Wantana Siritaratiwat

Incidence and factors associated with falls in independent ambulatory individuals with spinal cord injury: a 6-month prospective study.

Background Sensorimotor impairments following spinal cord injury (SCI) affect mobility and subsequently increase the risk of falls to patients. However, most of the fall data for these patients were retrospectively gathered. Objectives This study prospectively assessed falls and intrinsic factors associated with falls in 89 independent ambulatory individuals with SCI over the course of 6 months. In addition, functional ability between participants who did and did not fall was compared. Methods Participants were interviewed and assessed for their baseline data and functional ability using the Timed “Up & Go” Test and the Six-Minute Walk Test. Then they were interviewed by telephone to complete a self-report questionnaire once per week to gather fall data for 6 months. A stepwise multiple logistic regression was utilized to determine the effects of demographics and SCI characteristics on occurrence of falls. The functional data between participants who fell and those who did not fall were compared using the Mann-Whitney U test. Results Thirty-five participants (39%) experienced at least 1 fall during 6 months (range=1–11). Two participants required medical attention due to patellar and sternum fractures after falling. Participants with an educational level of high school graduate or greater, an American Spinal Injury Association Impairment Scale C (AIS-C) classification, and a fear of falling (FOF) significantly increased their risk of falls approximately 4 times more than those who graduated primary education, had an AIS-D classification, and did not have FOF. Moreover, the functional abilities of participants who fell were significantly poorer than those who did not fall. Limitations The sample size was calculated based on the primary objective (incidence of falls), which may not be sufficient to clearly indicate factors associated with falls for the participants. Conclusions More than one third of the independent ambulatory participants with SCI experienced at least 1 fall during the 6-month period of the study. The findings suggest the importance of functional improvement on the reduction of fall risk in these individuals.

Reference Values of Physical Performance in Thai Elderly People Who Are Functioning Well and Dwelling in the Community

Background Because the number of elderly people is rapidly increasing, reference values for the physical abilities necessary to independently conduct daily activities are crucial for promoting good health. Although a few studies have reported reference values for functional tests relating to these abilities, all of those values were derived from populations in developed countries, which have baseline demographic and anthropometric characteristics different from those of Thai people. Objective The purpose of this study was to describe reference values for 5 physical performance tests for Thai elderly people who were functioning well and dwelling in the community. Design A cross-sectional design was used in this study. Methods A total of 1,030 Thai elderly people who were functioning well were cross-sectionally assessed for their physical abilities with 5 functional tests: 10-Meter Walk Test, Berg Balance Scale, Timed “Up & Go” Test, Five Times Sit-to-Stand Test, and Six-Minute Walk Test. The data were reported with descriptive statistics according to decade of age and sex. Differences among the age decades and between the sexes were analyzed with a 1-way analysis of variance and an independent-sample t test, respectively. Multiple linear regression analyses were used to determine baseline characteristics important in functional abilities. Results Most of the values found for the performance-based measures were lower than those previously reported, with a significant trend toward age- and sex-related functional decline. Weight and height were important contributors to level of functional ability. Limitations Only a few elderly individuals older than 90 years of age participated in this study. Therefore, their findings were combined with those of participants aged 80 to 89 years. Conclusions The findings described here may be useful as reference values for 5 physical performance tests for Thai elderly people. Health practitioners can use this information to identify functional impairments early and to promote independence in Thai and other elderly populations with similar anthropometric characteristics, such as those in the Association of South East Asian Nations.

