- Email: [email protected]
Poster 91 refer to abstract 53 in the rehabilitation II poster grand rounds for the full abstract. e-mail: [email protected]
E26
2004 Academy Annual Assembly Abstracts
research grant from the Ministry of Science & Technology, Republic of Korea; Y. Kim, research grant from the Ministry of Science & Technology, Republic of Korea; P.K. Lee, research grant from the Ministry of Science & Technology, Republic of Korea; N. Kim, research grant from the Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea. Objective: To determine the stability parameters in posturography that can assess more sensitively age-related changes in posture control. Design: Descriptive study with repeated measures. Setting: Complex continuing care facility for geriatric population in Korea. Participants: 39 healthy geriatric people aged 60y and older who were free of neurologic and medical conditions that cause motor weakness, visual disturbance, and vestibular dysfunction. Interventions: Not applicable. Mean Outcome Measures: Subjects were divided into 3 groups by age (aged 60 – 69y, 70 –79y, ⱖ80y). Center of pressure (COP) parameters were obtained as total path distance, integration of total path, and mean frequency of sway in comfortable standing with eyes open and closed in each group. A visual feedback system (VFS) was added to posturography and then subjects were asked to move their COP into the target circle on a CRT monitor with active movement on forceplate. Clinical COP parameters (moving time to get in the circle, total path of deviation, elapsed time in the circle) were obtained with the VFS. Results: There was no difference in COP parameters in static posturography between age groups. Total path of deviation assessed by posturography with the VFS showed a significant difference between age groups (P⬍.05); significant correlations with a clinical balance test (Berg Balance Scale) were also found (correlation coefficient⫽⫺.471, P⫽.002). Conclusions: A posturographic balance assessment system with visual feedback was clinically useful in more sensitive evaluation of age-related change of balance control in healthy geriatric people. The therapeutic use of visual feedback as a tool of balance training may be a valuable subject of further study. Key Words: Feedback; Geriatrics; Posture; Rehabilitation. Poster 90 Modified Arnis de Mano as a Tool to Improve Balance in the Elderly: A Randomized Controlled Trial. Maria Luisa P. Santos, MD (Univ Santo Tomas Hosp, Manila, Philippines); Consuelo G. Suarez, MD; Joven Christopher T. Cerdenia, PTRP; Michael Jorge N. Peralta, PTRP, e-mail: [email protected]. Disclosure: M.P. Santos, None; C.G. Suarez, None; J.T. Cerdenia, None; M.N. Peralta, None. Objective: To determine the effectiveness of the Modified Arnis de Mano, a Filipino form of martial arts adopted as a form of exercise, in improving balance among the elderly. Design: Randomized controlled, single-blinded trial. Setting: A government-run home-for-the-aged community in the Philippines. Participants: Elderly men and women aged 60 to 84y. Interventions: The Modified Arnis de Mano and a standardized strengthening exercise protocol for the lower extremities geared toward improving balance. Main Outcome Measures: Functional performance measures done pre- and postintervention were the Timed Up & Go (TUG) test, Functional Reach Test (FRT), and 10-meter speed test (10MST). Results: 22 participants were randomly grouped into 2: 11 participants (mean age, 72.73⫾8.34y) were assigned in the Arnis group and the other 11 participants (mean age, 70.45⫾6.88y) were placed in the structured exercise group. 9 participants completed the 4-wk strengthening exercise protocols and another 9 completed the 4-wk Arnis protocol. No participants were injured during the program. The overall dropout rate was 39%. Outcome measures showed improvement in the Arnis group on the FRT and a reduction in time on the 10MST and TUG test. Although the strengthening group also showed similar changes on the 3 outcome measures, 10MST times differed significantly between the 2 groups. Conclusions: Exercise programs done regularly improved balance among the elderly. Both the standard strengthening exercise protocol and the Modified Arnis de Mano exercise showed absolute change in clinical measurements but only the latter showed a positive effect in dynamic balance. Key Words: Balance; Elderly; Rehabilitation. Poster 91: Refer to Abstract 53 in the Rehabilitation II Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 92: Refer to Abstract 54 in the Rehabilitation II Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 93 Clinical Balance Test More Sensitive to Age-Related Changes and Correlation With Joint Motion. Juha An, MD (Samsung Med Ctr, Seoul, Republic of Korea); JiHye Hwang, MD, PhD; Young-keun Woo, MSPT; Yun-Hee Kim, MD, PhD; Peter K. Lee, MD, PhD; Nam-Gyun Kim, PhD, e-mail: [email protected]. Disclosure: J. An, None; J. Hwang, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; Y. Woo, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; Y. Kim, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; P.K. Lee, None; N. Kim, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea. Objectives: To identify a balance test that can reflect more sensitively changes according to age and to investigate the test’s correlation with flexibility of joint. Design: Descriptive survey with repeated measures. Setting: Complex continuing care facility for a geriatric population in Korea. Participants: 39 healthy geriatric people aged 60y and older who were free of neurologic and medical conditions that cause motor weakness, visual disturbance, and vestibular dysfunction. Intervention: Not applicable. Main Outcome Measures: Subjects were divided into 3 groups by age (aged 60 – 69y, 70 –79y, ⱖ80y) and each group was evaluated with clinical balance tests (Berg Balance Scale [BBS], Functional Reach Test, Tinetti Performance Oriented Mobility Assessment [POMA]). Bilateral lower-extremity range of motion (ROM) was measured with goniometry to quantify the flexibility of whole joints. Results: The BBS was the most sensitive clinical balance test reflecting the changes by age (P⫽.002) and the POMA balance subtest was also more sensitive test than others (P⫽.022). Correlations between clinical balance tests and joint flexibility were found.
