The purpose of this thesis was to determine the perceived risk of falling and its relationship to balance and falls in older community-dwelling adults with type 2 diabetes mellitus (DM2). Study One was a systematic review of published literature on risk factors for falling in older adults with DM2. Study Two was a prospective cohort study for parameter estimation, the goal was to determine the test-retest reliability, internal consistency, construct validity and factor structure of a falls Risk Perception Questionnaire in older community-dwelling adults with DM2. Study Three was also a prospective cohort study; the goals of this study were to determine the association between perceived of falling and balance in older adults with DM2 and to determine whether older adults alter their perceived risk of falling after receiving feedback about their balance. The information gained from these studies will be used to guide subsequent research as well as falls risk assessment and prevention in older adults with DM2. / Thesis / Master of Science (MSc)

Tyrimo objektas: Jonavos miesto bei Kėdainių rajono kaimo vyresniojo amžiaus gyventojai. Tyrimo tikslas: Nustatyti mieste ir kaime gyvenančių vyresnio amžiaus žmonių fizinio aktyvumo ir griuvimų rizikos sąsajas. Hipotezė: Kaime gyvenantys žmonės yra fiziškai aktyvesni bei jų kritimų rizika yra mažesnė. Tyrimo uždaviniai: 1. Nustatyti vyresnio amžiaus žmonių fizinį aktyvumą. 2. Nustatyti fizinio aktyvumo sąsają su vyresniojo amžiaus žmonių kritimų rizika. 3. Aptarti miesto ir kaimo žmonių kritimų rizikos skirtumus. Tyrimo imtis ir organizavimas. Anketinė, anoniminė apklausa buvo vykdoma 2013m. Vasario – Balandžio mėnesiais Jonavos mieste bei Kėdainių rajono kaimeliuose (Nociūnų k., ir t.t). Apklausiami buvo vyresniojo amžiaus žmonės (nuo 50m.). Mieste buvo apklausiama 100 gyvenančių respondentų, kaime taip pat - 100 respondentų. Išvados: 1. Nustačius vyresniojo amžiaus žmonių fizinį aktyvumą, fiziškai aktyvių žmonių kaime buvo net du trečdaliai, nei mieste, todėl galime manyti, jog kaime gyvenantys žmonės save laiko fiziškai aktyviais, nes jų kasdieninė veikla susijusi su fiziniu darbu: ūkio - sodo darbai. 2. Per pastaruosius metus aktyvūs žmonės šiek tiek dažniau krisdavo nei neaktyvūs. Tačiau tarp grupių statistiškai patikimo skirtumo nenustatyta. 3. Kaime ir mieste gyvenančių vyresniojo amžiaus žmonių griuvimų riziką labiausiai įtakojantys šie veiksniai: baimė pargriūti, galvos svaigimas ar sukimosi pojūtis kai atsigula, regos sutrikimai, pusiausvyros praradimas keičiant... [toliau žr. visą tekstą] / Subject: Jonava city and Kėdainiai district rural older populations. Aim of the study: to identify the relation between physical activity and fall risk of older people in city and village. Hypothesis: people in village are more physical active and they have less risk to fall. Objectives: 1. To identify physical activity of older people. 2. To identify the relation between physical activity and risk of falls of older people. 3. Discuss both urban and rural people to take the risk of falls differences. Sample and organization. Questionnaire, an anonymous survey was implemented the 2013. February - April in Jonava city and Kėdainiai district villages ( Nociūnai, etc. ). Interviewed were older people (from 50m).. The town people were surveyed 100 respondents living in rural areas - as well as 100 respondents. Conclusions: 1. Identified older people physical activity was observed that physically active people in rural consisted 70 proc., while in city only 14 proc. To assume, rural people consider themselves more actives because of daily activities on farm and garden. 2. During the last year physically active people fell a little more than inactive. However no statistically significant difference between two groups. 3. The most influencing factors of older people in falls risk: fear of falling, dizziness or spinning when they lie down, visual disturbances, loss of balance moving body position.