Five-times-sit-to-stand test in children with cerebral palsy: Reliability and concurrent validity

BACKGROUND/PURPOSE Five-times-sit-to-stand test (FTSST) is a reliable tool for measuring lower limb functional strength and balance ability. However, reports of the reliability of FTSST in children with cerebral palsy have been scarce. The purposes of this study were (1) to investigate the test-retest and inter-rater reliability of the FTSST and (2) to investigate the correlation between the FTSST and standard functional balance tests in children with cerebral palsy. STUDY DESIGN Cross-sectional study. MATERIALS AND METHODS Thirty-three school children aged from 6 to 18 years with Gross motor functional classification system expanded and revised version (GMFCS-E&R) level I to III were recruited. Reliability of the FTSST and concurrent validity between FTSST and Timed up and go test (TUG) and Berg balance scale (BBS) were determined using the Pearson product moment correlation. RESULTS The intra-class correlation coefficient (ICC) for test-retest and inter-rater reliability of FTSST were 0.91 and 0.88 respectively. FTSST showed moderate correlation with TUG (r = 0.552, P < 0.01) and with BBS (r = -0.561, P < 0.01). CONCLUSION FTSST is a reliable assessment tool and correlates with functional balance ability tests in children with mild to moderate cerebral palsy.

Factors related to obstacle crossing in independent ambulatory patients with spinal cord injury.

Abstract Background/Objectives: To evaluate factors related to the ability of ambulatory patients with spinal cord injury (SCI) to walk over small obstacles. Study Design: Cross-sectional study. Methods: Thirty-four patients with SCI (ASIA impairment scale [AIS] D) who were able to walk independently at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1,4, and 8 cm in height or width; total of 6 conditions). A “fail” was recorded when either the lower limbs or the walking device contacted the obstacle. Multiple logistic regression models were applied to determine the effects of walking devices (presence or absence), SCI levels (tetraparesis or paraparesis), and SCI stages (acute or chronic) on the ability of obstacle crossing. Results: Fifteen participants (44%) failed to adequately clear the foot or walking device over obstacles in at least one condition (range 1–3 conditions). After adjusting for covariates, the chance of failure on obstacle crossing was greatly increased with the use of walking devices (odds ratio = 8.50; 95% CI = 0.85−75.03) Conclusions: Gait safety in independent ambulatory participants with SCI remains threatened. Participants who walked with walking devices encountered a greater chance of failing to walk over obstacles as a result of inefficiently moving the foot or walking device over small obstacles. Thus, instead of training in an empty/ quiet room, rehabilitation procedures should incorporate contextual conditions that patients encounter at home and in the community in order to minimize risk of injury and prepare patients to be more independent after discharge.

External cues benefit walking ability of ambulatory patients with spinal cord injury

Abstract Background/objectives Sensorimotor dysfunction following spinal cord injury (SCI) reduces ability of the patients to perceive information and control movements. They may need alternative sources of input to optimize their walking ability. This study investigated effects of external cues on walking ability in 33 independent ambulatory participants with SCI. Methods Participants’ walking ability was cross-sectionally assessed under three conditions including self-determined fastest walking speed (uncued condition), and fastest walking speed with the use of external cues (visual cue and visuotemporal cue conditions). Walking ability was measured in terms of walking speed, stride length, cadence, and percent step symmetry. Findings of the three conditions were compared using the one-way analysis of variance with repeated measures. Results When using external cues particularly the visuotemporal cue, participants showed a significant increase in walking speed, stride length, and cadence as compared with those of the uncued condition (P < 0.005). The increment of walking speed was demonstrated even in participants at a chronic stage of injury (post-injury time ≥12 months), with severe SCI (American Spinal Injury Association Impairment Scale C), or who required a walking device. Conclusion The results suggested the benefit of external cues, particularly the visuotemporal cues, as a potential rehabilitation tool to improve walking speed of individuals with SCI.

Effects of task-specific training on functional ability in children with mild to moderate cerebral palsy

Objective: To examine the relationship between Five times sit-to-stand Test (FTSST) and functional tests and investigate the effects of task-specific training on functional ability in children with mild to moderate cerebral palsy (CP). Methods: Twenty-one subjects were randomly assigned to experimental and control groups. Motor Assessment Scale (MAS: sit-to-stand), Pediatric Balance Scale (PBS), Functional Reach Test and FTSST were tested before training, after training and at follow-up at 6 weeks post training. Results: FTSST correlated significantly with MAS (ρ = −0.733) and with PBS (ρ = −0.813) in all children with CP. There were no significant differences in all outcomes between groups. However, FTSST and MAS in children with Gross Motor Function Classification System-Expanded and Revised levels I–II were significantly different between pre and post training within the experimental group (p = 0.03). Conclusions: FTSST is a reliable and valid functional outcome measure after the task-specific training in children with mild to moderate CP.

