A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study

Background Sports concussion is a risk for players involved in high impact, collision sports. Post-concussion, the majority of symptoms subside within 7–10 days, but can persist in 10–20% of athletes. Understanding the effects of sports concussion on sensorimotor systems could inform physiotherapy treatment. Objective To explore changes in sensorimotor function in the acute phase following sports concussion. Design Prospective cohort study. Methods Fifty-four players from elite rugby union and league teams were assessed at the start of the playing season. Players who sustained a concussion were assessed three to five days later. Measures included assessments of balance (sway velocity), vestibular system function (vestibular ocular reflex gain; right-left asymmetry), cervical proprioception (joint position error) and trunk muscle size and function. Results During the playing season, 14 post-concussion assessments were performed within 3–5 days of injury. Significantly decreased sway velocity and increased size/contraction of trunk muscles, were identified. Whilst not significant overall, large inter-individual variation of test results for cervical proprioception and the vestibular system was observed. Limitations The number of players who sustained a concussion was not large, but numbers were comparable with other studies in this field. There was missing baseline data for vestibular and cervical proprioception testing for some players. Conclusions Preliminary findings post-concussion suggest an altered balance strategy and trunk muscle control with splinting/over-holding requiring consideration as part of the development of appropriate physiotherapy management strategies

Frailty and mobility

Frailty represents a state of heightened vulnerability. Mobility impairment contributes to the construct of frailty and channels adverse events. While mobility disorder is universal at a high burden of frailty, neither mobility nor balance dysfunction is sufficient to fully define frailty. Frailty represents proximity to complex system failure, with higher-order disturbance, such as mobility and balance disturbance, as a consequence. Impairment of mobility and balance is a common manifestation of illness in the frail individual and is therefore a sensitive marker of acute disease, putatively also in delirium. Clinical measurement of mobility and balance should be prioritized. Consequently, assessment tools, such as the de Morton Mobility Index and the Hierarchical Assessment of Balance and Mobility, are being explored, with the sensitivity of the latter illustrated in the acute hospital setting. Walking with speed and under dual/multi-task conditions better differentiates healthier and frail ambulant adults, providing a basis for screening older adults for pre-emptive interventions. Specific mobility and balance interventions reduce falls risk. However, patients with dementia walk too fast for their level of frailty, creating an ethical dimension to rehabilitation and risk. Overall, there is no need for reduced mobility to reinforce the frailty stereotype; both are potentially modifiable and amenable to intervention strategies

Frailty and mobility

Frailty represents a state of heightened vulnerability. Mobility impairment contributes to the construct of frailty and channels adverse events. While mobility disorder is universal at a high burden of frailty, neither mobility nor balance dysfunction is sufficient to fully define frailty. Frailty represents proximity to complex system failure, with higher-order disturbance, such as mobility and balance disturbance, as a consequence. Impairment of mobility and balance is a common manifestation of illness in the frail individual and is therefore a sensitive marker of acute disease, putatively also in delirium. Clinical measurement of mobility and balance should be prioritized. Consequently, assessment tools, such as the de Morton Mobility Index and the Hierarchical Assessment of Balance and Mobility, are being explored, with the sensitivity of the latter illustrated in the acute hospital setting. Walking with speed and under dual/multi-task conditions better differentiates healthier and frail ambulant adults, providing a basis for screening older adults for pre-emptive interventions. Specific mobility and balance interventions reduce falls risk. However, patients with dementia walk too fast for their level of frailty, creating an ethical dimension to rehabilitation and risk. Overall, there is no need for reduced mobility to reinforce the frailty stereotype; both are potentially modifiable and amenable to intervention strategies

Investigating the relationship of the functional gait assessment to spatiotemporal parameters of gait and quality of life in individuals with stroke

Background and Purpose: Walking in the community is an important aspect of independence and quality of life (QOL) that poses challenges for individuals with stroke. This study investigated whether performance on the Functional Gait Assessment (FGA) differentiated spatiotemporal gait parameters, QOL, and fall history of community-ambulating individuals with stroke. We hypothesized that those scoring higher on the FGA would present with better gait speed and cadence, stride width and length, and improved load time on the paretic limb, report a higher QOL, and be less likely to have a fall history than those who scored lower on the FGA. Methods: Participants were screened for cognitive impairment and the ability to walk independently. Participant demographics and stroke characteristics were recorded. The Falls Risk for Older People in the Community (FROP-Com) screening tool determined whether the participant had incurred 1 or more falls within the preceding 12 months. The FGA provided a composite measure of gait with varied walking tasks challenging different aspects of walking. The total score was recorded. The GAITRite instrumented-walkway was used to acquire high-resolution footfall data during performance of the first 9 FGA walking tasks. The Assessment of Quality of Life-6D (AQoL-6D) was used to measure health-related QOL across the domains of independent living, mental health, coping, relationships, pain, and senses. Pearson and Spearman correlations were used to check for correlations between FGA score and the demographic characteristics, AQoL-6D scores, and 12-month fall history. Pearson correlations were used to check for correlations between FGA score and multiple spatiotemporal gait parameters for each FGA item. Results and Discussion: A sample of 29 volunteers who were community-ambulating individuals with stroke was recruited. Participants had a mean age of 62.31 (10.89) years, mean time since stroke of 3.78 (4.10) years, and included both males and females (52% male). Individuals presented with both left- and right-sided strokes. FGA score correlated positively with velocity, cadence, and step length, and negatively with stride width, double-support percent, and single-support variability (P = .001 to P = .031). FGA score correlated positively with the AQoL-6D dimension of independent living. FGA score correlated significantly with the FROP-Com screening tool predicted fall risk, but not with fall history. Conclusions: The FGA is a clinical measure of functional gait performance that reflected spatiotemporal gait parameters and ability of individuals with chronic stroke to live independently. The FGA could be used to target interventions to improve functional gait performance of individuals with chronic stroke

The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomised controlled trial

Background: Older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups. Objective: To determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls. Design: A randomised controlled trial model. Setting: Neurological Disorders, Ageing and Balance Clinic, Department of Physiotherapy, The University of Queensland. Subjects: 73 males and females over 60 years, living independently in the community and who had fallen in the previous year were recruited. Methods: All subjects received a falls risk education booklet and completed an incident calendar for the duration of the study. Treatment sessions were once a week for 10 weeks. Subject assessment before and after intervention and at 3 months follow-up included number of falls, co-morbidities, medications, community services and activity level, functional motor ability, clinical and laboratory balance measures and fear of falling. Results: All participants significantly reduced the number of falls (P < 0.000). The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group (P=0.034). Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group (P < 0.04). The control group only improved in TUG and TUGcog. Conclusions: The results provide evidence that all participants achieved a significant reduction in falls. Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance