Medicine and Health Sciences Commons^™

Short-Term Benefits From Manual Therapy As An Adjunct Treatment For Persistent Postural-Perceptual Dizziness Symptoms: A Preliminary Prospective Case Series, Brent A. Harper, Larry Steinbeck

Physical Therapy Faculty Articles and Research

Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation^® method (FM^®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients …

Influences Of Balance Confidence, Fear Of Falling, And Fall History On Physical Activity Levels In Community-Dwelling Older Adults, Alison Yang Spt, Holly Roberts Pt, Phd

Physical Therapy Research Symposium

Background: Physical activity levels generally decline with increasing age. Few studies have examined the influences of balance confidence, fear of falling, and fall history on physical activity levels in older adults.

Purpose: To determine the relationships between balance confidence, fear of falling, fall history, and physical activity level in community-dwelling older adults.

Methods: Eighty-eight participants completed the Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), and a self-reported fall history. They reported their monthly activity levels using the Physical Activity Scale for the Elderly (PASE). Pearson correlation coefficients (r) were used to analyze …

Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers., Kristin E Musselman, Tarun Arora, Katherine Chan, Mohammad Alavinia, Mackenzie Bone, Janelle Unger, Joel Lanovaz, Alison Oates

Physical Therapy Publications

OBJECTIVE: To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D).

DESIGN: Prospective cohort study.

SETTING: Community.

PARTICIPANTS: Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury.

MAIN OUTCOME MEASURES: Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity …

Patient-Reported, Not Performance Based, Outcome Measures Are Correlated With Future Falls In Community Dwelling Older Adults, Alex Carr Spt, Hannah Johnson Spt, Elise Whisler Spt, Holly Roberts Pt, Phd

Physical Therapy Research Symposium

Background: One-third of community-dwelling older adults fall at least once a year, yet many commonly used performance-based outcome measures for falls have ceiling effects. Additionally, psychological factors such as fear of falling and avoidance behaviors may contribute to fall risk.

Purpose: To determine whether balance confidence, fear of falling avoidance behaviors, or performance on high-level mobility outcome measures can predict falls in community-dwelling older adults.

Methods: Eighty-nine participants (76 ± 7 years) completed the Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behaviors Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance & Mobility Scale (CB&M) and then recorded …

Comparison Of Balance Confidence, Balance Performance, And Falls Among Age Groups For Community-Dwelling Older Adults, Lindsay Dirringer Spt, Ana Sabates Spt, Holly Roberts Pt, Phd

Physical Therapy Research Symposium

Background: Balance confidence and performance is crucial for fall prevention among the elderly but the correlation with age is unknown.

Purpose: Identify changes in balance confidence, balance performance and falls of older age.

Methods: 90 community-dwelling older adults (76+7 years, 54 female, 34 fallers) completed the Activity Specific Balance Confidence Scale (ABC), Fear Avoidance Beliefs Questionnaire (FABQ), Community Balance and Mobility Scale (CB&M), and Functional Gait Assessment (FGA), and self-reported falls for 6 months. Scores on outcome measures and fall rates were compared using a one-way repeated measures ANOVA for age groups 65-74, 75-84, and 85+.

Results: There were no …

Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young

Case Report Papers

Background and Purpose: The main focus of chronic disease in healthcare has typically been about treatment of the disease itself, with little attention given to secondary injuries that result from the chronic disease process. As these individuals age, the risk of secondary injuries increases. This is costly and adds to the caregiver burden. The purpose of this case report was to investigate a comprehensive physical therapy (PT) program focused on rehabilitation for a female with chronic disease who sustained a femoral fracture following her most recent fall. Case Description: A 42-year-old female presented to outpatient PT following a right femoral …

Evaluating Knowledge Of Falls Risk Factors And Falls Prevention Strategies Among Lower Extremity Amputees After Inpatient Prosthetic Rehabilitation: A Prospective Study, Susan W. Hunter, Jordan Higa, Courtney Frengopoulos, Ricardo Viana, Michael Payne

Physical Therapy Publications

Purpose: Falls are prevalent among people with lower extremity amputations. A knowledge of risk factors is important in preventing falls, though no research has evaluated patient understanding of falls in this population. The study objective was to evaluate knowledge of falls risk factors and falls prevention strategies at discharge and 4-months after inpatient prosthetic rehabilitation.

Methods: Participants completed a falls questionnaires with four sections: (1) falls during rehabilitation and after discharge, (2) falls self-efficacy using the Activities-specific Balance Confidence scale, (3) knowledge of falls risk factors, and (4) falls prevention strategies. Questionnaire responses were quantified using means and standard deviations …

Incidence And Prevalence Of Falls In Adults Living With An Intellectual Disability Living In The Community: A Systematic Review, Portia Ho, Shane Patman, Caroline Bulsara, Jenny Downs, Max Bulsara, Anne-Marie Hill

Physiotherapy Papers and Journal Articles

Review question/objective: The objective of this review is to synthesize the best available evidence to determine the incidence and prevalence of falls in adults with intellectual disability living in the community.

Mobility And Cognition In Seniors. Report From The 2008 Institute Of Aging (Cihr) Mobility And Cognition Workshop, Manuel Montero-Odasso, Louis Bherer, Stephanie Studenski, Karen Gopaul, Afua Oteng-Amoako, Sarah Woolmore-Goodwin, Paul Stoole, Jennie Wells, Timothy Doherty, Aleksandra A. Zecevic, David Galinsky, R. Jane Rylett, Jeffrey Jutai, Susan W. Muir-Hunter, Mark Speechley, Richard Camicioli

Physical Therapy Publications

Background

The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop.

Methods

Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors.

Results

Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research …

Influence Of Pelvis Impact Angle During A Fall: On The Protective Benefit Of Hip Protectors, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Over 90% of hip fractures are due to falls [1]. Laboratory measures have shown that wearable hip protectors reduce impact forces to the proximal femur during a simulated sideways fall on the hip [2, 3]. However, clinical evidence suggests that hip fractures still occur when hip protectors are worn [4]. Furthermore, while falls in real life result in a variety of impact configurations, biomechanical tests to date have focused only on lateral impact to the pelvis. In the current study, we examined how the force reduction provided by wearable hip protectors is affected by pelvis impact configuration during simulated sideways …

Identification Of Functional Parameters For The Classification Of Older Female Fallers And Prediction Of ‘First-Time’ Fallers, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Falls remain a challenge for ageing societies. Strong evidence indicates that a previous fall is the strongest single screening indicator for a subsequent fall and the need for assessing fall risk without accounting for fall history is therefore imperative. Testing in three functional domains (using a total 92 measures) were completed in 84 older women (60–85 years of age), including muscular control, standing balance, and mean and variability of gait. Participants were retrospectively classified as fallers (n = 38) or non-fallers (n = 42) and additionally in a prospective manner to identify first-time fallers (FTFs) (n = 6) within a …

Classifying Lower Extremity Muscle Fatigue During Walking Using Machine Learning And Inertial Sensors, Jian Zhang, Thurmon Lockhart, Rahul Soangra

Physical Therapy Faculty Articles and Research

Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and …

Circumstances Of Falls And Falls-Related Injuries In A Cohort Of Older Patients Following Hospital Discharge, Anne-Marie Hill, Tammy Hoffman, Terry P. Haines

Physiotherapy Papers and Journal Articles

Background:

Older people are at increased risk of falls after hospital discharge. This study aimed to describe the circumstances of falls in the six months after hospital discharge and to identify factors associated with the time and location of these falls.

Methods:

Participants in this randomized controlled study comprised fallers (n = 138) who were part of a prospective observational cohort (n = 343) nested within a randomized controlled trial (n = 1206). The study tested patient education on falls prevention in hospital compared with usual care in older patients who were discharged from hospital and followed for six months …

Wavelet Based Automated Postural Event Detection And Activity Classification With Single Imu (Tempo), Thurmon E. Lockhart, Rahul Soangra, Jian Zhang, Xuefang Wu

Physical Therapy Faculty Articles and Research

Mobility characteristics associated with activity of daily living such as sitting down, lying down, rising up, and walking are considered to be important in maintaining functional independence and healthy life style especially for the growing elderly population. Characteristics of postural transitions such as sit-to-stand are widely used by clinicians as a physical indicator of health, and walking is used as an important mobility assessment tool. Many tools have been developed to assist in the assessment of functional levels and to detect a person’s activities during daily life. These include questionnaires, observation, diaries, kinetic and kinematic systems, and validated functional tests. …

Pressure Distribution Over The Palm Region During Forward Falls On The Outstretched Hands, Woochol J. Choi, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

Falls on the outstretched hands are the cause of over 90% of wrist fractures, yet little is known about bone loading during this event. We tested how the magnitude and distribution of pressure over the palm region during a forward fall is affected by foam padding (simulating a glove) and arm configuration, and by the faller’s body mass index (BMI) and thickness of soft tissues over the palm region.

Thirteen young women with high (n=7) or low (n=6) BMI participated in a “torso release experiment” that simulated falling on both outstretched hands with the arm inclined either at 20° or …

Performance Of A Hip Protector Depends On Its Position During A Fall, Woochol J. Choi, Joaquin A. Hoffer, Stephen N. Robinovitch

Physical Therapy Faculty Articles and Research

"Hip protectors are designed to attenuate and redistribute the force applied to the hip region during a fall, and thereby reduce risk for hip fracture [1]. However, little information exists on the effectiveness of hip protectors in achieving these goals, and how this is altered by displacement of the hip protector relative to the greater trochanter (GT). In the current study, we tested these issues."

Whole Body Momentum During Gait: A Preliminary Study Of Non-Fallers And Frequent Fallers, Guy G. Simoneau, David E. Krebs

Physical Therapy Faculty Research and Publications

The importance of momentum in compensating for elderly individua ls ' strength deficits to achieve activities of daily living. such as rising from a chair ha.!o been demonstrated in earlier studies. Here we present a case control study of three healthy "non-fallers" and two "frequent fallers," All 5 elders were community-living and were tested in the gai l laboratory. A four-camera Selspot system was used to obtain whole-body momentum from an 11-segment kinematic model. Ground reaction forces and kinematics were used 10 calculate lower extremity join! moments. With the exception of the whole-body's angular momentum about the vertical axis, linear …