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266 PSYCHOLOGICAL AND BEHAVIOURAL SYMPTOMS – ARE THEY PREDICTORS FOR FALLS AMONG NURSING-HOME RESIDENTS?
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Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
265 WEIGHT OF TEMPORAL–SPATIAL PARAMETERS OF GAIT AND BALANCE ON GAIT CAPACITY AND QUALITY OF LIFE IN PARKINSON DISEASE
267 THE POSTURAL RESPONSES OF OLDER WOMEN TO STATIC AND DYNAMIC PERTURBATIONS ON THE NEUROCOM EQUITEST®
C. Swank. Baylor Institute for Rehabilitation, Dallas, TX, USA
L. Alcock, N. Vanicek, L. McNaughton. Department of Sport, Health and Exercise Science, The University of Hull, Hull, UK
Background and Aims: Motor impairment including postural instability produces gait dysfunction in Parkinson disease (PD) characterized by stride variability, reduced speed, and increased double limb support time. Mobility deterioration has been identified as a contributing factor to decline in quality of life (QOL). The aim of this study is to determine the relative contributions of motor impairment, postural instability, and temporal–spatial parameters of gait on functional gait capacity and QOL. Methods: Participants with PD (N = 26) were administered the UPDRS and Gait & Balance Scale (GABS) and subjectively reported QOL on the Parkinson Disease Questionnaire-8 (PDQ-8). The 6-Minute Walk Test (6MWT) was performed along with computerized GAITRite and Balance Master® limits of stability assessments. Stepwise multiple regression analyzed the contributions of motor impairment, postural instability and temporal-spatial parameters on gait capacity and QOL separately. Results: Our participants demonstrated a distance-limited functional gait capacity (mean = 302.06±46.98 m) and reduced QOL (28.46%). In our sample, only GABS was predictive of 6MWT distance (R2 = 0.110, p = 0.01). GABS and 6MWT were predictive of PDQ-8 (R2 = 0.192, p = 0.002). Neither specific temporal–spatial parameters nor limits of stability measures made significant contributions to the regression equations. Conclusions: Summative gait and balance impairment adversely impacts gait capacity and QOL, though no specific parameter predominates. However, only 11% and 19% of the variance was explained in our models respectively. Additional factors need to be explored to expound the role of gait and balance dysfunction in PD.
Background: It is well established that as we age, our ability to maintain balance may naturally deteriorate with important implications for the prevalence of falls in older populations. The relative contribution of the systems responsible for balance and controlling posture are fundamental to execute many essential daily activities. The aim of this study was to undertake a comprehensive postural assessment in older women so balance deficits to static and dynamic conditions could be identified. Methods: Five healthy older women were recruited for this study (age 67±4yrs, height 1.63±7.6 m, mass 78.5±15 kg) and completed the Sensory Organisation Test (SOT) and Motor Control Test (MCT) on the NeuroCom Balance® Equitest Smart® System. Results: SOT – Equilibrium scores were lowest for conditions 5 and 6 where visual and somatosensory information were inaccurate. Low Equilibrium values indicated increased sway. Strategy scores reflected a full ankle strategy for the majority of conditions (conditions 1–4) with a larger contribution from the hip in conditions 5 and 6. MCT – Latency times were 135 ms and 125 ms for the medium and large backwards translations respectively, compared with latency times of 140 ms and 130 ms for the medium and large forward translations respectively. Large forward translations presented the greatest difficulty resulting in more asymmetrical weight-bearing. Conclusions: Instability caused by inaccurate somatosensory information on the SOT may be responsible for the greatest risk of a loss of balance represented by reduced equilibrium scores. The balance of older women was most affected by inaccurate somatosensory information regardless of visual or no visual input.
266 PSYCHOLOGICAL AND BEHAVIOURAL SYMPTOMS – ARE THEY PREDICTORS FOR FALLS AMONG NURSING-HOME RESIDENTS? H. Sylliaas1 , A. Bergland2 , G. Selbæk3 . 1 Oslo University Hospital, Ullevaal, 2 Oslo University College, 3 Oslo University Hospital, Oslo, Norway Background and Aims: The purpose of our study was to examine whether psychological and behavioral symptoms predict falls among nursing-home residents. Falls are responsible for immobility, considerable morbidity and mortality and falling is considerably higher among nursing-home residents than among those living in their own home. Methods: 782 nursing-home residents were included in the oneyear follow-up study. All residents were examined with The Physical Self-Maintenance scale (ADL), Clinical Dementia Rating Scale (CDR), The Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, patients’ diagnoses and use of medication were collected from the medical records. Results: Totally, 46% of the participants had at least one fall, 33% had two or more falls during the one- year-follow-up period. The bivariate survival analysis revealed that education, high score on CDR, NPI, and Cornell scale, old age and a worsening in self-reported health significantly predict one or more falls. The multivariate survival analysis analyses showed that old age, a worsening in selfreported health, high scores on NPI and CDR were all independently associated with risk of falling, 30%, 55%, 45%, 36% respectively. Conclusion: Having poor self-rated health was in our study identified as a significant and independent predictor for falls. Selfrated health is identified as predictors for falls in nursing-homes and in previous studies information about self-rated health may be useful as crude indices for successful ageing in later life for nursing-home residents.