Made available in DSpace on 2018-06-04T19:14:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-06-05 / Acredita-se que o exercício físico regular contribui para melhorar a postura corporal e a Qualidade de Vida (QV) de idosos. Objetivos: analisar os efeitos da hidroginástica na postura corporal estática, na QV, na capacidade funcional, no nível de dor e no risco de quedas de idosos. Métodos: foram formados dois grupos, sendo o grupo intervenção GI (n=49, média de idade: 67,2 +7,58) e o grupo controle GC (n=34, média de idade: 67,65, +7,43). Inicialmente, os idosos, de ambos os grupos, realizaram avaliação da postura corporal estática, utilizando como instrumento o simetrógrafo e o fio de prumo, além de fotografias nas vistas anterior, posterior e lateral. Na QV, utilizaram-se o questionário SF-36. Para avaliar a capacidade funcional, utilizaram-se três perguntas básicas relacionadas a andar 100 metros, entrar e sair da cama e tomar banho. O nível de dor foi analisado através da escala analógica visual para a dor e o risco de quedas através do teste “time up & go”. Após as avaliações, os idosos do GI realizaram aulas de hidroginástica, sendo duas vezes por semana, por um período de três meses. Enquanto que os idosos do GC não realizaram a hidroginástica. Após os três meses de estudo, os idosos realizaram nova avaliação. Na análise estatística, utilizou-se o teste de wilcoxon e o teste de wilcoxon-mann-whitney. Resultados: em relação à postura corporal estática, observou-se melhora significativa do GI quando comparado com os idosos do GC, destacando os segmentos cabeça (vista anterior e lateral), ombros (vista lateral) e joelhos (vista lateral). Na QV, observou-se melhora significativa do GI em todas as variáveis analisadas. No quesito capacidade funcional, não se observaram resultados significativos (p>0,05). No nível de dor, verificou-se que no GI, obteve-se aumento de 63,3% da dor leve e redução em 30,6% da dor moderada (p<0,05). Em relação ao risco de quedas, observou-se que no GI, obteve-se aumento de 19% do baixo risco para quedas e redução em 18% do médio risco para quedas (p<0,05). Conclusão: em relação à amostra estudada, pode-se concluir que a hidroginástica contribuiu de maneira eficaz e positiva na melhora da postura corporal estática, melhora QV, redução do nível de dor e do risco de quedas de idosos em estudo. Não se observou melhora significativa para variável capacidade funcional (Ramos et al. 2013). Diante dos achados, recomenda-se a prática regular de hidroginástica por idosos, com forma de prevenir e tratar os efeitos deletérios decorrentes do processo do envelhecimento. / It is believed that regular physical exercise contributes to improve the body posture and Quality of Life (QOL) among the elderly. Objectives: This study aimed to analyze the effects of water aerobics on static body posture, QOL, functional capacity, pain level, and risk of falls of elderly people. Methods: Two groups were formed: the intervention group (IG), n=49, mean age of 67.2 ±7.58; and the control group (CG), n=34, mean age of 67.65 ±7.43. At first, the elderly of both groups underwent static body posture assessment using the symmetry and plumb line, as well as photographs in anterior, posterior, and lateral views. The SF-36 questionnaire was applied in QOL evaluation. To analyze functional capacity, three basic questions were used, related to walking 100 meters, getting into and out of bed, and showering. The pain level was analyzed through a pain visual analogue scale, and the risk of falls through the Timed Up and Go test. After the evaluations, the IG elders performed water aerobics classes, twice a week for three months. While the CG elders did not perform water aerobics. After the three months of study, the elderly underwent a new evaluation. In the statistical analysis, the Wilcoxon test and the Wilcoxon-Mann-Whitney test were used. Results: In relation to the static body posture, a significant improvement in the IG was observed when compared to the elderly in the CG, highlighting the segments: head (anterior and lateral view), shoulders (lateral view), and knees (lateral view). As for the QOL, a significant improvement in the IG was verified in all analyzed variables. Regarding functional capacity, no significant results were found (p>0,05). In the pain level, the IG showed a 63.3% increase in mild pain and a 30,6% reduction in moderate pain (p<0,05). About the risk of falls, the IG presented a 19% increase in the low risk for falls and a 18% reduction in the average risk for falls (p<0,05). Conclusion: In relation to the studied sample, it can be concluded that water aerobics contributed effectively and positively to improve the static body posture, QOL, and risk of falls in the elderly, as well as to reduce the pain level. The functional capacity variable demonstrated no significant improvement (Ramos et al. 2013). Given the results, it is recommended the regular practice of water aerobics by the elderly, aiming to prevent and treat the deleterious effects arising from the aging process. / BV UNIFESP: Teses e dissertações

