Conciliation measures related to performance are the fundamental basis of physical therapy salary clinical documentation for performance and practices based on evidence. current clinical tools for balance assessment can not be domain specific balance, unable to challenge the systems to prevent falls from occurring. The following studies raise questions and challenge the identification of current scales fall hazards and measures to balance performance evaluation. Is clinical performance measures measure, and current practice reflect the existing data?
A functional balance test (POMA BBS) does not necessarily coincide with the ability of the individual to cope with external threats balance (Neuls, et al, Berg Balance Scale for Utility predict falls among the elderly, Jl Ger Phys Ther: .. 2011; (34)) It may be that the BBS does not test the fields of balance required to prevent or successfully recover from a fall ,. which may indicate that a measure most sensitive balance, including major components of responsive, dynamic balance is necessary. The level of reactive balance control ability in the elderly must be treated sufficiently before interventions can be developed. (Lin, Woolacott; Association between sensorimotor function, functional and responsive balance control in older people, age and aging: 05: 34). Decreased Berg Balance Scale wounds do not predict the frequency of falls increases. (Bogle, Thornbahn, Norton; Using Berg Balance Test to predict falls among elderly Phys Ther 1996; 76 (6) The BBS is able to identify the disease in the living community of older adults (Brotherton, are- measures used for evaluating .. Balance useful to detect differences between groups that vary by age and disease JGPT 28, 05) the Tinetti POMA shows poor reactivity to fall state Lin et al;?. psychometric comparisons Tugt and One-Leg stand, functional scope and Tinetti balance measures in the housing community for the elderly, J. Amer Geriatr Soc, 04). The usefulness of the POMA scales to predict future falls is severely limited. (Faber MJ, clinimétrique Properties oriented performance assessment Mobility: .. Phys Ther, 06, 86 (7) proactive and reactive adaptations should be targeted in interventions to reduce the incidence of falls in older people (Pavol, Runtz, Pai, young and old adults exhibit proactive and reactive adaptations to repeated exposure slip 04. J Gerontol A Biol Sci Med Sci)
measures of postural stability are not predictors of recovery of large postural perturbations in healthy adults aged distances Tour of. the center of pressure (COP), mediolateral and anteroposterior standing quiet position (postural fixity), static bending (static stability limit) and the dynamic swing (dynamic stability limits) were determined from the reaction forces of the ground through the plate strength. postural rigidity and stability limits variables were weakly correlated. rigidity and postural stability limits are not related to recoverable maximum lean angle. Recovery following postural disorders could not generally be predicted from measures of postural stability. The postural stability measures are of limited use in identifying potential fallers previously directed in healthy elderly adults. (Owings, Pavol; postural stability measures are not significant disruptions recovery predictors postural healthy seniors; Jl Am Ger Soc 00 :. 48 (1)) postural fixity during the Quiet position is not predictive of ability to find a balance with the strategy of the ankle. The postural stability measures during the quiet position were acquired, (amplitude, frequency and speed of the center of pressure movement) standing with eyes open or closed on a rigid or compliant surface. strategy ankle was measured at the release of a bending forward to evaluate the recovery of the balance. The reaction time and peak torque are not correlated with the fixity of variables. (Mackey Robinovitch, postural Regularity During Quiet Stance do not associate with the ability to recover the balance in older women; Clin Biomech: 05 July). functional scope does not differentiate fallers from non-fallers. (Wallman; Comparison of elderly fallers and non-fallers on performance measures; J Gerontol A Bio Sci Med Sci, 01, 56 (9) .. The functional scope is a small degree of stability limits Jonsson, The Functional Reach Test Reflect stability. limits in the elderly Jl Rehab Med 03 :? 35 (11)). functional scope does not measure the dynamic balance. seniors healthy and people with disabilities with the vestibular dysfunction reached the same distance from functional scope. (Wernick, Robinson, Krebs; Functional range: Is it really measure the dynamic balance: Arch Phys Med and Rehab 1999; 80 (3)
ABC 6 balance scale is an assessment tool the confidence of the most useful balance compared to ABC 16 for community living adults (Schepens, the short version of the balance scale specific activities confidence.. Its validity, reliability and the relationship to balance Depreciation and falls in the elderly; Gerontology and Geriatrics Archive. July 09) caution is advised when interpreting ABC scores of seniors living community more confident seniors are not necessarily more active and less confident seniors do not limit necessarily their activity (Cavanaugh, JGPT: 29 abstract) ...