268 BIOMECHANICAL DIFFERENCES DURING STAIR DESCENT IN FALLERS VS. NON-FALLERS N. Vanicek1 , S. Strike2 , L. Mcnaughton1 , R. Polman3 . 1 Sport, Health & Exercise Science, University of Hull, Hull, 2 School of Human and Life Sciences, Roehampton University, London, 3 Centre for Applied Sport & Exercise Sciences, University of Central Lancashire, Preston, UK Background: Difficulties descending stairs are linked with poor balance and gait abnormalities in non-disabled older adults. Older adults function close to their biomechanical limits during stair descent. Falls that occur during stair negotiation are more likely to occur during stair descent than ascent. The aim of this study was to compare the gait patterns of fallers and non-fallers during stair descent. It was hypothesised that the fallers would walk slower and exhibit reduced joint range of motion (ROM) and mechanics at the ankle and the knee. Methods: 4 fallers and 5 non-fallers (mean±SD age: 52±16 and 72±5 years, respectively) descended a 3-step staircase and 3D kinematic and kinetic data were captured during steadystate walking. The results were analysed using independent t-tests (p < 0.05). Results: The fallers walked significantly slower than the non-fallers (0.53±0.10 vs. 0.77±0.17 m/s) but no differences were observed in ankle or knee joint ROM. The fallers exhibited significantly larger peak braking GRF (p = 0.05) but no differences were reported for vertical GRF. Contrary to the hypothesis, the fallers did not show reduced mechanics at the ankle or knee as there were no significant differences in peak ankle or knee joint moments or powers. Conclusions: The results demonstrated that walking velocity differentiated previous fallers from non-fallers during stair descent. With their slower speed, the fallers adopted a more cautious walking strategy by also displaying a greater peak braking force. In
Posters / Parkinsonism and Related Disorders 16S1 (2010) S11–S86
265 WEIGHT OF TEMPORAL–SPATIAL PARAMETERS OF GAIT AND BALANCE ON GAIT CAPACITY AND QUALITY OF LIFE IN PARKINSON DISEASE
267 THE POSTURAL RESPONSES OF OLDER WOMEN TO STATIC AND DYNAMIC PERTURBATIONS ON THE NEUROCOM EQUITEST®
C. Swank. Baylor Institute for Rehabilitation, Dallas, TX, USA
L. Alcock, N. Vanicek, L. McNaughton. Department of Sport, Health and Exercise Science, The University of Hull, Hull, UK
Background and Aims: Motor impairment including postural instability produces gait dysfunction in Parkinson disease (PD) characterized by stride variability, reduced speed, and increased double limb support time. Mobility deterioration has been identified as a contributing factor to decline in quality of life (QOL). The aim of this study is to determine the relative contributions of motor impairment, postural instability, and temporal–spatial parameters of gait on functional gait capacity and QOL. Methods: Participants with PD (N = 26) were administered the UPDRS and Gait & Balance Scale (GABS) and subjectively reported QOL on the Parkinson Disease Questionnaire-8 (PDQ-8). The 6-Minute Walk Test (6MWT) was performed along with computerized GAITRite and Balance Master® limits of stability assessments. Stepwise multiple regression analyzed the contributions of motor impairment, postural instability and temporal-spatial parameters on gait capacity and QOL separately. Results: Our participants demonstrated a distance-limited functional gait capacity (mean = 302.06±46.98 m) and reduced QOL (28.46%). In our sample, only GABS was predictive of 6MWT distance (R2 = 0.110, p = 0.01). GABS and 6MWT were predictive of PDQ-8 (R2 = 0.192, p = 0.002). Neither specific temporal–spatial parameters nor limits of stability measures made significant contributions to the regression equations. Conclusions: Summative gait and balance impairment adversely impacts gait capacity and QOL, though no specific parameter predominates. However, only 11% and 19% of the variance was explained in our models respectively. Additional factors need to be explored to expound the role of gait and balance dysfunction in PD.
