Physical Therapy Commons^™

Functional Reach Test, Single-Leg Stance Test, And Tinetti Performance-Oriented Mobility Assessment For The Prediction Of Falls In Older Adults: A Systematic Review, Humberto Omaña, Kari Bezaire, Kyla Brady, Jayme Davies, Nancy Louwagie, Sean Power, Sydney Santin, Susan W. Hunter

Physical Therapy Publications

OBJECTIVE: The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations.

METHODS: The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale.

RESULTS: Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 …

The Effect Of First-Time 4-Wheeled Walker Use On The Gait Of Younger And Older Adults, Humberto A. Omana, Edward Madou, Alison Divine, Walter Wittich, Keith D. Hill, Andrew M. Johnson, Jeffrey D. Holmes, Susan W. Hunter

Physical Therapy Publications

INTRODUCTION: The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required.

OBJECTIVE: To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults.

DESIGN: Cross-sectional, repeated-measures.

SETTING: Community-dwelling.

PARTICIPANTS: Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people …

Perspectives Of Individuals With Chronic Spinal Cord Injury Following Novel Balance Training Involving Functional Electrical Stimulation With Visual Feedback: A Qualitative Exploratory Study, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

METHODS: Five individuals with a motor …

Prevalence And Risk Factors Of Falls In Adults 1 Year After Total Hip Arthroplasty For Osteoarthritis: A Cross-Sectional Study, Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward M Vasarhelyi, Brent Lanting

Physical Therapy Publications

Total hip arthroplasty is very successful in alleviating the pain from osteoarthritis. However, deficits in lower limb strength, gait, and balance after surgery has identified this group at risk of falls. Considering the high number of people annually receiving a total hip arthroplasty, further elaboration of factors associated with falls is needed to refine fall prevention guidelines. The objective was to examine the prevalence and circumstances of falling and the risk factors associated with falling in older adults in the first year after total hip arthroplasty surgery. This was a cross-sectional study involving 108 individuals (age of 72.4 ± 6.5 …

Executive Function As A Mediating Factor Between Visual Acuity And Postural Stability In Cognitively Healthy Adults And Adults With Alzheimer's Dementia, Susan W. Hunter, Alison Divine, Edward Madou, Humberto Omana, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes, Walter Wittich

Physical Therapy Publications

BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability.

METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and …

Reactive Stepping After A Forward Fall In People Living With Incomplete Spinal Cord Injury Or Disease, Katherine Chan, Jae Woung Lee, Janelle Unger, Jaeeun Yoo, Kei Masani, Kristin E Musselman

Physical Therapy Publications

STUDY DESIGN: Cross sectional.

OBJECTIVES: To compare the reactive stepping ability of individuals living with incomplete spinal cord injury or disease (SCI/D) to that of sex- and age-matched able-bodied adults.

SETTING: A tertiary SCI/D rehabilitation center in Canada.

METHODS: Thirty-three individuals (20 with incomplete SCI/D) participated. Participants assumed a forward lean position in standing whilst 8-12% of their body weight was supported by a horizontal cable at waist height affixed to a rigid structure. The cable was released unexpectedly, simulating a forward fall and eliciting one or more reactive steps. Behavioral responses (i.e., single step versus non-single step) were compared …

Risk Factors For Falls In Individuals With Lower Extremity Amputations During The Pre-Prosthetic Phase: A Retrospective Cohort Study, Kimberly Vu, Michael W C Payne, Susan W. Hunter, Ricardo Viana

Physical Therapy Publications

BACKGROUND: Falls in individuals with lower limb amputations (LLAs) pose significant health concerns. The literature is limited regarding falls during the preprosthetic phase of rehabilitation for persons with LLAs.

OBJECTIVE: To determine the incidence of falls and identify factors associated with falls during the preprosthetic recovery phase.

DESIGN: Retrospective chart audit.

SETTING: Inpatient rehabilitation program.

PARTICIPANTS: Four hundred forty individuals with LLAs (age ± SD = 61.93 ± 14.53 years, 73.18% male) who attended inpatient rehabilitation from 26 July 2011 to 21 August 2017.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASUREMENTS: The number of self-reported falls was recorded from the time …

Intensive Balance Training For Adults With Incomplete Spinal Cord Injuries: Protocol For An Assessor-Blinded Randomized Clinical Trial., Janelle Unger, Katherine Chan, Carol Y Scovil, B Catharine Craven, Avril Mansfield, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke.

