Baggrund. Faldulykker blandt gamle mennesker er et folkesundhedsproblem i Danmark, Norden såvel som i den vestlige verden. Forebyggelse af fald har været grebet an i en befolkningsorienteret adfærdsmotiverendeog –regulerende modus. Denne faldforebyggelsestankegang er i opbrud. Formål. At beskrive hvorledes fald,faldhændelser og at miste balanceopleves og håndteres af gamle mennesker, der bor i selvstændig bolig. Studiet har ligeledes fokus på at undersøge sammenhænge i den faldforebyggende indsats med udgangspunkt i hvad de, der er faldet, har oplevet. Studiet bidragertil udvikling af sundhedsfremmende og faldforebyggende indsats i forhold til den enkelte og til den samlede indsats. Metode. Afhandlingenbygger på fire delstudier (I-IV). I de fire studier anvendes fortolkende fænomenologiskfilosofisk tilgang og analytisk metode. I et studie (III) sker det i en case study ramme og er suppleret med kritisk diskursanalytisk analyse og fortolkning af dokumenter. I alt blev ni kvinder og fire mænd (75-94 år) narrativt interviewetom at falde. To social-og sundhedshjælperen blev individuelt interviewet, de deltog også i fokusgruppeinterview sammen med to social-og sundhedsassistent kolleger og en sygeplejerske, der alle kom ihovedpersonernes hjem irelation til den faldforebyggende indsats. Resultater. For at kunne håndtere det sårbare, skrøbeligeog dødens nærhed ved fald udviklede fortællerne forskellige metoder til at klare situationer for at kunne tilpasse egne ressourcer til konteksten og opnå følelser af velvære (I). Frygt eller bekymring for at falde var altid usynligt tilstede og blev håndteret forskelligt. På den ene side blev frygten konkretiseret i en bekymring for at befinde sig i en nedværdigende situation på den anden side var frygten en eksistentiel udfordring og tegn på dødens nærhed (II). Hovedpersonerne forventede personlige relationer, indflydelse og valgmuligheder i samarbejdet med sundhedspersonale om forebyggelseaf fald. Løsninger skulle forhandles og balancerede mellem professionel og personlig omsorg (III). De, der var faldet viste ikke stor appetit på mad men spiste for at være i live. Appetitten viste sig i at have indflydelse i sociale relationer både til social-og sundhedspersonalet, til familie og naboer og med udgangspunkt i oplevelse af sociale tilhørsforhold have samfundsmæssig indflydelse. Konklusion. Forebyggelse af fald må fremover indebære også sundhedsfremmetankegang og tager udgangspunkt i betydninger og kontekst for på denne måde ikke blotat være multifaktoriel, men også multidimensionel med eksistentielt perspektiv / Background. Falls among older persons are a public health problem in Denmark, the Nordic countries and the rest of the Western world. In a population perspective fall-prevention has been characterised by an individual behavioural modificationand a regulating mode. This kind of fall-prevention discourseis nowbreaking up. Aim. To describe how community-dwelling older adults experience and handle falls, falling and loss ofbalance. The focus is also on examination offalls as contextual phenomena with the older adults’ experiences. This study will contribute to develop health promotion and fall-prevention to individuals and to the fall-prevention as so. Methodology. This thesis consists offour studies/articles (I-IV). Interpretative phenomenology as philosophical and analytical method was used. In one study (III) case study methodwas used as a framework,complemented bycritical discourse-analytic interpretation of documents. Within thefour studies nine women and four men (75-94 years old) were interviewed in narrative in-depth interviews about falling. In article III,five health and social workers and a nurse were interviewed. Results. In coping withfalling accidents, vulnerability, frailty and death imminence the participants developed various methods ofmanagingeveryday lifeat home. They describedadaptive resourcesused to achieve an adequate quality oflife andexperiencea feeling of well-being (I). Fear of fallingwas always present and was met in differentways. On one handwas worry aboutungraceful situationsnot able to manage on your own; on the other hand was the willto live with the fear.(II). The two protagonists, dependent onhome-care developed their own strategies for preventingfalls. The health professionals created a supportive network; a platform of continuity where the efforts of the older persons and the staff complemented each other. The staff had no clear approachto addressing issues raised by accidental falls or the prevention of falls (III).Eating and appetite on foodwerenot trivial everyday routines. The participants showed no particular interest in eating but ateto stay alive. Even if they had little appetite forfood, the participants showed great appetite forestablishing social relationships withfamily, neighbours and health care staff,as well as appetite forestablishing an influence in these relations and in local communities and society. Conclusion. In the future,fall-prevention must takea health promotion approach and contextualise falling accidents withexperiences and meanings as point of reference. Fall-prevention will be not only multifactorial,but also multidimenssional and existential

