Theo Mulder

Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study

Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance. Design : Randomized clinical trial. Setting : University hospital physiotherapy department. Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of —1.8 (0.8). Interventions : A three-month programme consisting of exercise/protein including training of muscular strength, co-ordination, balance and endurance. Calcium/ vitamin D was supplemented in all participants for a 12-month period. Outcome measures : Assessment took place prior to and following the months 3, 6, 9 and at the end of the study; primary dependent variables assessed were risk of falling (Berg Balance Test) and postural balance (forceplate). Secondary measures included body composition, strength, activity level, number of falls, bone mineral content, biochemical indices, nutritional status and general health. Results : Significant reductions of risk of falling (repeated measures ANOVA F = 8.90, P = 0.008), an increase in muscular strength (ANOVA F = 3.0, P = 0.03), and an increase in activity level (ANOVA F = 3.38, P = 0.02) were found in the experimental group as compared to the control group. Further on, there was 89% reduction of falls reported in the experimental group (experimental pre/post 8/1 falls; control group pre/post 5/6 falls). Conclusion : This study provides support for our intervention programme aimed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis. The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger randomized trial.

Falls prediction in elderly people: A 1-year prospective study

The aim of the present study was to determine whether force plate variables in single- and dual-task situations are able to predict the risk of multiple falls in a community-dwelling elderly population. Two hundred and seventy elderly persons (225 females, 45 males; age, 73+/-7 years) performed balance assessment with and without vision. Seven force plate variables were assessed to predict the risk of multiple falls; maximum displacement in the anteroposterior and medial-lateral directions (Max-AP, Max-ML), mean displacement in the medial-lateral direction (MML), the root mean square amplitude in anteroposterior and medial-lateral directions (RMS-AP, RMS-ML), the average speed of displacement (V), and the area of the 95th percentile ellipse (AoE). Falls were prospectively recorded during the following year. A total of 437 registered falls occurred during monitoring period. The force plate variable RMS-ML in the single-task condition (odds ratio, 21.8) predicted multiple falls together with the following covariables: history of multiple falls (odds ratio, 5.6), use of medications (fall-risk medications or multiple medicine use; odds ratio, 2.3), and gender (odds ratio, 0.34). Multiple fallers had a narrower stance width than non-fallers.

The reliability of postural balance measures in single and dual tasking in elderly fallers and non-fallers

BackgroundThe purpose of this study was to determine the reliability of a forceplate postural balance protocol in a group of elderly fallers and non-fallers. The measurements were tested in single and dual-task conditions, with and without vision.Methods37 elderly (mean age 73 ± 6 years) community-dwellers were included in this study. All were tested in a single (two-legged stance) and in a dual-task (two-legged stance while counting backwards aloud in steps of 7s) condition, with and without vision. A forceplate was used for registering postural variables: the maximal and the root-mean-square amplitude in medio-lateral (Max-ML, RMS-ML) and antero-posterior (Max-AP, RMS-AP) direction, mean velocity (MV), and the area of the 95% confidence ellipse (AoE). Reliability of the test protocol was expressed with intraclass correlation coefficients (ICC), with 95% limits of agreement (LoA), and with the smallest detectable difference (SDD).ResultsThe ICCs for inter-rater reliability and test-retest reliability of the balance variables were r = 0.70–0.89. For the variables Max-AP and RMS-AP the ICCs were r = 0.52–0.74. The SDD values were for variable Max-ML and Max-AP between 0.37 cm and 0.83 cm, for MV between 0.48 cm/s and 1.2 cm/s and for AoE between 1.48 cm2 and 3.75 cm2. The LoA analysis by Bland-Altman plots showed no systematic differences between test-retest measurements.ConclusionThe study showed good reliability results for group assessment and no systematic errors of the measurement protocol in measuring postural balance in the elderly in a single-task and dual-task condition.

Long-Term Outcome after Stroke: A Disability-Orientated Approach.

Patients (N=165) under 75 who had suffered a stroke in the past 5 years completed a Sickness Impact Profile. Analysis of results indicated the influence of stroke on everyday functioning. Chronic psychosocial disabilities, independent of the degree of physical disability, were reported in fifty-two percent of the patients. This psychosocial dysfunction hindered the patients from re-establishing quality of life.

Effects of motor imagery on hand function during immobilization after flexor tendon repair.

OBJECTIVE To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function. DESIGN Randomized controlled trial. SETTING Tertiary referral hospital. PARTICIPANTS Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group. INTERVENTION Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period. MAIN OUTCOME MEASURES The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength. RESULTS After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P</=.001). CONCLUSIONS Motor imagery significantly improves central aspects of hand function, namely movement preparation time, while other modalities of hand function appear to be unaffected.

