Debra J. Rose

Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults

OBJECTIVE Reliability of platform posturography tests is essential for the identification and treatment of balance-related disorders. The purposes of this study were to establish the reliability of the limits of stability (LOS) test and to determine the relative variance contributions from identified sources of measurement error. DESIGN Generalizability theory was used to calculate (1) variance estimates and percentage of variation for the sources of measurement error, and (2) generalizability coefficients. Random effects repeated measures analysis of variance (RM ANOVA) was used to assess consistency of measurements across both days and targets. PARTICIPANTS Thirty-eight community-dwelling older adults with no recent history of falls. MAIN OUTCOME MEASURES Outcome measures derived from the LOS tests included movement velocity (MV), maximum center of gravity (COG) excursion (ME), end point COG excursion (EE), and directional control (DC). RESULTS Estimated generalizability coefficients for 2 and 3 days of testing ranged from .69 to .91. Relative contributions of the day facet were minimal. The RM ANOVA results indicated that for three of the movement variables, no significant differences in scores were observed across days. CONCLUSIONS The 75% and 100% LOS tests are reliable tests of dynamic balance when administered to healthy older adults with no recent history of falls. Dynamic balance measures were generally consistent across multiple evaluations.

Predicting Which Older Adults Will or Will Not Fall Using the Fullerton Advanced Balance Scale

OBJECTIVE The purpose of this study was to determine if the Fullerton Advanced Balance (FAB) scale can predict faller status in a group of independently functioning older adults. DESIGN A cross-sectional design was used to establish the sensitivity and specificity of the FAB scale to predict faller status based on a retrospective self-reported fall history. For the purpose of this study, a faller was classified as an older adult with a history of 2 or more falls in the previous 12 months. SETTING Multipurpose senior centers in an urban community. PARTICIPANTS A sample of independently functioning older adults (N=192; mean age+/-SD, 77+/-6.5 y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FAB scale, a retrospective history of falls. RESULTS Binary logistic regression analysis indicated that the total FAB scale score could be used to predict faller status (as determined by a retrospective self-reported fall history). In the present sample, the probability of falling increased by 8% with each 1-point decrease in total FAB scale score. Receiver operating characteristic analysis determined that a cut-off score of 25 out of 40 on the FAB scale produced the highest sensitivity (74.6%) and specificity (52.6%) in predicting faller status. Five individual test items on the FAB scale were particularly predictive of faller status and could be combined to form a short version of the scale that may be even more predictive of faller status and require less time to administer. CONCLUSIONS The FAB scale is a predictive measure of faller status when used with independently functioning older adults. A practitioner can be confident in more than 7 out of 10 cases that an older adult who scores 25 or lower on the FAB scale is at high risk for falls and in need of immediate intervention.

Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls

OBJECTIVE: To determine the short‐term effectiveness of a biofeedback‐based, computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling.

Optokinetic backgrounds affect perceived velocity during ocular tracking

The perceived velocity of visually tracked moving objects may depend on interactions between reflexive and voluntary oculomotor mechanisms. To investigate this hypothesis, subjects were required to compare sequentially the velocity of a standard target with that of a test target moving at one of five velocities. The standard target was viewed against a plain field (no optokinetic stimulation), and the test target was viewed against (1) a plain field, (2) a stationary grating, (3) a grating drifting in the direction of target motion, or (4) a grating drifting against target motion. In one condition, subjects tracked the target; in the other, a stationary point was fixated. The tracking group overestimated velocity when backgrounds drifted against target motion, but underestimated velocity when gratings drifted with target motion. Subjects not required to track experienced no such misestimations. The results are discussed in relation to the interactive mechanisms of the two eye-movement systems.

Premotor and Motor Reaction Time As a Function of Response Complexity

Abstract Two experiments were conducted to identify the response elements responsible for the complexity effect found by Henry and Rogers (1960). An attempt was made to determine if these elements were affecting the premotor time component of simple reaction time (SRT). If they were, a strong case could be made for the argument that neuromotor programming time was affected because premotor time is a more exact estimate of it than SRT. The results revealed that premotor time was unaffected by a forward change in movement direction, but increased as the number of movement parts increased from one to two and as the demand for movement accuracy increased. Thus, increasing the (1) number of parts and (2) accuracy demands were identified as elements of response complexity which increase programming time and support Henry and Rogers (1960) hypothesis that the time to initiate a response becomes longer as the programming process become more complex.