Title: Evaluation of the effects of different walking types on the postural stability in healthy seniors - a systematic review. Objective: The main objective of this diploma thesis is the evaluation of the impact of different types of walking on the postural stability in healthy elderly, based on the available resources corresponding to the established inclusion criteria. Force platforms were used as the tool to evaluate and to objectify postural stability in all studies included. These platforms are capable of measurement the level of postural stability by recording stance excursions in multiple directions. This thesis makes efforts to review the level of the possible future inclusion of different walking types in the process of physical therapy among older patients, regarding to improve the postural stability as well as the fall prevention in these patients. The next goals of this diploma thesis are to determine which type of walking appears to be the most efficient comprising the fall prevention as well as to assess the optimal frequency of the ordinary walking performance to achieve the same objective. Methods: This diploma thesis is processed in the form of a systematic review based on the available literary resources. First part of the thesis comprises the theoretical basis and the...

One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and categorize the resident's risk for falls. Guided by Lewin's theory of change, this project was designed to assess the effectiveness of the fall initiative as a quality improvement 60-day (August 2016- September 2016) pilot study in a skilled nursing and rehabilitation facility as a potential means to reduce the number of resident falls. Sixty residents (aged 64 to 98, mean age 81) were assessed at a minimum 2 time points to determine their level of fall risk and needed intervention, within 60 minutes of admission to the facility and 7 days postadmission. De-identified pre- and post-implementation data were provided from the corporate quality measure database, entered into a spreadsheet, and numbers were compared. As a result of the fall prevention pilot, for August 2016, 5 falls occurred with no repeat fallers; September 2016, 3 falls with 1 repeat faller which is a significant decrease from 14-22 falls occurring per month for 2 consecutive years. Following implementation, the facility scored 3%-5% for the number of falls, which is below the 7% threshold set forth by the pilot facility's corporate office. Prior to the implementation of the initiative, the facility had not met the 7% fall threshold in 2 years

The deep learning technique Human Pose Estimation (or Human Keypoint Detection) is a promising field in tracking a person and identifying its posture. As posture and balance are two closely related concepts, the use of human pose estimation could be applied to fall prevention. By deriving the location of a persons Center of Mass and thereafter its Center of Pressure, one can evaluate the balance of a person without the use of force plates or sensors and solely using cameras. In this study, a human pose estimation model together with a predefined human weight distribution model were used to extract the location of a persons Center of Pressure in real time. The proposed method utilized two different methods of acquiring depth information from the frames - stereoscopy through two RGB-cameras and with the use of one RGB-depth camera. The estimated location of the Center of Pressure were compared to the location of the same parameter extracted while using the force plate Wii Balance Board. As the proposed method were to operate in real-time and without the use of computational processor enhancement, the choice of human pose estimation model were aimed to maximize software input/output speed. Thus, three models were used - one smaller and faster model called Lightweight Pose Network, one larger and accurate model called High-Resolution Network and one model placing itself somewhere in between the two other models, namely Pose Residual Network. The proposed method showed promising results for a real-time method of acquiring balance parameters. Although the largest source of error were the acquisition of depth information from the cameras. The results also showed that using a smaller and faster human pose estimation model proved to be sufficient in relation to the larger more accurate models in real-time usage and without the use of computational processor enhancement. / Djupinlärningstekniken Kroppshållningsestimation är ett lovande medel gällande att följa en person och identifiera dess kroppshållning. Eftersom kroppshållning och balans är två närliggande koncept, kan användning av kroppshållningsestimation appliceras till fallprevention. Genom att härleda läget för en persons tyngdpunkt och därefter läget för dess tryckcentrum, kan utvärdering en persons balans genomföras utan att använda kraftplattor eller sensorer och att enbart använda kameror. I denna studie har en kroppshållningsestimationmodell tillsammans med en fördefinierad