Losing confidence in the ability to maintain balance can be more debilitating than a fall. Therefore, considering the importance of measuring balance confidence, the purpose of this study was to examine the validity and reliability of the ABC-6, a shortened version of the ABC-16, among diverse older adults. Participants were 251 diverse (72.1% African Americans, 62.5% low-income, 61% low-education) older adults (M age = 71.2 years, SD = 8.9). Participants volunteered for a falls risk screening which assessed multiple falls risk factors and balance confidence. The ABC-6 had excellent internal consistency reliability, substantial intraclass correlations, significant moderate to large correlations with physical activity, mobility, balance, and total falls risk, the ability to discriminate between fallers and nonfallers, and it was the only significant predictor of total falls risk. The ABC-6 was a valid and reliable measure of balance confidence and is a suitable measure for use among diverse older adults.

No description available.

Physical Performance and Balance Confidence Among Community- Dwelling Older Adult Men: The Priest Study Purpose: Studies examining physical performance among older adult men remain limited. The purpose of this study was to examine gait, balance ability, and balance confidence within two cohorts of Roman Catholic priests (age 60-74 years of age and 75+ years) and to analyze predictive markers of physical performance. Participants: Subjects included 131 community-dwelling Roman Catholic priests over 60 (x = 76.1; SD = 9.0; range: 60-97 years) living in rectories, senior housing, or religious communities in 10 states. Materials/Methods: Subjects completed a basic demographic profile, the Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, the Dynamic Gait Index (DGI), and the Activities-specific Balance Confidence (ABC) Scale. Additional assessments included BMI, blood pressure, grip strength, and the Physical Activity Scale for the Elderly (PASE). Data were analyzed data using descriptive statistics, independent T tests with Bonferroni correction, MANCOVA analysis, and stepwise regression modeling. Results: Demographic profiles revealed that 46 subjects (35%) had fallen over the past year. Eighty-six subjects (65%) were taking four or more medications. Younger priests (60--74 years) demonstrated a significantly higher ABC score than the older cohort (75 and above years) of priests (89.1+ 12.6 vs.78.4 + 13.9). Significant differences (p < 0.001) in physical performance between the younger and older age cohorts were noted on the BBS (53.4 + 4.8 vs. 45.5 + 7.5), TUG (10.4 sec. + 2.3 vs. 13.4 sec. + 4.2), and DGI (22.6 + 2.6 vs. 19.0 + 4.2) respectively. Stepwise regression analysis demonstrated that age, balance confidence, a fall in the past three months, and diastolic blood pressure predicted 60% of the variance in the BBS, 61% of the variance on the DGI, and 49% of the variance on the TUG (all p < 0.001). Conclusions: Data findings suggest that both physiologic and psychosocial factors impact the functional profile of the older adult priest. Common tests of physical performance may be incorporated with modifiable variables to establish target interventions for balance, gait, and functional mobility. / Physical Therapy

The thesis deals with the issues of balance disorders in patients after vestibular schwannoma surgery. The aim of this thesis is to evaluate the effect of targeted rehabilitation with biofeedback on balance disorders and subjective visual vertical compensation. During the period of one year, a group of 20 vestibular schwannoma patients were examined and treated in University Hospital Motol. The compensation of vestbuloocular refex was assessed by a tilt of subjective visual vertical. The level of vestibulospinal compensation was determined according to score of the Activities-Specific Balance Confidence Scale. Patients were examined before the surgery, after the surgery and after the rehabilitation. The Homebalance system, developed by Support center for application outputs and spin-off companies at the 1st Faculty of Medicine, Charles University in Prague, branch office in Kladno, was used for the therapy with visual biofeedback. Another aim of this thesis was to monitor the effect of vestibular prehabituation with ototoxic gentamicin application two months before surgery. The statistical analysis of data proved in the case of subjective visual vertical tilt a significant increase of deviation after surgery and a decrease after rehabilitation. According to the ABC questionnaire the confidence of...

Background: The main objective of this study was to investigate older people’s physical activity, their participation in various life situations, and their perceptions of their own health. This included an exploration of potential influences of urban versus rural residency on these outcomes, an evaluation of the measurement properties of a balance confidence scale, and an examination of the proposed usefulness of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to facilitate analysis and understanding of selected outcomes. Methods: The study design was cross-sectional, population-based, with random selection from the national register of one urban and two rural municipalities in Northern Iceland. There were 186 participants, all community-dwelling, aged 65 to 88 years (mean = 73.8), and 48% of the group were women. The participation rate was 79%. Data was collected in 2004, in face-to-face interviews and through various standardized assessments. The main outcomes were total physical activity; leisure-time, household, and work-related physical activity; participation frequency and perceived participation restrictions; and self-rated health. Other assessments represented aspects of the ICF body functions, activities, environmental factors and personal factors. Moreover, Rasch analysis methods were applied to examine and modify the Activities-specific Balance Confidence (ABC) scale and the ICF used as a conceptual framework throughout the study. Results: The total physical activity score was the same for urban and rural people and the largest proportion of the total physical activity behavior was derived from the household domain. Rural females received the highest scores of all in household physical activity and rural males were more physically active than the others in the work-related domain. However, leisure-time physical activity was more common in urban than rural communities. A physically active lifestyle, urban living, a higher level of cognition, younger age, and fewer depressive symptoms were all associated with more frequent participation. Rural living and depressive symptoms were associated with perceived participation restrictions. Moreover, perceived participation restrictions were associated with not being employed and limitations in advanced lower extremity capacity. Both fewer depressive symptoms and advanced lower extremity capacity also increased the likelihood of better self-rated health, as did capacity in upper extremities, older age, and household physical activity. Rasch rating scale analysis indicated a need to modify the ABC to improve its psychometric properties. The modified ABC was then used to measure balance confidence which, however, was found not to play a major role in explaining participation or self-rated health. Finally, the ICF was useful as a conceptual framework for mapping various components of functioning and health and to facilitate analyses of their relationships. Conclusions: The results highlighted the commonalities and differences in factors associated with participation frequency, perceived participation restrictions, and self-rated health in old age. Some of these factors, such as advanced lower extremity capacity, depressive symptoms, and physical activity pattern should be of particular interest for geriatric physical therapy due to their potential for interventions. While the associations between depressive symptoms, participation, and self-rated health are well known, research is needed on the effects of advanced lower extremity capacity on participation and self-rated health in old age. The environment (urban versus rural) also presented itself as an important contextual variable to be aware of when working with older people’s participation and physically active life-style. Greater emphasis should be placed on using Rasch measurement methods for improving the availability of quality scientific measures to evaluate various aspects of functioning and health among older adults. Finally, a coordinated implementation of a conceptual framework such as ICF may further advance interdisciplinary and international studies on aging, functioning, and health.