OBJECTIVE: The objective is to investigate whether PBT or conventional intensive balance training (CIBT) results in greater improvements in reactive stepping ability in individuals with chronic incomplete spinal cord injury (iSCI).

DESIGN: The design consists of an assessor-blind randomized clinical trial comparing the efficacy of 2 balance training programs (PBT and CIBT) matched for training duration …

Physical Therapists’ Perceptions Of Barriers To The Use Of Evidence-Based Fall Prevention Intervention With Individuals Of 65 Years Of Age Or Older, Charles Agbonghae

Student Dissertations

Falls are a problem in the elderly population. Evidence-based fall prevention programs are available but physical therapists do not always utilize them. The literature identifies a number of barriers to clinician’s use of evidence-based interventions in general but there is limited knowledge of barriers to the use of evidence-based interventions in the clinical practice area of fall prevention. The purpose of this study was to identify barriers perceived by physical therapists to the use of evidence-based fall prevention interventions with individuals of 65 years of age or older. The study utilized an on-line survey of physical therapists licensed in Texas. …

Cognition Predicts Mobility Change In Lower Extremity Amputees Between Discharge From Rehabilitation And 4-Month Follow-Up: A Prospective Cohort Study., Susan W. Hunter, Pavlos Bobos, Courtney Frengopoulos, Austin Macpherson, Ricardo Viana, Michael W Payne

Physical Therapy Publications

OBJECTIVES: To assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months' follow-up.

DESIGN: Prospective cohort study.

SETTING: Rehabilitation hospital.

PARTICIPANTS: People with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Gait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment …

Effect Of Learning To Use A Mobility Aid On Gait And Cognitive Demands In People With Mild To Moderate Alzheimer's Disease: Part Ii - 4-Wheeled Walker., Susan W. Hunter, Alison Divine, Humberto Omana, Walter Wittich, Keith D Hill, Andrew M Johnson, Jeffrey D Holmes

Physical Therapy Publications

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk.

OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults.

METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight …

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …

Effects Of Pole Walking On Older Adults Following Six Weeks Of Training, Samantha Forsch, Raevyn Haugland

Physical Therapy Scholarly Projects

Introduction: Age-related changes in adults over 60 include reduced mobility and function as well as an increase in frailty. Conventional walking has been shown to be an effective physical activity to maintain mobility and improve function and overall health and fitness. Specifically, walking speed has been identified as a crucial predicting factor for fall risk and decreased functional mobility. For this reason, clinicians considered the element of walking speed as the sixth vital sign. Pole walking has gained popularity over the years and may provide additional benefits, when compared to conventional walking, such as improved stride and step length, faster …

A Framework For Secondary Cognitive And Motor Tasks In Dual-Task Gait Testing In People With Mild Cognitive Impairment., Susan W Hunter, Alison Divine, Courtney Frengopoulos, Manuel Montero Odasso

Physical Therapy Publications

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).

METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined …

The Modified Dynamic Gait Index And Limits Of Stability In Myotonic Dystrophy Type 1, Evan M. Pucillo, Melissa M. Mcintyre, Mary Pautler, Man Hung, Jerry Bounsanga, Maren W. Voss, Heather Hayes, Deanna Dibella, Caren Trujillo, Melissa Dixon, Russell Butterfield, Nicholas E. Johnson

Physical Therapy Collection

INTRODUCTION:

The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1).

METHODS:

Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests.

RESULTS:

Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those …

Trunk Motion Visual Feedback During Walking Improves Dynamic Balance In Older Adults: Assessor Blinded Randomized Controlled Trial., Eric Anson, Lei Ma, Tippawan Meetam, Elizabeth Thompson, Roshita Rathore, Victoria Dean, John Jeka

Department of Physical Therapy Faculty Papers

BACKGROUND: Virtual reality and augmented feedback have become more prevalent as training methods to improve balance. Few reports exist on the benefits of providing trunk motion visual feedback (VFB) during treadmill walking, and most of those reports only describe within session changes.

RESEARCH QUESTION: To determine whether trunk motion VFB treadmill walking would improve over-ground balance for older adults with self-reported balance problems.

