Jennifer C. Nitz

Normal values of balance tests in women aged 20-80.

Objectives: To determine normal values for four commonly used clinical functional balance tests from community‐dwelling women aged 20 to 80 and to identify any significant decline due to aging.

A Specific Inpatient Aquatic Physiotherapy Program Improves Strength After Total Hip or Knee Replacement Surgery: A Randomized Controlled Trial

OBJECTIVE To evaluate the effect of inpatient aquatic physiotherapy in addition to usual ward physiotherapy on the recovery of strength, function, and gait speed after total hip or knee replacement surgery. DESIGN Pragmatic randomized controlled trial with blinded 6-month follow-up. SETTING Acute-care private hospital. PARTICIPANTS People (n=65) undergoing primary hip or knee arthroplasty (average age, 69.6+/-8.2y; 30 men). INTERVENTIONS Participants were randomly assigned to receive supplementary inpatient physiotherapy, beginning on day 4: aquatic physiotherapy, nonspecific water exercise, or additional ward physiotherapy. MAIN OUTCOME MEASURES Strength, gait speed, and functional ability at day 14. RESULTS At day 14, hip abductor strength was significantly greater after aquatic physiotherapy intervention than additional ward treatment (P=.001) or water exercise (P=.011). No other outcome measures were significantly different at any time point in the trial, but relative differences favored the aquatic physiotherapy intervention at day 14. No adverse events occurred with early aquatic intervention. CONCLUSIONS A specific inpatient aquatic physiotherapy program has a positive effect on early recovery of hip strength after joint replacement surgery. Further studies are required to confirm these findings. Our research indicates that aquatic physiotherapy can be safely considered in this early postoperative phase.

Somatosensation, circulation and stance balance in elderly dysvascular transtibial amputees

Objective: To establish the relationship between poor lower limb somatosensory and circulatory status with standing balance, falls history, age and mobility level in dysvascular transtibial amputees (TTAs). Design: Within-subjects evaluation of somatosensation, circulation and stance balance measures in dysvascular transtibial amputees. Setting: Physiotherapy department of a tertiary metropolitan hospital in Australia. Participants: Twenty-two community-dwelling unilateral dysvascular transtibial amputee volunteers, aged between 54 and 86 recruited from a metropolitan hospital outpatient amputee clinic. Main outcome measures: Lower limb vibration sense, light touch sensation and circulatory status were related to centre of pressure excursion during quiet stance, dynamic balance measures of forward and lateral reach distance, and demographic information such as falls history and mobility level. Results: Overall, poor somatosensory status was associated with poor stance balance. There was an association between poor vibration and circulation and increased centre of pressure excursion in quiet stance and reduced reach distance, whereas poor light touch was linked with even weight-bearing in quiet stance. Poor vibration sense was associated with a history of frequent falls. Conclusions: Compromised lower limb somatosensation and circulation was linked with poor balance and a history of frequent falls in the elderly dysvascular amputee population.

Age-related changes in strength and somatosensation during midlife: Rationale for targeted preventive intervention programs

Abstract:  Age‐related changes in strength and somatosensation have a negative impact on balance with advanced age. Knowledge of the decades of life when strength and somatosensation show initial and subsequent reductions could inform balance assessment and targeted preventive intervention. We report a cross‐sectional study investigating strength and somatosensation of 316 healthy women aged 20–80 years. Demographics, health profile, and activity level were recorded. Strength of quadriceps, hip abductors and adductors, and lower limb somatosensation (tactile acuity, vibration threshold, and joint position error) were measured. Significant age‐related changes in strength and somatosensory function were identified, even when demographic variables of activity level, weight, number of reported conditions, medications used, and history of falls were included as covariates. Tested muscles achieved peak force in women in their 40s and then trending reductions presented for those in their 50s and 60s, with significant reductions by the 70s. Tactile acuity, vibration sensitivity, and joint position sense for a non–weight‐bearing toe‐matching task were significantly reduced by the 40s or 50s, with further reductions by either the 60s or 70s. For the weight‐bearing replication task, joint position error was significantly increased by the 60s. A main effect of activity level and body weight was identified for strength measures, and weight also had a main effect for most of the somatosensory modalities. These findings can inform health professionals to use knowledge of early and any subsequent reductions in muscle strength and somatosensation, along with effects of demographics, to develop targeted, innovative programs across the mid‐life, a preclinical change period for balance, to promote healthier aging.