Show and tell in the gymnasium revisited: developmental differences in modeling and verbal rehearsal effects on motor skill learning and performance.

Little research has investigated the observational learning process from a developmental perspective. The purpose of this study was to extend previous research by considering two factors: performance versus learning and sequencing versus form scores. Children (N = 60) comprising two age groups (5-0 to 6-11 and 8-0 to 9-11 years) were randomly assigned to verbal rehearsal only, model only, or model plus verbal rehearsal conditions. The task was a 6-part motor skill sequence in which proper sequencing and quality of form were assessed. A 2 x 3 x 4 (age group by model type by trial blocks) repeated measures MANOVA revealed a significant three-way interaction. Older children performed equally well under any of the model type conditions during both performance and learning. For younger children, a model plus rehearsal was superior to rehearsal only on sequence and form at performance and learning and superior to model only on sequence scores during the first two performance trial blocks. Model only and model plus rehearsal conditions were equally effective on form scores. These results suggest that age differences exist in the modeling of motor skills under conditions varying in model type, sequence and form scores, and performance and learning phases.

The Role of Exercise in Fall Prevention for Older Adults

This article reviews the evidence for the effectiveness of stand-alone exercise interventions and multifactorial intervention strategies that include exercise in lowering fall incidence rates and/or fall risk among older adults residing in the community, acute, subacute, and long-term care settings. Stand-alone exercise programs that emphasize multiple exercise categories are effective in reducing fall rates and fall risk in community-residing older adults, and may also be effective when conducted for a sufficient duration with older adult patients in subacute settings. In contrast, multifactorial fall risk reduction programs that include exercise as a component and are delivered by a multidisciplinary team are more effective in lowering fall rates in long-term care settings.

Rasch Analysis of the Fullerton Advanced Balance (FAB) Scale

PURPOSE This cross-sectional study explores the psychometric properties and dimensionality of the Fullerton Advanced Balance (FAB) Scale, a multi-item balance test for higher-functioning older adults. METHODS Participants (n=480) were community-dwelling adults able to ambulate independently. Data gathering consisted of survey and balance performance assessment. Psychometric properties were assessed using Rasch analysis. RESULTS Mean age of participants was 76.4 (SD=7.1) years. Mean FAB Scale scores were 24.7/40 (SD=7.5). Analyses for scale dimensionality showed that 9 of the 10 items fit a unidimensional measure of balance. Item 10 (Reactive Postural Control) did not fit the model. The reliability of the scale to separate persons was 0.81 out of 1.00; the reliability of the scale to separate items in terms of their difficulty was 0.99 out of 1.00. Cronbachs alpha for a 10-item model was 0.805. Items of differing difficulties formed a useful ordinal hierarchy for scaling patterns of expected balance ability scoring for a normative population. CONCLUSION The FAB Scale appears to be a reliable and valid tool to assess balance function in higher-functioning older adults. The test was found to discriminate among participants of varying balance abilities. Further exploration of concurrent validity of Rasch-generated expected item scoring patterns should be undertaken to determine the tests diagnostic and prescriptive utility.

Evidence-Based Interventions in Fall Prevention

SUMMARY Falls and fall-related injuries, prevalent among older adults, not only have devastating consequences for older adults in terms of morbidity and mortality, but are also associated with high health care costs. Studies have found that multifactorial intervention strategies can effectively prevent and/or reduce falls among older adults. The purpose of this article is to describe evidence-based intervention strategies for community-dwelling older adults. Fall prevention efforts are clearly an important area of health promotion and injury prevention, and evidence presented in this article provides support for effective intervention strategies. Home health care professionals can play a significant role in such intervention strategies. However, further research is needed to clarify which groups will benefit most from specific intervention programs.

Do fall predictors in middle aged and older adults predict fall status in persons 50+ with fibromyalgia? An exploratory study.

We explored potential predictors of fall status in 70 community-dwelling persons > or =50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study. A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status. Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed. The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors. Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.