kroppsviktfördelning använts för att extrahera läget för en persons tryckcentrum i realtid. Den föreslagna metoden använder två olika metoder för att utvinna djupseende av bilderna från kameror - stereoskopi genom användning av två RGB-kameror eller genom användning av en RGB-djupseende kamera. Det estimerade läget av tryckcentrat jämfördes med läget av samma parameter utvunnet genom användning av tryckplattan Wii Balance Board. Eftersom den föreslagna metoden var ämnad att fungera i realtid och utan hjälp av en GPU, blev valet av kroppshållningsestimationsmodellen inriktat på att maximera mjukvaruhastighet. Därför användes tre olika modeller - en mindre och snabbare modell vid namn Lightweight Pose Network, en större och mer träffsäker modell vid namn High-Resolution Network och en model som placerar sig någonstans mitt emellan de två andra modellerna gällande snabbhet och träffsäkerhet vid namn Pose Resolution Network. Den föreslagna metoden visade lovande resultat för utvinning av balansparametrar i realtid, fastän den största felfaktorn visade sig vara djupseendetekniken. Resultaten visade att användning av en mindre och snabbare kroppshållningsestimationsmodellen påvisar att hålla måttet i jämförelse med större och mer träffsäkra modeller vid användning i realtid och utan användning av externa dataprocessorer.

Stürze sind weltweit die zweithäufigste Ursache für Verletzungen und Todesfälle, und stellen eine massive Belastung für jedes Gesundheitssystem dar. Die meisten Stürze resultieren aus einer fehlgeschlagenen Reaktion auf unerwartete Störungen der Fortbewegung, wie z. B. Stolpern oder Ausrutschen. Unter den vielen bestehenden Interventionsmodellen, die auf das Risiko von Stürzen abzielen, sind bewegungsbasierte Interventionen die kosteneffektivsten. Da bei den meisten Trainingsansätzen die verbesserte Gleichgewichtsfähigkeit nur begrenzt auf untrainierte Situationen übertragen werden kann, müssen Faktoren, wie die Retention und die Dosis-Wirkungs-Beziehung noch ermittelt werden. Des Weiteren sind die Mechanismen, welche den wirksamen Trainingsmaßnahmen zugrunde liegen, noch nicht vollständig erforscht. Training der grundlegenden Mechanismen zur Wiederherstellung des Gleichgewichts (d. h. die Gegenrotation von Körpersegmenten und die Modulation der Unterstützungsfläche) unter instabilen Bedingungen, sowohl unter den trainierten Bedingungen als auch unter unbekannten Bedingungen, verbessert. Darüber hinaus erhöhte dieses Training die kraftgenerierende Kapazität der Muskeln der unteren Extremitäten, was die Ausführung von Gleichgewichtswiederherstellungsreaktionen weiter fördert. Auf der Grundlage dieser vielversprechenden Ergebnisse versucht diese Arbeit, Kenntnisse über die zugrundeliegenden neuromechanischen Anpassungen dieses vorteilhaften Trainingsansatzes, zu liefern. Robustheit kann als Folge verschiedener Modulationen von Muskelsynergien entstehen. Die Wahl der Strategie von Faktoren wie der Ausprägung der Störung, sowie der Ausprägung und Beschränkungen der Bewegungsaufgabe, und der wahrgenommenen Herausforderung für das Gleichgewicht bestimmt wird. Außerdem erhöht das Training auf instabilen Oberflächen nicht per se die mechanischen Anforderungen an die Beinmuskulatur. Die Zunahme der Muskelkraft scheint daher eine Folge neuronaler Anpassungen zu sein. / Falls are the second leading cause of unintentional injury and death worldwide. Among manifold causes, most fall result from a failed response to unexpected perturbations such as a trip or slip. Fall-related injuries can significantly impair quality of life, and their consequences represent a massive burden for any healthcare system. Amid fall prevention paradigms, exercise-based interventions are the most cost-effective. However, most training approaches have a limited transfer to untrained situations and the underlying mechanisms of effective training interventions are still not fully understood. Training the execution of the fundamental balance recovery mechanism (i.e., counterrotating body segments and increasing the base of support) in the presence of perturbations has been reported as an alternative capable of improving balance recovery performance in both trained and non-trained situations and of increasing the force capacity of the lower limb, further promoting the execution of balance recovery reactions. Based on these promising results, this thesis endeavours to provide insight into the fundamental elements promoting the neuromechanical adaptations underpinning the reported advantages of this training paradigm. The analysis of the neuromuscular responses to unstable surfaces during a training session revealed different strategies to cope with perturbations and increase robustness. These different modulations of muscle synergies depend on several factors such as the characteristics of the task and the individual capacities. Moreover, training on unstable surfaces did not increase the mechanical demands upon the leg muscles per-se. Thus the gains in muscle force observed after training the fundamental mechanism of balance recovery onto unstable surfaces are likely a consequence of neural adaptations.