Le risque de chute est une problématique bien présente chez les personnes âgées ou ayant une atteinte neurologique et reflète un déficit des mécanismes neuronaux assurant l’équilibre. De précédentes études démontrent que l’intégration des informations sensorielles est essentielle au contrôle de l’équilibre et que l’inhibition présynaptique (IP) serait un mécanisme important dans le contrôle de la transmission sensorielle. Ainsi, le but de cette étude était d’identifier la contribution du mécanisme d’IP à l’induction de réponses posturales efficaces suite à une perturbation d’équilibre. Notre hypothèse est qu’une diminution d’IP contribuerait à l’induction des ces réponses, en augmentant l’influence de la rétroaction sensorielle sur les réseaux de neurones spinaux. Afin de démontrer cette hypothèse, nous avons d’abord évalué l’excitabilité spinale pendant les perturbations vers l’avant ou vers l’arrière, à l’aide du réflexe H. L’excitabilité spinale était modulée selon la direction de la perturbation et cette modulation survenait dès 75 ou 100 ms (p<0.05), soit avant l’induction des réactions posturales. Puis, à l’aide de techniques plus précises de convergence spinale, nous avons démontré que l’IP était diminuée dès 75 et 100 ms dans les deux directions, suggérant que la transmission des informations sensorielles vers la moelle épinière est accrue juste avant le déclenchement de la réponse posturale. Cette étude met en évidence un mécanisme-clé permettant d’augmenter la rétroaction des informations sensorielles nécessaires à l’induction de réponses posturales appropriées. L’évaluation de ce mécanisme pourrait mener à une meilleure identification des individus à risque de chute. / Falls are a significant problem among the elderly or persons with a neurological impairment, and reflect a deficit in the nervous mechanisms underlying postural control. Previous research shows that the integration of sensory feedback is a crucial component of postural control and that presynaptic inhibition (PSI) plays an important role in controlling the sensory processing of information. The aim of this study was to identify the contribution of PSI to the induction of effective postural responses following an unexpected balance perturbation. We hypothesized that a decrease in PSI would contribute to the induction of these responses by increasing the influence of sensory feedback onto spinal networks during the perturbation. First we assessed the level of spinal excitability during perturbations, using the soleus H-reflex. Results show that spinal excitability is modulated according to the direction of the perturbation (forward and backward tilts) and that this modulation occurs 75 and 100 ms after tilt-onset in all subjects (p<0.05). To further estimate changes in PSI, spatial facilitation techniques were used. PSI was shown to decrease in both perturbation directions shortly after tilt onset at 75 and 100 ms (p<0.05), suggesting an increase in sensory transmission in the spinal cord. These observations suggest that sensory feedback is critical for the induction of effective postural responses and that impaired sensory transmission or integration, due to CNS lesions or ageing, may lead to certain balance deficits. Identifying patients with such impairments may improve fall risk-assessment and prevention.

Made available in DSpace on 2016-12-12T17:32:56Z (GMT). No. of bitstreams: 1 MORGAN LANZARIN.pdf: 1063402 bytes, checksum: 3821998e28304e20605b743f7fd66efb (MD5) Previous issue date: 2014-08-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Intermittent claudication (IC) is a debilitating condition that affects mainly the elderly and manifested by decreased ability of ambulatory function. Furthermore, subjects whit CI present motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance and increased risk of falls. This study aims to evaluate the risk of falls in subjects whit CI by measuring postural control and muscle performance. The study included 32 subjects of both genders, 16 patients within IC (64 ± 6 years) and 16 healthy subjects (67 ± 5 years). Postural control was assessed by computerized dynamic posturography (CDP). The CDP have a static test and a dynamic test. The variables analyzed were: range of the center of pressure (COP) displacement and mean velocity of COP displacement in anteroposterior and mediolateral direction. Muscle performance of the flexor and extensor muscles of the knee and ankle was measured by isokinetic dynamometry. The results of this research showed that the subjects with IC have largest range and speed COPap during displacement of the platform behind in average intensity, and longer latency. There were no observed statistical differences between groups during the SOT. In