several studies have questioned the usefulness of the timed get up and go test (Tugt) the Tugt with or without cognitive task, not predict falls in the community life of older women (Valliant, J et al .. Prediction of falls with performance on Timed up and Go and One-Leg balance tests and additional cognitive tasks; Ann Readapt Med Phys 06 49 (1). The Tugt showed poor responsiveness to fall state. (Lin et al; psychometric comparisons of the Timed Up and Go, One-Leg Stand, functional scope and measures Tinetti Balance in the Community dwelling elderly ;. Amer J Geriatr Soc 04, 52 (8) Tugt not suitable for older people high. adults operation (Boulgarides, L, clinical use and Impairment Tests to predict falls by Community Based Housing P
elderly ;. Phys Ther 03 83 (4) Even in the retrospective design, virtually no association was found between the risk of falling and Tugt the Tugt can not be used as a fall risk test in ambulatory elderly population (Thrane, the association between the Timed Get Up and Go test and risk of falling; BMC Geriatr 07 7: 1.) .. Tugt lower scores do not translate less retrospective reports of falls the Tugt not discriminating to the known fall state (Arnold, history of falls and the Association Tugt falls and near falls in older people with arthritis osteitis; .. 07 BMC Geriatr :. 7:17)
Tai Chi has gained recent popularity as improved balance and fall prevention intervention. The results of a randomized clinical trial on the effects of Tai Chi preventing falls in the elderly living in the community with a high risk of falling in the Netherlands have shown no beneficial effect on falls and secondary outcomes (eg balance, fear of falling). Logghe IH et al explain the ineffectiveness of a Tai Chi Fall Prevention Training Community of life of older people: A process evaluation Alongside a randomized clinical trial (RCT); Arch Gerontol Geriatr 2010 June). Tai Chi has the potential to reduce falls or risk of falling among older people, provided they are relatively young and not fragile. (OK for welfare programs, but does not reflect the typical patient populations) (Low S et al; A systematic review of the effectiveness of Tai Chi on the prevention of falls in older people: Arch Gerontol Geriatr; 09 :. 48 (3) There is insufficient evidence to conclude that Tai Chi is effective in preventing falls, reduced fear of falling and improve balance in elderly people over 50 years Nine trials (2203 participants) were included in the analysis (Logghe IH, et al; .. the effects of Tai Chi on fall prevention, fear of falling and balance in the elderly :. A meta-analysis Prev Med. 2010 51 (3-4)
physical disabilities such as muscular strength may not be sufficient to predict changes in this. capacity is (Schlicht, intense Bodybuilding effect on permanent balance and speed walk, and Sit-stand performance in the elderly Jl Gerontol A Biol Sci Med Sci: 01).
Researchers may need to test situations in which people are required to get the balance reactive in response to disturbances imposed from outside (Harris, P.Eng. Equilibrium relationship and mobility in fall Incidence in people with chronic diseases, Phys Ther 05: 85 (2)
Balance and disturbances neurophysiological Foundations
Scaling Predictable
individuals without neurological scale unrest. in proportion to the extent of their automatic postural responses to the scale of their imbalance. This scaling is based on direct sensory characteristics such as initial velocity of the perturbation and anticipation mechanisms based on predicting the movement characteristics, such as amplitude estimated displacement. the nervous system must be based on predictive mechanisms based on past experience. Scaling is a test component of predictable disturbance
Replies :.
proactive and reactive proactive and reactive adaptations each have an important role in preventing falls. reactive adaptations can reduce the probability of a loss of balance will lead to lower, while proactive adjustments may eliminate the occurrence of a loss of balance completely. proactive adaptations can be very effective when management of disruption is predictable and can lead to undesirable movement patterns that maintain the balance in both disturbed and undisturbed conditions. When the disturbances are less certain, reactive responses can play the dominant role to prevent a fall. So it can be argued that adjustments both proactive and reactive should be targeted in interventions to reduce the incidence of falls in the elderly. motor learning from past results is similar in young and older adults. (Pavol, Runtz, Pai, Young and elderly Exhibit proactive and reactive adaptations to repeated exposure Slip; Jl of Gerontology: 59a 04 (5) Proactive adaptation to the movement stability is a first line of defense against drops, while reactive responses represent. ;. second line of defense both are important feed-forward control Adaptive stability is based on an internal model continuously updated COG appears to be used by young and old evidence suggests that effective size of possible stable region decreases. age, and extent of adaptive changes in the feed-forward control (Pai, Wening, Runtz, Pavol, Role of feed-forward control of the stability of movements reducing the loss of balance and Slip-Related falls in the elderly ;. J. Neurophysiol: 03 :. 0) both anticipation and reaction mechanisms are routinely used to control balance while walking , patterns of muscle activity organized in the center, and modulated based on information available sensory, biomechanical constraints, support surface conditions and objectives of behavioral and learning. anticipation mechanisms are based on a feed-forward motion plane used in predictable situations well learned, while reactive mechanisms are generated by the use of sensorimotor feedback used in unpredictable situations. the reactive postural control can be used to modify the movements already underway and can be either automatic (reflexive) trip, or volition in case a correction on its own feet placement initiative. Vision is a key sensory feedback input for the reagent control (Tseng, Stanhope, Morton, Stepping adjustments doubtful reagents in older adults; A Biol Sci Jl Gerontolol Med Sci 09: 64; (7).).