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence levels are not well known. Following face-to-face interviews with adults age 60 and older, Colaizzi'€™s data analysis strategy demonstrated thematic older adult reports of constant anxiety, loss of confidence, and activities of daily living (ADLs) avoidance as perceptions of FOF; traumatic health incidence, loss of health, and decreased quality of life as contributing factors in FOF; and depending on others, loss of muscle strength, and loss of balance as to how FOF affected older adult independence levels. Recommendations for future research include exploring the influence of gender, race, education level, and socioeconomic status on FOF in older adults. This study may enhance social change through greater FOF awareness and added context among caregivers.

Introduktion  Fallolyckor är den vanligaste typen av olycka hos äldre personer och det finns behov av nya fallpreventiva åtgärder där fysisk träning med mobilapplikation är en möjlighet. Syftet med studien var att undersöka om träningsmängden påverkar effekten av ett års fallpreventiv träning med mobilapplikation för äldre personer i ordinärt boende mätt i funktionell benstyrka, upplevd balans och benstyrka samt fallrädsla och hälsorelaterad livskvalité hos äldre personer.  Metod  Deltagarna medverkade i ett större projekt där de under ett år erbjudits fallpreventiv träning med en mobilapplikation. Innan studiens start samt efter 12 månader besvarades en enkät som behandlade bland annat ett 30 sekunders uppresningstest för funktionell benstyrka, upplevd balans, upplevd benstyrka, fallrädsla och hälsorelaterad livskvalité. Vid 12 månader skattade deltagarna även sin genomsnittliga träningsmängd under de senaste tre månaderna. Deltagarna delades in i grupper efter träningsmängd; ingen träning (n=13), <30 minuter (n=31), 30-59 minuter (n=13), ≥60 minuter (n=25). Effekten av träningen jämfördes mellan grupperna med hjälp av Kruskal–Wallis one-way analysis of variance. Resultat 82 deltagare inkluderades i denna studie, de hade en medelålder på 76 år, varav 72% var kvinnor. Gruppen som tränat ≥60 minuter hade signifikant förbättrad funktionell benstyrka samt upplevd benstyrka i dagsläget i jämförelse med hur den var för ett år sedan vid jämförelse med gruppen som tränat <30 minuter. De som tränat ≥60 minuter visade även en signifikant förbättring i upplevd balans i dagsläget i jämförelse med ett år sedan gentemot gruppen som inte tränat alls samt gruppen som tränat <30. Inga signifikanta gruppskillnader sågs i fallrädsla eller hälsorelaterad livskvalité. Konklusion Fallpreventiv träning som utförs ≥60 minuter i veckan ger signifikanta förbättringar i jämförelse med mindre träningsmängd gällande funktionell benstyrka samt upplevd balans och benstyrka i jämförelse med för ett år sedan.

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Autor Bc. Markéta Vychodilová Title Evaluation of the effectiveness of physiotherapy practice in prevention of falls -literature review Objectives The aim of this thesis is to find out which physiotherapeutic methods and techniques are currently used to prevent falls in seniors and which of these methods appear to be most effective in preventing falls. Furthermore, the work is focused on summarizing current knowledge of this issue. Methods The thesis is processed in the form of literature review and has an analytical-descriptive character. The studies used meet the predetermined criteria. The thesis is divided into several parts. In the first part, which is called theoretical basis, are described mainly physiotherapeutic methods and techniques, which are currently used to ensure the prevention of falls in seniors. The second part, part of the results, summarizes these physiotherapeutic techniques and methods and evaluates their effect. The thesis is concluded with a discussion, which is focused mainly on two basic research questions of the thesis. Results A total of 13 randomized controlled trials and 3 systematic searches and meta-analyzes that met the criteria for inclusion in this thesis were described. Studies, research and meta-analysis show that the following physiotherapeutic techniques and...