Shoulder pain, range of motion, and functional motor skills after acute tetraplegia

OBJECTIVES To investigate (1) the prevalence and course of shoulder pain in acute tetraplegia and (2) its relationship with range of motion (ROM) and function and any associated risk factors. DESIGN A longitudinal prospective study. SETTING Spinal injury unit in an Australian hospital. PARTICIPANTS Inpatients with acute tetraplegia. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographics, pain intensity, shoulder ROM, and functional motor skills. RESULTS The prevalence of pain during rehabilitation was 85%. Risk factors associated with pain during rehabilitation included age less than 30 years or more than 50 years (F=8.892, P=.064), admission motor level at C2-5 (F=5.833, P=.016), admission sensory level at C2-5 (F=7.543, P=.006), lower left upper limb (P=.005; 95% confidence interval [CI], -14.74 to -2.86) and total American Spinal Injury Association motor scores (P=.009; 95% CI, -29.53 to -4.67), and a shorter duration of bedrest (F=5.794, P=.055). Subjects with pain lost ROM in left abduction (P=.038; 95% CI, -25.9 to -0.9) and right abduction (P=.05; 95% CI, -30 to 9.3). No relationship existed between shoulder pain and functional motor skills on discharge. CONCLUSION Shoulder pain is common in acute tetraplegia and is associated with loss of shoulder ROM. Risk factors identified include age, injury level, and duration of bedrest. Areas for further study are identified.

Medial-lateral postural stability in community-dwelling women over 40 years of age.

Objective: To document the change in medial–lateral balance in women aged between 40 and 80 years. Design: A cross-sectional study of six measures of medial–lateral balance was undertaken. Setting: The Betty Byrne Henderson Centre for Women and Ageing, Royal Womens Hospital, Australia. Subjects: Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria. Measurements: The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of stability. Results: A significant decline in all measures (p < 0.02) was evident between the forties and sixties age decade cohorts. The clinical step test showed a significant (p < 0.001) decline between the forties and fifties groups. A significant correlation was shown between step test and unilateral stance (p < 0.001) and movement velocity, reaction time and end-point excursion centre of gravity (COG) on the limits of stability test (p < 0.001). Conclusions: This new evidence demonstrates that there is a significant decline in medial–lateral balance in women that occurs between their forties and sixties. Suggestions for further study were made.

Age-related changes in musculoskeletal function, balance and mobility measures in men aged 30–80 years

Objectives. This study aimed to establish age-related changes in musculoskeletal function, balance and mobility measures in men. Design. An observational, cross-sectional cohort study was undertaken. Methods. One hundred six healthy, community-ambulant men (30–80 years) participated in this study. Recruitment of a convenience sample continued until a minimum of 20 men represented each decade between 30 and 80 years. Demographics (age, height, weight), health and current activity level were recorded. Balance and mobility were measured using the timed up and go test, the step test, functional and lateral reach. Reaction time was determined from limits of stability test. Leg muscle strength was measured with a spring gauge (kg), and ankle flexibility was measured using goniometry. Results. Balance, mobility and most strength measures were reduced by the 60s while ankle flexibility declined by the 70s (p < 0.01). Reaction times increased by the 60s (p < 0.01). Conclusion. This study of men demonstrated reduced musculoskeletal function, balance and mobility generally by the 60s. These results provide health professionals with normal performance levels to use as therapeutic goals as well as identify musculoskeletal factors associated with reducing balance and mobility. Hence, these results inform clinicians and policy makers for the establishment of pre-emptive interventions to promote healthier ageing.

A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy

Objectives: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. Design: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. Results: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. Conclusion: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.

Shoulder pain following tetraplegia: a follow-up study 2–4 years after injury

Objectives:To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life.Design:Longitudinal study.Setting:Spinal Injuries Unit, Australia.Methods:Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair Users Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life.Results:Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6–T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants.Conclusion:Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.

Post stroke recovery of balanced sitting and ambulation ability

The primary aim of this retrospective audit was to determine whether sitting balance ability at initial physiotherapy assessment post stroke could predict ambulation ability at discharge. Also considered were the side affected by the stroke, sensory loss, dysphasia, whether they affected outcome and whether ambulation ability determined social destination at discharge. Forty stroke patients were treated during the 12-month study period. All patients received early physiotherapy treatment in the acute then rehabilitation wards. The average length of hospital stay was 47.7 ± 28.2 [SD] days. All patients achieved independent sitting balance at discharge, with a significant improvement (p < 0.001) from initial assessment. Twenty-seven achieved independent ambulation by discharge. This was shown to have a significant (p < 0.001) relationship to early independent sitting balance but was not significantly related to side of stroke or sensory loss.