Nobuou Matsusaka

Effect of Ankle Disk Training Combined with Tactile Stimulation to the Leg and Foot on Functional Instability of the Ankle

Twenty-two university students with unilateral functional instability of the ankle participated in this study. They were randomly assigned to one of two experimental groups. Subjects in both groups were trained to stand on the affected limb on an ankle disk. In group 1, two pieces of 1-cm wide nonelastic adhesive tape were applied to the skin around the lateral malleolus from the distal third of the lower leg to the sole of the foot before the training sessions. Subjects in group 2 participated in the training sessions without the application of the adhesive tape. Training was performed for 10 minutes a day, five times per week, for a period of 10 weeks. Subjects were tested for postural sway while standing on the affected limb before, during, and after the training period. In group 1, postural sway values decreased significantly after 4 weeks compared with the pretraining performance, and they were within the normal range after not more than 6 weeks of training. In group 2, the values did not improve significantly compared with the pretraining performance until after 6 weeks of training, and they were not within the normal range until after 8 weeks of training. The findings suggest that the 2-week earlier correction of postural sway in group 1 was due to an increased afferent input from skin receptors that were stimulated by the traction of the adhesive tape.

Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: A multi-centre controlled trial

OBJECTIVE To determine whether an exercise programme provided by public health nurses is effective in improving physical function and psychological status in elderly people, in reducing falls and risk factors for falls in elderly people, and whether the intervention is a feasible programme within the community. DESIGN Controlled intervention trial. SUBJECTS Participants included 144 persons in the intervention group and 124 persons in the control group, who were living at home, aged over 65 years, and with 5 or more risk factors for falls identified using the questionnaire for fall assessment (Suzuki). METHODS For participants in the intervention group, an exercise programme was provided by public health nurses. This comprised a weekly exercise class of 2 hours for 17 weeks, supplemented by daily home exercises. Number of risk factors, physical function and psychological status were compared between the intervention and control groups before and after intervention. The number of further falls during the intervention was also compared between the 2 groups. RESULTS The programme significantly improved physical function and emotional status, and reduced the number of falls and risk factors for falls. The excellent adherence rate represented broad acceptance of the intervention. CONCLUSION The intervention programme was effective and feasible to operate in the community.

Control of the medial-lateral balance in walking

Eleven normal adults had their gait tested from the viewpoint of ground reaction force, myoelectric activity, and the motion of pronation-supination in the foot. There were marked differences in the myoelectric activity between the large lateral component force and the smaller one during the midstance phase. When the lateral component force was large, the pronation of the foot was small; the peroneus longus was active during the midstance phase; and the activity of the tibialis posterior disappeared earlier than in the small component. On the other hand, when the lateral component force was small, the pronation was large; the tibialis posterior, flexor digitorum longus, and extensor hallucis longus were all active; but the peroneus longus remained inactive during the midstance phase. Based on these findings, it is suggested that the leg muscles and the motion of the foot take part in controlling the medial lateral balance in walking.

Effects of a balance training program using a foam rubber pad in community-based older adults: a randomized controlled trial.

Background and Purpose:Exercise programs aimed at improving balance are effective in fall prevention for older adults. Guidelines indicate that unstable elements should be integrated in balance training with this population. Balance training on an unstable surface facilitates proprioception mediated by skin receptors in the soles of the feet and by mechanoreceptors in the joints and muscles. This randomized controlled trial examined whether balance training performed using a foam rubber pad was more beneficial than balance training performed on a stable flat surface in older adults. Methods:Older adults using Japanese community day centers once or twice per week were enrolled in this trial. In total, 93 participants were randomized to 1 of 3 groups: foam rubber exercise group (n = 32), stable surface exercise group (n = 31), and control group (n = 30). Participants in the foam rubber and stable surface exercise groups attended a 60-minute exercise class once a week for 4 months and followed a home-based exercise routine. Outcome measures were the following performance tests: the one-leg standing test (OLST), the chair standing test, the timed up-and-go test (TUGT), and the tandem-stance test (TST). These assessments were conducted before the intervention, and at 1, 2, 3, and 4 months after starting the intervention. Results:There were group × time interactions (P < 0.001) for all performance tests. The foam rubber exercise group showed significant improvements in the OLST, TST, and TUGT at 1 to 4 months compared with the control group (P < 0.02). The foam rubber exercise group also showed significant improvements in the OLST and TST at 2 and 3 months compared with the stable surface exercise group (P < 0.02). Within the foam rubber exercise group, the OLST, TUGT, and TST, at 1 to 4 months, were significantly improved compared with before the intervention (P < 0.01). Within the stable surface exercise group, the TUGT and TST, at 3 and 4 months, were significantly improved compared with before the intervention (P < 0.01). Conclusions:This study confirms that balance training in older adults performed using a foam rubber pad is effective for improving balance ability, and that this improvement occurs 2 months earlier compared with balance training performed on a stable surface. These findings suggest that balance training performed using a foam rubber pad is beneficial to clients and service providers because the programs improve physical functioning with a reduced number of exercise sessions.