Prognostic Predictors for Ambulation in Thai Children With Cerebral Palsy Aged 2 to 18 Years

The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy.

Early developmental milestones and age of independent walking in orphans compared with typical home-raised infants.

AIM Early gross motor development is a major indicator of global milestones in the first year of life, affecting the walking ability of a child. There has been limited research reporting on early motor development and the age of independent walking of orphaned infants compared to typical home-raised infants. The purpose of this study was to compare the mean scores of early gross motor movement at 4, 6 and 8months of age and at the age of walking attainment of typically raised infants and orphaned infants. In addition, we looked to compare the walking age between these same infants. MATERIALS AND METHODS This cross-sectional study recruited 59 typical home-raised infants and 62 orphans. Their gross motor development was assessed using the Alberta Infant Motor Scale (AIMS). The age of walking attainment was also prospectively monitored and ascertained. The Students independent t-test was used to analyse the differences of the AIMS scores at 4, 6 and 8months of age and at the age of independent walking between the two groups. RESULTS The orphans showed significantly lower AIMS scores at 4, 6 and 8months of age and the age of independent walking (P-value<0.05). The orphan group had a 5-month older mean age of walking attainment (15.0±4.2months) compared with typical home-raised infants (9.9±1.4months). CONCLUSION Orphans have delays in early gross motor development and walk independently at an older age, compared with home-raised infants.

Capacity of adolescents with cerebral palsy on paediatric balance scale and Berg balance scale

The Berg balance scale (BBS) and the paediatric balance scale (PBS) are reliable tools for measuring balance ability. However, reports of BBS and PBS scores in adolescent cerebral palsy have been limited. The objectives of this study were to investigate functional balance capacities, as tested with the BBS and PBS in adolescents with cerebral palsy, to compare the total PBS and BBS scores between Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) levels and to compare the static balance PBS and BBS scores within each GMFCS-E&R level. Fifty-eight school-aged adolescents with cerebral palsy between the ages of 12 and 18 years with GMFCS-E&R levels of I to IV were recruited. The Kruskal-Wallis test was utilized to compare the median scores for the PBS and BBS between the different GMFCS-E&R levels. Wilcoxon signed-rank tests were performed to examine the differences in the static balance scores between the PBS and the BBS within the same GMFCS-E&R levels. The results reveal that there were differences in the BBS and PBS scores among the four GMFCS-E&R levels. A significant difference was found between the BBS and PBS scores only among the patients with cerebral palsy and level III GMFCS-E&R. The BBS and PBS are valid and reliable tools for clinical examination and for distinguishing between levels of functional balance in adolescents with cerebral palsy.

Effects of Combined Exercise Training on Functional Performance in Children With Cerebral Palsy: A Randomized-controlled Study

Purpose: The purpose of this study was to investigate the effects of combined exercise training on functional performance in participants with cerebral palsy. Methods: Fifteen participants with spastic cerebral palsy were randomly allocated into either exercise or control groups. Participants in the exercise group participated in a combined strength and endurance training program for 70 minutes per day, 3 days per week, for 8 weeks, whereas those in the control group did not participate in an exercise program. Study participants in both groups continued with their regular physical therapy during the study. Results: After the 8-week training, a 6-minute walk, 30-second sit-to-stand, 10-m walk, and Functional Reach Tests, participants in the exercise group had significant improvement over their baseline values and were significantly higher than those in the control group. Conclusions: Combined exercise training improved walking ability, functional lower limb strength, and balance in participants with cerebral palsy.