METHODS: 40 adults (75.8 years (SD 6.5)) with self-reported balance difficulties or a history of falling were randomized to a control or experimental group. Everyone walked on a treadmill at a comfortable speed 3×/week for 4 weeks …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Don’T Let Me Fall: Implementing The Use Of Assistive Standing Device With Functional Task Specific Training Can Improve Safety Of Transfers In A 65 Y/O Woman With Primary Lateral Sclerosis: A Case Report, Megan Farr, Lindsay Perry

St. Augustine, Spring 2017

The purpose of this case report is to describe improvements of a novel functional training program in a patient diagnosed with PLS.

Evaluating The Impact Of A Falls Prevention Community Of Practice In A Residential Aged Care Organisation, Jacqueline Francis-Coad

Theses

Falls in the residential aged care (RAC) sector are a global concern with humanitarian and economic consequences. Reducing falls using a multifactorial approach involving multidisciplinary staff is recommended, but it is not clear how RAC organisations in Australia can achieve this in a resource constrained environment. One potential solution is to develop a sustainable means of addressing falls prevention from within an organisation, creating a forum for staff to share ideas, expertise and achieve goals in a community of practice (CoP). The purpose of this research was to evaluate the impact of a falls prevention CoP on falls outcomes in …

Multiple Fracture Following Non-Occupational Fall: A Case Report, Brittany Olson

Physical Therapy Scholarly Projects

Background and Purpose: Falls are prevalent in adults over the age of sixty-five due to lack of balance and decreased lower extremity strength. Non-occupational falls are reported to have an increasing prevalence with age and one-fifth of these types of falls results in hospitalization. The hospitalization of patients who sustain injuries following falls most often results in skeletal fractures. The cost to treat these patients is projected to reach $54.9 billion by the year 2020. The objective of this case report is to demonstrate the outcomes of a patient who sustained multiple fractures following a nonoccupational fall.

Case Description …

Environmental Illumination In Relation To Balance Performance In Healthy Community-Dwelling Elders, Laura Habermann

Physical Therapy Scholarly Projects

The purpose of this study was to determine the effects low levels of lighting have on balance in healthy, community dwelling elders. The balance of 14 volunteer subjects (13 females and 1 male) who are older than 65, who live in · the community and who are generally healthy was tested. Each subject's balance was tested in both optimal and poor lighting conditions using the functional reach balance assessment tool. Subjects were given two practice trials and were then instructed to reach three times in each condition while the researcher measured the amount of light in the room and the …

Lower Extremity Strength Training To Decrease Falls In The Elderly, Kelly L. Spadolini

Physical Therapy Scholarly Projects

p>As the elderly population grows, the health care needs of people over the age of sixty-five will dominate the medical profession. Methods of prevention of health problems are key to providing the optimal medical care. Falling has been reported as the most prevalent means of injury in older people. One third of all seniors living in the community and one half of those residing in nursing homes fall each year. Research indicates that elderly people who fall have weaker lower extremity strength than elderly people who do not fall. As a result, some clinicians have incorporated strengthening regiments into …

Balance Exercise For Fall Prevention In The Elderly, Lorrina Mcclellan

Physical Therapy Scholarly Projects

Falls are a very common and serious problem in the elderly population. Individuals who fall may suffer from physical trauma, psychological problems, and possible death. In the past, falls were thought to be an unavoidable occurrence that accompanied aging. Research has .recently identified risk factors that may predict those who are at risk for falling. By recognizing and then modifying these risk factors, potential falls may be prevented. Examples of risk factors that occur with aging include visual impairments, vestibular decline, deterioration of muscle strength, decrease in joint flexibility, and the loss of sensation. Natural biological declines may have profound …

Physical Therapy Interventions For Falls In The Elderly, Melanie Benson

Physical Therapy Scholarly Projects

The elderly in America represent a population that is continually growing. As part of the aging process, various changes occur that contribute to falls. Therefore, as the number of elderly people in America increases, the possibility of falls in the elderly also increases.

The consequences of falls in the elderly are significant. Some of the more serious consequences include functional decline, increased medical cost, and death. Therefore, the scope of the problem is clear; strategies to prevent falls and treat those who have fallen are indicated.

The purpose of this independent study is to review the literature pertaining to falls …