Background: It is well established that as we age, our ability to maintain balance may naturally deteriorate with important implications for the prevalence of falls in older populations. The relative contribution of the systems responsible for balance and controlling posture are fundamental to execute many essential daily activities. The aim of this study was to undertake a comprehensive postural assessment in older women so balance deficits to static and dynamic conditions could be identified. Methods: Five healthy older women were recruited for this study (age 67±4yrs, height 1.63±7.6 m, mass 78.5±15 kg) and completed the Sensory Organisation Test (SOT) and Motor Control Test (MCT) on the NeuroCom Balance® Equitest Smart® System. Results: SOT – Equilibrium scores were lowest for conditions 5 and 6 where visual and somatosensory information were inaccurate. Low Equilibrium values indicated increased sway. Strategy scores reflected a full ankle strategy for the majority of conditions (conditions 1–4) with a larger contribution from the hip in conditions 5 and 6. MCT – Latency times were 135 ms and 125 ms for the medium and large backwards translations respectively, compared with latency times of 140 ms and 130 ms for the medium and large forward translations respectively. Large forward translations presented the greatest difficulty resulting in more asymmetrical weight-bearing. Conclusions: Instability caused by inaccurate somatosensory information on the SOT may be responsible for the greatest risk of a loss of balance represented by reduced equilibrium scores. The balance of older women was most affected by inaccurate somatosensory information regardless of visual or no visual input.
266 PSYCHOLOGICAL AND BEHAVIOURAL SYMPTOMS – ARE THEY PREDICTORS FOR FALLS AMONG NURSING-HOME RESIDENTS? H. Sylliaas1 , A. Bergland2 , G. Selbæk3 . 1 Oslo University Hospital, Ullevaal, 2 Oslo University College, 3 Oslo University Hospital, Oslo, Norway Background and Aims: The purpose of our study was to examine whether psychological and behavioral symptoms predict falls among nursing-home residents. Falls are responsible for immobility, considerable morbidity and mortality and falling is considerably higher among nursing-home residents than among those living in their own home. Methods: 782 nursing-home residents were included in the oneyear follow-up study. All residents were examined with The Physical Self-Maintenance scale (ADL), Clinical Dementia Rating Scale (CDR), The Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, patients’ diagnoses and use of medication were collected from the medical records. Results: Totally, 46% of the participants had at least one fall, 33% had two or more falls during the one- year-follow-up period. The bivariate survival analysis revealed that education, high score on CDR, NPI, and Cornell scale, old age and a worsening in self-reported health significantly predict one or more falls. The multivariate survival analysis analyses showed that old age, a worsening in selfreported health, high scores on NPI and CDR were all independently associated with risk of falling, 30%, 55%, 45%, 36% respectively. Conclusion: Having poor self-rated health was in our study identified as a significant and independent predictor for falls. Selfrated health is identified as predictors for falls in nursing-homes and in previous studies information about self-rated health may be useful as crude indices for successful ageing in later life for nursing-home residents.
268 BIOMECHANICAL DIFFERENCES DURING STAIR DESCENT IN FALLERS VS. NON-FALLERS N. Vanicek1 , S. Strike2 , L. Mcnaughton1 , R. Polman3 . 1 Sport, Health & Exercise Science, University of Hull, Hull, 2 School of Human and Life Sciences, Roehampton University, London, 3 Centre for Applied Sport & Exercise Sciences, University of Central Lancashire, Preston, UK Background: Difficulties descending stairs are linked with poor balance and gait abnormalities in non-disabled older adults. Older adults function close to their biomechanical limits during stair descent. Falls that occur during stair negotiation are more likely to occur during stair descent than ascent. The aim of this study was to compare the gait patterns of fallers and non-fallers during stair descent. It was hypothesised that the fallers would walk slower and exhibit reduced joint range of motion (ROM) and mechanics at the ankle and the knee. Methods: 4 fallers and 5 non-fallers (mean±SD age: 52±16 and 72±5 years, respectively) descended a 3-step staircase and 3D kinematic and kinetic data were captured during steadystate walking. The results were analysed using independent t-tests (p < 0.05). Results: The fallers walked significantly slower than the non-fallers (0.53±0.10 vs. 0.77±0.17 m/s) but no differences were observed in ankle or knee joint ROM. The fallers exhibited significantly larger peak braking GRF (p = 0.05) but no differences were reported for vertical GRF. Contrary to the hypothesis, the fallers did not show reduced mechanics at the ankle or knee as there were no significant differences in peak ankle or knee joint moments or powers. Conclusions: The results demonstrated that walking velocity differentiated previous fallers from non-fallers during stair descent. With their slower speed, the fallers adopted a more cautious walking strategy by also displaying a greater peak braking force. In