Gleichgewichtsstörungen und Stürze gehören zu den wichtigsten Symptomen der Parkinson Krankheit (PD). Bei jungen PD-Patienten werden diese Probleme durch Nebenwirkungen der Medikation zusätzlich verstärkt. Aufgrund des noch sehr limitierten Verständnisses der zugrunde liegenden Mechanismen, die zum erhöhten Sturzrisiko bei jungen PD-Patienten beitragen, mangelt es derzeit an alternativen und effektiven bewegungsbasierten Therapien, um diese Sturzgefahr zu verringern. Diese Arbeit zielt darauf ab, solche Mechanismen zu identifizieren und eine effektive Methode zur Früherkennung des Sturzrisikos bei jungen PD-Patienten zu entwickeln. Es wurde der Beitrag der zentralen und peripheren neuromuskulären sowie sensomotorischen Fähigkeiten, dynamischen Stabilitätskontrolle und Anpassungsfähigkeit der Fortbewegung auf die Sturzrate junger PD-Patienten mittels eines Vergleichs zwischen gesunden Probanden und jungen PD-Patienten mit und ohne Sturzerfahrung (Fallers vs. Non-Fallers) untersucht. Der Vergleich zeigte, dass die PD-Fallers zentral begründete Defizite in der Muskelkraft ihrer Beinstrecker aufwiesen sowie eine verringerte Abfangleistung nach simulierten Vorwärtsstürzen. Die Parameter „Muskelkraft“ und „Annäherung an die vordere Stabilitätsgrenze“ identifizieren gemeinsam 90% der Fälle junger PD-Faller. PD-Patienten zeigten auch eine uneingeschränkte prädiktive Anpassungsfähigkeit auf Gangstörungen, aber ein weniger stabiles Gangmuster und weniger effektive reaktive Antworten auf wiederholte Gangstörungen im Vergleich zu Kontrollpersonen. Diese Arbeit stellt relevante Informationen dar, die für die Entwicklung von alternativen nicht-medikamentösen Therapien zur Reduzierung des Sturzrisikos bei jungen PD-Patienten nützlich sind. Darüber hinaus wurde eine akkurate Methode zur Früherkennung von jungen PD-Patienten mit einem erhöhen Sturzrisiko erarbeitet. Diese Patienten könnten von Training der Beinstrecker und der dynamischen Stabilität profitieren. / Postural instability and falls are some of the main symptoms associated with the Parkinson`s disease (PD). In early-onset patients (diagnosed before the age of 51) these problems are worsened by medication-related side-effects. There is a lack of effective exercise-based training interventions to reduce the risk of falling due to our limited understanding of the underlying mechanisms contributing to falls in early-onset PD. The present thesis aims to identify those mechanisms responsible for falls and to develop a sensitive method of assessment for the early discrimination of patients at risk of falling in early-onset PD. We investigated the contribution of central and peripheral neuromuscular and sensory-motor capacities, dynamic stability control and locomotor adaptability to the increased risk of falling in young PD patients by means of comparing healthy controls and early-onset PD fallers and non-fallers. The comparison revealed that PD fallers have central originated deficits in leg extensors` muscle strength - evidenced by increased antagonistic moments and activation deficit of the agonists - and a reduced increase of the base of support in response to simulated forward falls, both resulting in decreased recovery performance. The factors “muscle strength” and “approach to the anterior limit of stability” together could correctly classify 90% of the PD fallers. In addition, while young PD patients showed unaltered predictive adaptability to gait perturbations, they exhibited less stable gait patterns and less effective reactive responses to repeated gait perturbations compared to controls. This thesis provides relevant information for the development of alternative non-medication based therapies aiming to reduce falls in early-onset PD and an accurate assessment tool for the early identification of young patients at a high risk of falling. These patients may benefit from leg-extensors'' strengthening and dynamic stability training.