No description available.

Falling among older adults is a leading cause of concern due to the known impacts including physical injury, loss of independence, increased health care costs, and mortality. In efforts to decrease the numbers of falls experienced by older adults, healthcare providers assess individuals’ fall risks and provide corresponding fall prevention recommendations. The effectiveness however, of these recommendations, is only as strong as the level of adherence to those recommendations; which has proven low in recent research. Using the theoretical foundation of the Health Belief Model, this study quantified adherence to environmental fall prevention recommendations. Twenty-two community-dwelling older adults participated in this randomized control group study that took place across three home visits, scheduled approximately 30 days apart. Participants were interviewed regarding their recent falls and perceived susceptibility to future falls; then a home evaluation was conducted. Treatment group participants were provided personalized education explaining how and why environmental fall prevention recommendations were important to decrease their risk of falls while control group participants were provided general recommendations. A two-sample t-test for independent groups determined a statistically significant relationship: participants who received personalized education intervention were more likely to follow recommendations than those who received general education intervention. Multiple regressions were conducted to review relationships between an individual’s recent falls, and their perceived susceptibility to future falls, with their extent of adherence with fall prevention recommendations. No statistically significant relationship was found. This study suggests that providing personalized education for community-dwelling older adults regarding environmental fall prevention recommendations increases their extent of adherence with such recommendations.

Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.

Die posturale Instabilität zählt zu den am meisten beeinträchtigenden Symptomen der Parkinson-Krankheit. Die Störung der motorischen Gleichgewichtskontrolle ist progressiv im Verlauf und weder durch medikamentöse noch durch operative Methoden zufriedenstellend einzudämmen. In der Bewegungstherapie werden häufig Gleichgewichtsübungen empfohlen, um ein Fortschreiten der körperlichen Einschränkungen zu verringern. Der aktuelle wissenschaftliche Stand lässt allerdings eine Einschätzung zur Effektivität von Gleichgewichtstraining bei Parkinsonpatienten kaum zu. Dies ist u. a. auf einen Mangel an geeigneten Testverfahren zur Beurteilung der posturalen Instabilität zurückzuführen. In der vorliegenden Untersuchung wurden die Auswirkungen eines 12-wöchigen Gleichgewichtstrainings bei Parkinsonpatienten auf die posturale Stabilität in einem umfassenden Testdesign, bestehend aus alltagsmotorischen, biomechanischen und subjektiven Testverfahren evaluiert. In nahezu allen eingesetzten Testverfahren zeigte sich ein mehr oder weniger deutlicher Trend zu einer Verbesserung der posturalen Stabilität. Durch den Einsatz einer Testbatterie konnte somit insgesamt von einem positiven Einfluss eines Gleichgewichtstrainings auf die posturale Stabilität von Parkinsonpatienten ausgegangen werden. Weiterhin werden zahlreiche positive Nebeneffekte bzgl. der allgemeinen Fitness, der psychischen und sozialen Situation durch ein zielgerichtetes Gruppentraining unter geschulter Anleitung vermutet.

Die posturale Instabilität zählt zu den am meisten beeinträchtigenden Symptomen der Parkinson-Krankheit. Die Störung der motorischen Gleichgewichtskontrolle ist progressiv im Verlauf und weder durch medikamentöse noch durch operative Methoden zufriedenstellend einzudämmen. In der Bewegungstherapie werden häufig Gleichgewichtsübungen empfohlen, um ein Fortschreiten der körperlichen Einschränkungen zu verringern. Der aktuelle wissenschaftliche Stand lässt allerdings eine Einschätzung zur Effektivität von Gleichgewichtstraining bei Parkinsonpatienten kaum zu. Dies ist u. a. auf einen Mangel an geeigneten Testverfahren zur Beurteilung der posturalen Instabilität zurückzuführen. In der vorliegenden Untersuchung wurden die Auswirkungen eines 12-wöchigen Gleichgewichtstrainings bei Parkinsonpatienten auf die posturale Stabilität in einem umfassenden Testdesign, bestehend aus alltagsmotorischen, biomechanischen und subjektiven Testverfahren evaluiert. In nahezu allen eingesetzten Testverfahren zeigte sich ein mehr oder weniger deutlicher Trend zu einer Verbesserung der posturalen Stabilität. Durch den Einsatz einer Testbatterie konnte somit insgesamt von einem positiven Einfluss eines Gleichgewichtstrainings auf die posturale Stabilität von Parkinsonpatienten ausgegangen werden. Weiterhin werden zahlreiche positive Nebeneffekte bzgl. der allgemeinen Fitness, der psychischen und sozialen Situation durch ein zielgerichtetes Gruppentraining unter geschulter Anleitung vermutet.