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 …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

The Psychometric Properties Of The Modified Fear Of Falling Avoidance Behavior Questionnaire In Parkinson’S Disease And Older Adults, Billy La, Arturo Aldaco, Ashley Haller

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background/purpose: The Fear of Falling Avoidance Behavior Questionnaire (FFABQ), developed in 2011 to measure fear of falling avoidance behavior, has good evidence for reliability and validity. However, a recently modified version (mFFABQ) is theorized to be easier to understand for those completing the questionnaire because the Likert responses are more logical in completing the item stem. The purpose of this study was to examine the test-retest reliability and construct validity of the mFFABQ in adults with Parkinson’s Disease (PD) and older adults aged 60-90 years. Methods: Thirty-nine participants (age 72.21 ± 9.5; 29 men, 10 women) diagnosed with PD (diagnosis …

Development Of A Multifactorial Virtual Fall Prevention Tool For Community Dwelling Older Women, Eduardo Gutierrez, Jacob James Nogra, Carol Sparks, Bradley Voels

UNLV Theses, Dissertations, Professional Papers, and Capstones

Falls are the leading causes of injury-related death in adults over the age of 65, with women sustaining more than twice the rate of fall-related fractures as men. Reduced access to in-person falls prevention programs during the COVID-19 pandemic created a need for a user-friendly guide to existing online fall prevention resources targeted at this vulnerable population. The first aim of this study was to create and make widely available a website with evidence-based resources that address a range of modifiable fall risk factors, and the second was to test its feasibility in a convenience sample of older women. The …

Lower Extremity Power And Movement Velocity In Competitive Older Athletes, Becca D. Jordre

Dissertations and Theses

Older adults are a rapidly growing population which house a subset of older athletes who regularly engage in sport competition. The physical health and risk factors of this competitive older athlete population have been largely overlooked by healthcare providers and researchers and are poorly understood. Older athletes exhibit distinctly different measures of physical performance which require unique thresholds to identify health-related risk factors. While lower extremity power and movement velocity have been identified as valuable measures of physical performance and fall risk in community-dwelling older adults this relationship has not been explored in competitive older athletes. One method for analyzing …

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 …

Association Between Patient Ability In Activities Of Daily Living At Hospital Admission And Key Indicators, Stephanie Rosen, Amber Steele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Illness and inactivity in the hospital frequently leads to disability that can reduce quality of life and increase costs. Early identification of people with limitations in activities of daily living (ADL) who are at risk for poor outcomes such as increased length of stay (LOS), hospital acquired conditions (i.e., falls and pressure injuries (PIs)), and discharge away from home can facilitate appropriate intervention. The Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF), a reliable and valid tool to measure ADL limitations, is scored at admission for all patients in our hospital. The purpose of this study …

Hospital To Home: Fall Prevention Interventions For The Discharging Patient, Joy Bridewell

Nursing Masters Papers

Falls is a major public health problem globally, with an estimated 646,000 fatal falls per year. This makes falls the second leading cause of unintentional injury death. Falls are very costly with non-fatal fall injuries costing about $50 billion per year and fatal falls with an estimated $754 million. Many risk factors contribute to a person’s risk of falling. Risk factors include age, gender, muscle strength, underlying medical or disabling conditions, and unsafe environments. Patients who have been hospitalized are also among those at risk. Most hospitalized patients are assessed frequently to determine their risk of falling so that care …

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 …

Exploring The Use Of The Timed Up And Go Test To Identify Patient Fall Risk In An Inpatient Geriatric Psychiatry Unit, Danielle Struble-Fitzsimmons

Seton Hall University Dissertations and Theses (ETDs)

Background: Patient falls during hospitalization influence healthcare costs and quality, and hospitals are mandated to complete fall risk assessments on all patients. Inpatient geriatric psychiatry units have the highest fall rates in the acute care setting, and most falls in this population occur during the mobility tasks of transfers and ambulation. The Timed Up and Go (TUG) test includes these two specific functional tasks, and has been used to predict falls in other geriatric populations, but has never been tested in an inpatient geriatric psychiatry unit. The purpose of this study was to determine if the TUG is a predictive …

Effect Of Individual Height And Testing Methods On Outcome Of The Forward Functional Reach Test, Jill Elaine Heitzman

Department of Physical Therapy Student Theses, Dissertations and Capstones

Background: With falls a leading cause of injuries among those over age 65, early recognition of risk is imperative to reduce rising rates. The Forward Functional Reach test (FFRT) (Duncan et al., 1990) is frequently used to identify fall risk, however, the variability in cut values found in the research may be related to height and reach strategies.

Purpose: The purpose of this study was to determine if FFRT is affected by an individual’s height and if bilateral reach to height ratio could more accurately identify fall risk.

Methods: Sixty-six participants (60 and older) were recruited from a senior center …

Disposition And Success Of Patients Following Discharge In The Acute Setting, Ciera Cortney, Kathryn Lutjens, Kristopher Raines

UNLV Theses, Dissertations, Professional Papers, and Capstones

Abstract: Background & Purpose: Many patients are seen in the hospital by physical therapists who also help decide where the patient will go after discharge (e.g., home, rehab hospital, skilled nursing facility) with the goal being the safest and best quality of life. Therapists may use different tests and measures along with their own professional judgment to help make a recommendation for a discharge location. The purpose of this study was to examine how PT’s recommendation for discharge location, POMA score, “6-clicks” score, age, diagnosis, and gender determine patient’s fall/readmission status after being discharged by hospital. Subjects: There were 113 …

Gait And Balance In Alzheimer's Disease: A Retrospective Analysis Across Varying Levels Of Cognitive Impairment, Diana Contreras, Jessica Heim, Jun Nelson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: It was once thought that Alzheimer’s disease (AD) affected mostly cognition with minor motor impairment; however, it is becoming apparent that motor impairment may also be a prominent feature. Determining the extent of motor impairments throughout the continuum of cognitive impairment is critical in developing timely interventions for this population. Purpose/Hypothesis: The aim of this study was to gain a greater understanding of motor impairment in AD by exploring the relationships among gait, balance, and falls. Specifically, we explored the association of fall history to measures of cognition and performance-based balance measures in individuals with AD. We hypothesized that …

A Systems Approach To The Problem Of Falls In Old Age, Patrick A. Dillon

Theses and Dissertations--Gerontology

The problem of falls in old age is enormously costly and disruptive for the older individual, others, and society, and its severity is likely to intensify as our population ages. This dissertation takes a systems-oriented approach toward the falls problem and is presented in two parts. The first part critically develops a new approach to the problem of falls. The second part describes an empirical study that applies this new approach in a pragmatic manner.

Conventional fall prevention strategies employ a reductionist approach to the problem of falls. This approach is questioned because it corresponds poorly to the holistic nature …

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.

The Role Of Postural Stability And Other Factors In Distal Radius Fracture, Sheena Saju Philip

Electronic Thesis and Dissertation Repository

The objective of the thesis was to describe the factors leading to falls in distal radius fracture (DRF) events, explore patient perceived risk of falls, and postural stability. A mixed method study described the type of fall in DRF patients (n= 1454) and patient perceived contributing factors (n=29). A prospective cohort study examined the postural stability and related fall risk of DRF participants (n=137) in Biodex Balance System (BBS) and compared to normative values. Environmental factors were a major contributor to DRF events. Older adults (44 to 65 years) had the highest rate of DRF (female: male ratio of 2:1). …

Balance Confidence And Fear Of Falling Avoidance Behavior Are Most Predictive Of Falling In Older Adults: A Prospective Analysis, Sarrie Oscar, Jessica Sasaoka, Kyle Vaughn

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls. Objective: The purpose of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults. Design: This was a prospective cohort study. Methods: Sixty-four participants (mean age=72.2 years, SD=7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with …

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 …

Brachial Plexus Injury And Benign Paroxysmal Positional Vertigo Following A Fall: A Case Report, Przemyslaw Ilczyk

All Capstone Projects

Background: In the elderly population, research has shown that impairments of balance and strength are common reasons for falls. Falls constitute one of the main reasons for emergency department and hospital admissions, and are the second most common reason for brachial plexus injury. Another common symptom, after a fall and head trauma incident, is Benign Paroxysmal Positional Vertigo (BPPV). Approximately 50% of subjects with traumatic brain injury complain about positional vertigo. Research shows that traumatic BPPV is commonly misdiagnosed in clinical practice.

Purpose: The purpose of this case report is to present interventions that were used to treat a patient …

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 …

Modern Technology And An Aging Population: Can The Use Of The Wii Fit Gaming System Improve Functional Balance In Community Dwelling Seniors?, Curtis N. Phillips

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Seniors are a growing segment of the population of the United States. By 2030 they will make up nearly 20% of the general population. Senior citizens face many health challenges as they age. Injury due to falling is a major concern for many in this age group. Research shows that approximately one third of seniors will fall each year. Injuries that result from falls have been identified as the number one cause of accidental death in this age group each year. While falls have been studied by researchers for a number of years, and some progress has been made in …

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 …