Effects of age and content of augmented feedback on learning an isometric force-production task

This study addressed the interaction between age and the informational content of feedback on learning an isometric force-production task. Healthy men and women (30 young adults: 20 to 35 years; 30 older adults: 55 to 70 years) were randomly assigned to a certain type of feedback: knowledge of results or kinetic feedback. Results showed no differences between young and older adults in the accuracy and consistency of performance. There were no interactions of age with any of the feedback-related variables. These findings suggest that the effects of augmented feedback on motor learning are similar in both young and older adults.

Physiotherapy interventions in osteoporosis

Zusammenfassung.Osteoporose ist ein zunehmendes Gesundheitsproblem welches durch ein erhöhtes Frakturrisiko die Lebensqualität vermindert. Physiotherapeuten haben hier Aufgaben in der Prävention und der Behandlung zu erfüllen. Die Sturzprophylaxe ist ein Hauptelement der physiotherapeutischen Maßnahmen zur Vorbeugung von Frakturen bei älteren Patienten mit Osteoporose. Trainingsprogramme mit den Elementen Kraft und Balance haben eine positive Wirkung auf das Sturzrisiko. Eine Abnahme des Sturzrisikos hat eine Verringerung der Anzahl Frakturen zufolge, was ein entscheidender Beitrag zur Kostendämpfung im Gesundheitswesen ist. Bei einer Fraktur kann dem Patienten in der Rehabilitation mit passiven und aktiven Maßnahmen geholfen werden. Auch eine sekundäre Sturzprophylaxe ist angebracht, um weitere zukünftige Frakturen zu verhindern. Eine gute Aufklärung bezüglich Prävention der Osteoporose kann das Verhalten der Patienten verändern. Um dieses Ziel optimal zu erreichen sind physiotherapeutische Maßnahmen enorm wichtigSummary.Osteoporosis is an increasing public health problem which ultimately causes fractures and a significant reduction in patient’s health-related quality of life. In this context, physiotherapists are involved in a wide range of therapies related both to prevention and treatment of osteoporosis. The reduction of the risk of falling by elderly patients with osteoporosis is a very important goal for physiotherapists because it is known to significantly decrease fracture incidence. Indeed, exercise programs including elements of muscle strengthening and better body balance control have a positive effect on the risk of falling, hence reducing the incidence of fractures and increasing the health-related quality of life of osteoporotic patients. As a further consequence, the decreased fracture incidence has a key roll in reducing healthcare costs. Once a patient presents with an osteoporotic fracture, he may be assisted with various forms of passive, active-assisted and active therapies. This treatment will help reduce pain, increase patient’s mobility and prevent the occurrence of additional fractures. In addition, a good and well-balanced education process regarding secondary osteoporosis prevention may also help to modify the behavior of patients and help to improve skeletal health in the longer term. The physiotherapist has definitively a major role to play in the interdisciplinary team aimed at preventing osteoporotic fractures in both primary and secondary prevention levels.

Kinematic analysis of hand movements after tendon repair surgery: a new assessment using drawing movements

Stenekes MW, Nicolai J-PA, Geertzen JHB, Mulder T: Kinematic analysis of hand movements after tendon repair surgery: a new assessment using drawing movements. Am J Phys Med Rehabil 2008;87:169–176. Objective:Although several hand outcome tests exist to judge skill level after hand injury, currently none give insight into how tasks are performed by looking at kinematic parameters. In this article, the clinical value of analyzing kinematic parameters related to the drawing of a triangle on a graphics tablet by healthy subjects and patients with hand injury is discussed. Design:In a first experiment 10 healthy subjects drew the triangles as accurately as possible at various speeds. In a second experiment, 67 healthy subjects and 12 patients with flexor tendon injury were measured repeatedly. Results:In the first experiment, the analysis showed a high linear correlation between speed and accuracy for each individual (Pearson correlation coefficient ≥0.762, P ≤ 0.01). The data led to a formula to standardize deviation for drawing speed, so that different measurements can be compared. In the second experiment, these two measurements correlated well (Pearson correlation coefficient = 0.909, P < 0.001), although a learning effect was noticed (5.4% improvement on average). In healthy subjects the dominant hand performed significantly better than the nondominant hand (P < 0.001). Patients performed significantly worse with their injured hand after 6 wks of dynamic splinting than did healthy subjects (P = 0.003). With their uninjured hand, they performed better than the controls. Six weeks after removal of the splint, no kinematic differences could be discovered between patients and controls. Conclusion:The results show that kinematic parameters of hand movements may be of additional value for assessing functional recovery from hand injury.