Feasible stability Region
With repeated disruptions posture, CNS presumably built new or updated existing internal representations to improve its control of feed-forward, while decreasing dependence of a person on the feedback correction mechanisms for recovery. The relationship between the center of mass (COM) and the support base (BOS) standing person defines the limits of stability which describes a "stable region". The BOS consists of the contour area of each foot contact with the ground and the area between the feet biped position. a related increase in body sway age is often cited as an indication of a decline in stability, and has been associated with the decline in the elderly . However, no conclusive evidence indicates that people swaying with greater amplitude are less likely to regain balance after disturbance. Because most falls occur during locomotion, body sway evaluated in standing calm may not be the most appropriate indicator of stability in the everyday activities. a possible stability region (FSR) between forward and backward loss of balance thresholds. loss of equilibrium occurs when a large-scale disturbance moves the COM state outside the FSR exceeding up hip strategies resulting in an ankle and compensation step and establishing a new BOS. Undaunted locomotion is a series of volitional controlled before steadily declining before requiring stepper (Pai, Bhatt, repeated training Brief: A New Paradigm for the prevention of fall-related Slip Falls in the elderly, in 07 :. Phys Ther 89 (11)).
Plasticity
neuromuscular mechanisms of protection against falls can be developed or improved with appropriate adaptation training. With repeated exposure to disturbances, a newly acquired form, primarily predictive adaptive control emerges. These Feed- control exposures before the behavior in response to a disturbance in a predefined way that improves performance by modifying current and future motor commands, based on the information stored by previous experience. The CNS built, refines and updates an internal representation of potential threats that may occur in the external environment. No real experience and adaptive modification of the movement, explicit knowledge of the disturbance waiting is not enough fro humans exhibit appropriate behavior. With repeated disruptions posture, built CNS updates of new and existing internal representations to increase its control of feed-forward, while reducing the use of feedback correction mechanisms for successful recovery. (Pai, Bhatt, repeated sliding training: A new paradigm for the prevention of slip related falls among the elderly., 07: Phys Ther 87 (11)
Retention
Retention in the CNS is usually regarded as a long-term changes of function occurring in the neural circuits, a result of the consolidation process or to the stabilization of long term memory. This process accompanies the formation of new synapses, synthesis new protein and increase in strength of existing synapses. These changes occur in cortical and subcortical structures (basal ganglia, cerebellum) for tasks involving voluntary movements. the presence of a sequel to repeated disruption was well established. the maintenance of adaptive behavior can be conditioned by the sanctions inappropriate response by the NSC and the potential for increased injury. a very threatening environment would be sufficient to induce long-term retention of acquired motor behavior. New evidence supports applying disturbance mimicking real life situations as a form of motor training, with long-term effects on postural stability for the prevention of loss of balance and falls. Seniors can quickly develop coping skills for the prevention of falls in the same way as young adults. (Pai, Bhatt, Phys Ther: 07).
The main advantage of the training on the disturbance-base is a reduction in the travel time, rather than the time required to detect instability and initiate the response. (Mansfield, Maki Peters, Effect of Disturbance-based balance training program on Stepping compensatory and Grasping reactions in older adults: A randomized controlled trial 2010; Phys Ther 0 (4)
. a specific field, reliable and valid repeated, incremental, predictable disturbance in standing (RIPPS) of clinical balance assessment tool, very discriminating drop the story was reported; (DePasquale Toscano, spring balance test (SST): A reliable and valid to explain autumn History, Jl Geriatr Phys Ther; 09: 32 (4) The SST uses repeated additional foreseeable disturbances standing (RIPPS) to assess non stepper and the increased response limits in both anterior and posterior directions the measurement of clinical performance is .. RIPPS percent of total body weight (TBW% of) in accordance with the RIPPS performance criteria. in addition to balancing the evaluation RIPPS a suitable processing applications for the elderly.
- Bio
- Recent posts
Louis DePasquale PT, MA
Master of Arts Kinesiology, University of New York
physical Therapy certificate, Columbia University
BS physical Education, Manhattan College
Affiliations:
Good health system Relief term Programme Francis Schervier long Home health
Hebrew Home at Riverdale health Program long-term Home
Practice
setting 30 geriatric home care
Publications:
• DePasquale L, L. Toscano "the test of the spring scale (ESS) A reliable and valid to explain history. autumn "JGPT 09; . 32 (4)
• R Bohannon, DePasquale L. "Operation of the physical scale of the Short-Form (SF) 36 :. internal consistency and validity with the elderly "JGPT 2010. 33 (1)
• DePasquale L," Disturbance neurophysiology. " Advance: for Physical Therapy and Rehabilitation Medicine 2011: October 17.
• DePasquale L, "Security in the balance" Physical Therapy Products November 2011.
Latest posts Louis DePasquale PT, MA (see all)
- preventing falls: current Perspectives, Tools with evidence - April 1, 2014
- performance measures: Does the performance Really Measure Up - April 1 2014
- foreseeable disturbances :? an innovative clinically - September 30, 08
No comments:
Post a Comment