conclusion: The results of this pilot study suggest that the WBB instrument can be used in clinical settings as a complementary tool to QuickScreen, according to previous studies, being that it can identify an increase in the velocity of displacement at the center of pressure (COP) in elderly patients with higher risk factors for falls

The utilization of transient evoked otoacoustic emissions and tympanometry in hearing screening of hearing-impaired children

Thesis (B.Sc)--University of Hong Kong, 1999"A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 14, 1999."Also available in print.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Equilíbrio e risco de quedas em idosos : um estudo de correlação entre três instrumentos de avaliação

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, 2013.Introdução: O equilíbrio é um processo complexo que depende da interação harmônica de diversos sistemas do corpo humano. Déficits de equilíbrio deixam a pessoa idosa mais vulnerável a episódios de queda, que podem gerar prejuízos funcionais e aumentar os níveis de morbidade e mortalidade nessa população. Métodos clínicos e laboratoriais estão sendo cada vez mais desenvolvidos para avaliar os diferentes aspectos do equilíbrio postural e estabelecer parâmetros para identificação de idosos com maior risco de quedas. Apesar da existência de diversos instrumentos direcionados à avaliação do equilíbrio e risco de quedas em idosos, ainda é escasso o número de trabalhos que investigaram e discutiram a correlação entre testes clínicos e laboratoriais. Objetivos: Analisar a correlação entre três instrumentos utilizados para avaliar o risco de quedas em idosos, sendo dois clínicos e um laboratorial; verificar qual instrumento clínico se correlaciona melhor com laboratorial. Materiais e Métodos: Tratou-se de um estudo analítico transversal, realizado com 49 idosos comunitários, hígidos, com diferentes níveis de condicionamento físico. Foram utilizados dois testes clínicos, o Timed Up and Go (TUG) e o QuickScreen clinical fall risck assessment (QuickScreen), e um laboratorial, o Biodex Balance System – Modo Fall Risck (BBS-FR), para avaliar o risco de quedas em idosos. A correlação dos dados foi realizada por meio da aplicação do Coeficiente de Correlação de Spearman, com nível de significância de 5% (p≤0,05). Resultados: Verificou-se correlação positiva e moderada entre QuickScreen e BBS-FR (r=0,35; p=0,01) e entre QuickScreen e TUG (r=0,32; p=0,02). Não houve correlação significativa entre BBS-FR e TUG (r= -0,10; p=0,47). Conclusão: Os testes analisados são complementares, tendo em vista que não se correlacionaram fortemente e mostraram-se com particularidades e limitações distintas. Entretanto, sugerimos a utilização do instrumento QuickScreen no ambiente clínico, já que este foi o que melhor se correlacionou com o dispositivo laboratorial, o BBS-FR, e o que mais identificou idosos ativos com risco de quedas. Dessa forma, o QuickScreen avaliou o risco de quedas de forma mais ampla, uma vez que engloba questões não abordadas pelos dois outros testes estudados. ______________________________________________________________________________ ABSTRACTBackground: Balance is a complex process that depends on the harmonious interaction of various systems of the human body. Balance deficits leave the elderly vulnerable to episodes of falling, which can cause loss of function and increase levels of morbidity and mortality in this population. Clinical and laboratory methods are increasingly being developed to assess different aspects of body balance and establish parameters for identification of elderly at risk of falls. Despite the existence of several instruments aimed at evaluating the balance and risk of falls in the elderly, is still scarce number of studies that have investigated and discussed the correlation between clinical and laboratory tests. Objectives: To analyze the correlation between the three tests used to assess the risk of falls in the elderly; check which tool is better correlated with clinical laboratory. Materials and Methods: This was a cross-sectional study, conducted with 49 community-dwelling elderly, healthy controls, with different levels of fitness. We used two clinical tests, the Timed Up and Go (TUG) and QuickScreen clinical assessment fall risk (QuickScreen), and one laboratory, the Biodex Balance System - Mode Fall Risck (BBS-FR). The correlation of the data was was performed by using the Spearmam’s rank correlation coefficient, with a significance level of 5% (p ≤ .05). Results: There were moderate positive correlations between QuicScreen and BBS-FR (r = 0.35, p = 0.01) and between QuickScreen and TUG (r = 0.32, p = .02). There was no significant correlation between BBS-FR and TUG (r = -0.10, p = 0.47). Conclusion: The analyzed tests are complementary, given that not correlated strongly and showed up with specific and distinct limitations. However, we suggest the use of the instrument QuickScreen in the clinical setting, as this was what was best correlated with the laboratory device, the BBS-FR, and identified that more active seniors at risk of falling. Thus, QuickScreen assessed the risk of falls more broadly, as encompassing issues not addressed by the other two tests studied