regarding muscle performance, the group of IC had lower levels of muscle strength and power in plantiflexors. These findings suggest that the IC could be more susceptible to falls when compared to subjects without claudication. / A claudicação intermitente (CI) é uma condição debilitante que afeta principalmente idosos e manifesta-se pela diminuição da capacidade de locomoção. Além disso, os sujeitos com CI apresentam disfunção do nervo motor e sensorial das extremidades inferiores, o que pode levar a déficits de equilíbrio e um maior risco de quedas. Este estudo teve como objetivo avaliar o risco de quedas em claudicantes por meio da mensuração do controle postural e do desempenho muscular. Participaram do estudo 32 sujeitos de ambos os gêneros, 16 portadores de CI (64±6 anos) e 16 sujeitos saudáveis (67±5 anos). O controle postural foi avaliado por meio da posturografia dinâmica computadorizada (PDC). A PDC apresenta um teste estático e um teste dinâmico. As variáveis analisadas foram: amplitude de deslocamento do centro de pressão (COP) e velocidade média de deslocamento do COP nas direções ântero-posterior e médio-lateral. O desempenho muscular foi mensurado por meio da dinamômetria isocinética dos músculos flexores e extensores do joelho e platiflexores e dorsiflexores do tornozelo em ambos os membros. Os resultados evidenciaram que os sujeitos portadores de CI apresentaram maior deslocamento e velocidade do COPap durante o deslocamento da plataforma para trás em média intensidade, bem como maior tempo de latência. Não foram observadas diferenças estatísticas entre os grupos durante o SOT. Quanto ao desempenho muscular, o grupo de claudicantes apresentou menores níveis de força e potência muscular nos plantiflexores. Esses achados sugerem que claudicantes podem estar mais propensos à quedas quando comparados a sujeitos sem claudicação.

Introducción: Las caídas son uno de los principales problemas a los que se enfrenta hoy la población de adultos mayores. Objetivo: Determinar la efectividad de un programa de ejercicios físicos de 12 semanas de duración en comparación al mismo de 2 semanas, para reducir el riesgo de caídas en este grupo humano. Métodos: Estudio experimental paralelo y aleatorizado con dos grupos de intervención realizado a adultos mayores (AM) pertenecientes al Centro Integral del Adulto Mayor. Los participantes aleatorizados fueron 13 AM (Grupo 1 = 5; grupo 2 = 8). Se utilizó la prueba Timed Up and Go (TUG) para determinar el riesgo de caídas, y se les aplicó un cuestionario para obtener datos personales. Se ejecutó un mismo programa de ejercicios para ambos grupos, y solo se diferenció en el número de sesiones (Grupo 1 = 4 sesiones; Grupo 2 = 24 sesiones). Resultados: La mayor cantidad de participantes fueron mujeres, y presentaron un nivel de actividad física bajo en ambos grupos. El TUG reveló, al inicio, que el 87,5% del Grupo 2 presentó un riesgo normal/leve de caídas; y, al final del programa, que el total se encontraba ahí. El número de caídas desde la evaluación inicial a la final se redujo alrededor del 20%. Por último, la diferencia total del TUG inicial y final es una reducción de 0,46 segundos. En ninguna de las variables se encontró asociación significativa (p > 0,01) para ambos grupos. Conclusión: No se encontró asociación significativa entre realizar un programa de ejercicios físicos de 12 semanas en comparación al mismo programa con 2 semanas de duración para reducir el riesgo de caídas. / Introduction: Nowadays, falls have become one of the main problems faced by the elderly population. Objective: To determine the effectiveness of a 12-week exercise program compared to the same 2-week program to reduce the risk of falls in this human group. Methods: Randomized parallel experimental study with two intervention groups performed to elderly people (EP) belonging to Centro Integral del Adulto Mayor. The randomized participants were 13 EP (Group 1 = 5; Group 2 = 8). The test Timed Up and Go (TUG) was used to determine the risk of falls, and it was applied a questionnaire to them in order to obtain personal data. Same exercise program was implemented for both groups and only differed in the number of sessions (Group 1 = 4 sessions; Group 2 = 24 sessions). Results: Most participants were women, who had a low level of physical activity in both groups. The TUG revealed in the beginning that the 87,5% of Group 2 had a normal/low risk of falls and at the end of the program the total was found there. The number of falls from the initial to the final evaluation was reduced by about 20%. Finally, the total difference between the initial and final TUG is a reduction of 0,46 seconds. In any of the variables no significant association was found (p > 0.01) for both groups. Conclusion: No significant association was found between performing a 12-week physical exercise program compared to the same 2-week program to reduce the risk of falls. / Tesis