A modified fall risk assessment tool that is specific to physical function predicts falls in community-dwelling elderly people

Background and Purpose:Developing a practical fall risk assessment tool to predict the occurrence of falls in the primary care setting is important because investigators have reported deterioration of physical function associated with falls. Researchers have used many performance tests to predict the occurrence of falls. These performance tests predict falls and also assess physical function and determine exercise interventions. However, the need for such specialists as physical therapists to accurately conduct these tests limits their use in the primary care setting. Questionnaires for fall prediction offer an easy way to identify high-risk fallers without requiring specialists. Using an existing fall assessment questionnaire, this study aimed to identify items specific to physical function and determine whether those items were able to predict falls and estimate physical function of high-risk fallers. Methods:The analysis consisted of both retrospective and prospective studies and used 2 different samples (retrospective, n = 1871; prospective, n = 292). The retrospective study and 3-month prospective study comprised community-dwelling individuals aged 65 years or older and older adults using community day centers. The number of falls, risk factors for falls (15 risk factors on the questionnaire), and physical function determined by chair standing test (CST) and Timed Up and Go Test (TUGT) were assessed. The retrospective study selected fall risk factors related to physical function. The prospective study investigated whether the number of selected risk factors could predict falls. The predictive power was determined using the area under the receiver operating characteristic curve. Results:Seven of the 15 risk factors were related to physical function. The area under the receiver operating characteristic curve for the sum of the selected risk factors of previous falls plus the other risk factors was 0.82 (P = .00). The best cutoff point was 4 risk factors, with sensitivity and specificity of 84% and 68%, respectively. The mean values for the CST and TUGT at the best cutoff point were 12.9 and 12.5 seconds, respectively. In the retrospective study, the values for the CST and TUGT corresponding to the best cutoff point from the prospective study were 13.2 and 11.4 seconds, respectively. Discussion:This study confirms that a screening tool comprising 7 fall risk factors can be used to predict falls. The values for the CST and TUGT corresponding to the best cutoff point for the selected 7 risk factors determined in our prospective study were similar to the cutoff points for the CST and TUGT in previous studies for fall prediction. We propose that the sum of the selected risk factors of previous falls plus the other risk factors may be identified as the estimated value for physical function. Conclusions:These findings may contribute to earlier identification of high-risk fallers and intervention for fall prevention.

Gait Analysis in Patients with Osteosarcoma Treated by Limb Salvage Procedures

Gait analysis by ground reaction force measurement was performed on 17 cases of primary osteosarcoma around the knee treated by limb salvage procedure (eight cases) and by ablative surgery (nine cases). From the patterns of the ground reaction force, it was difficult to distinguish functionally which operative method was better. The only significant difference between them showed the locus of the center of pressure calculated by the vertical component of the ground reaction force. It was was revealed that the limb salvage procedure group had better function than the ablative surgery group, provided that the normal function of the foot could be preserved in the former group. On the other hand, measurement of the ground reaction force was useful in evaluating the recovery process of walking in the same patient.

Effects of a resistance training program performed with an interocclusal splint for community-dwelling older adults: a randomized controlled trial.

[Purpose] To examine whether resistance training for elderly community-dwellers performed with an interocclusal splint resulted in greater lower extremity muscle strength and better balance than resistance training performed without an interocclusal splint. [Subjects and Methods] Eighty-eight elderly persons using Japanese community day centers were randomly divided into two groups: an intervention group (n=45), which performed resistance training with an interocclusal splint; and a control group (n=43), which performed resistance training without an interocclusal splint. The resistance training program comprised a 40-min session performed twice a week for 12 weeks. Outcome measures were the chair stand test (CST), timed up and go test (TUG), and one-leg standing test (OLST). Assessments were conducted before the intervention and every 2 weeks after the start of the intervention. [Results] There was a significant group × time interaction for the OLST, with the intervention group showing significant improvement from 8 to 12 weeks compared to the control group. For the CST and TUG, no significant differences were found between the two groups throughout the 12 weeks. [Conclusion] Resistance training with an interocclusal splint improved the balance ability of elderly community-dwellers more effectively than resistance training without an interocclusal splint.

Effectiveness of a balance-training program provided by qualified care workers for community-based older adults: A preliminary study

The purpose of this study was to determine the effectiveness of a balance-training program provided by qualified care workers (QCWs) to community-based older adults attending day centers. Weekly balance training was conducted by QCWs working at day centers over a 6-month period. Fall risk factors, fear of falling, and physical function were compared between balance-training (n = 22) and control (n = 23) groups at baseline and after 6 months of intervention. Physical function assessments included the following: one-leg standing test, chair-standing test (CST), timed up-and-go test (TUGT), and a lower-extremity muscle strength test (LEST). Participants who underwent balance training significantly improved in the CST and LEST, and had reduced fear and risk of falling compared with the control group (p < 0.05). In the balance-training group, the TUGT was significantly better at 6 months than at baseline (p < 0.05). A balance-training program for community-dwelling older adults can be effectively implemented by QCWs.

Stress roentogenogram for the lateral ligament injury of the ankle. An experimental and clinical study.

Utilizing a specially designed apparatus, the anterior drawer test was performed on 30 healthy adults, 7 amputated legs and 10 cadaver and 29 injured ankles. The varus stress test was performed manually on 100 healthy adults (200 ankles) and each of the above mentioned ankles.The results in the healthy adults showed that the upper limit of the anterior drawer displacement (ADD) range was 4mm (3.03±0.75) and that of the talar tilt angle was 5 degrees (3.68±0.33, P<0.05).In the amputated legs, cadaver ankles and injured ankles compared with healthy adults, each measurement increased significantly (p<0.05) and there were no remarkable differences between the groups.The cases of single ligamentous injury showed that anterior drawer displacements were from 4 to 6mm and talar tilt angles were from 5 to 10 degrees. The cases of double ligamentous injury showed that the former ranged above 6mm and the latter above 10 degrees.Each measurement increased according to the severity of the ligamentous injury. There was significant positive correlation (r=0.554) between ADD and TTA in the cadaver ankles.