Arch Phys Med Rehabil Vol 85, September 2004
The strongest correlation existed between the BBS and bilateral ankle ROM inversion and eversion (correlation coefficient⫽.565, P⫽.000). Conclusions: Among the clinically validated balance tests, the BBS was the most sensitive test at reflecting the decline of balance performance related to aging. A correlation exists between ankle ROM and balance in healthy elderly people. Additional research is needed to determine whether treatment directed at increasing ankle ROM can improve balance. Key Words: Geriatrics; Posture; Range of motion, articular; Rehabilitation. Poster 94 Improvement in Lumbar Extensor Strength in Overweight Elderly Adults After 6 Months of Resistance Training. Kevin R. Vincent, MD, PhD (Univ Virginia, Charlottesville, VA); Heather K. Vincent, PhD; Randy W. Braith, PhD, e-mail: [email protected]. Disclosure: K.R. Vincent, None; H.K. Vincent, None; R.W. Braith, None. Objective: To measure lumbar extensor strength in overweight and nonoverweight (control) elderly adults before and after chronic resistance exercise. Design: Randomized controlled trial. Setting: Spine care center. Participants: Elderly adults 60 to 72y (N⫽62), grouped based on body mass index (BMI): control group (mean, 22.5kg/m2) and overweight group (mean, 29.2kg/m2). Interventions: 6mo of lumbar extensor resistance exercise using MedX equipment. Main Outcome Measures: Body fat and fat free mass, and isometric lumbar extensor strength in 12° increments in the 0° to 72° range of back flexion. Results: At baseline, the overweight group had 45% to 73% greater back extensor strength at positions 12° to 72° compared with the control group (P⬍.05). When expressed per unit of BMI, the overweight group had lower lumbar extensor strength compared with the control group at 12° to 48° (P⬍.05). After resistance exercise training, the increase in isometric lumbar extensor strength was greater in the overweight compared with the control group at positions 0° (46 vs 16Nm) and 12° (52 vs 20Nm) of flexion (P⬍.05). The differences in lumbar extensor strength per unit BMI were not present after training. Conclusions: Low back pain (LBP) was associated with excess body mass and decreased lumbar extensor strength. These study results showed that overweight adults have greater baseline lumbar extensor strength when compared with nonobese adults and displayed greater strength gains with lumbar extensor training. However, although their lumbar extensor strength was greater, it may be inadequate to prevent LBP caused by the increased mechanical demands associated with excess body mass. Despite greater absolute force production, the lumbar extensor may not have the endurance to counteract the mechanical strain of excess body mass throughout an entire day. Improvements in lumbar extensor strength, particularly in the obese group, after resistance exercise indicate that this form of rehabilitation may be used to enhance lumbar support and attenuate weight-related complications such as LBP and lordosis. Key Words: Elderly; Lumbar region; Rehabilitation. Poster 95 Efficacy of Acute Inpatient Stroke Rehabilitation in an Asian Geriatric Population. Swee Long Chong, MD (Singapore Gen Hosp, Singapore, Singapore); Yee Sien Ng, MD; Peter A. Lim, MD, e-mail: [email protected]. Disclosure: S. Chong, None; Y. Ng, None; P. Lim, None. Objective: To determine if geriatric patients can benefit from an acute inpatient stroke rehabilitation program. Design: Database review. Setting: Rehabilitation unit in a tertiary teaching hospital. Participants: 140 geriatric (defined as age ⬎64y) and 166 nongeriatric patients admitted consecutively for stroke rehabilitation. Interventions: Not applicable. Main Outcome Measures: FIM instrument, length of stay (LOS), and discharge disposition. Results: Mean ages were 73.3⫾5.8y and 52.0⫾13.3y for the geriatric and nongeriatric groups, respectively. There were no significant differences in gender distribution (P⫽.220) or ethnicity with Chinese being the largest proportion (P⫽.198), followed by Malays and Indians. Geriatric FIM scores were lower than nongeriatric scores in all categories at admission and discharge, but there was no significant difference in quantum of overall FIM gains (19.88⫾12.74 vs 22.14⫾14.64; P⫽.156). Mean rehabilitation LOS was 21.9⫾10.2d in the geriatric group and 22.7⫾13.5d in the nongeriatric group (P⫽.60). 127 (90.7%) of the geriatric patients and 157 (94.6%) of the nongeriatric patients were discharged home (P⫽0192). Only 7 (5 geriatric, 2 nongeriatric) patients were discharged to nursing homes. Although family members remained the main caregivers in both groups, there was greater reliance on hired live-in caregivers in the geriatric group (28.6%, P⬍.001). Conclusions: The benefits of a rehabilitation program have comparable benefits for both geriatric and nongeriatric patients in an Asian setting. Age per se should not be the sole determinant for inpatient rehabilitation. Home discharge rate was not significantly lower in geriatric patients, although there was a significantly higher demand for assistance from hired live-in caregivers. Key Words: Geriatrics; Rehabilitation; Stroke.
Musculoskeletal Poster 96 Persistent Hip Pain After Gunshot Wound: A Case Report. Jay S. Patel, MD (Univ Virginia, Charlottesville, VA); David S. Rubendall, DO, e-mail: [email protected]. Disclosure: J.S. Patel, None; D.S. Rubendall, None. Setting: Community hospital and university-based outpatient clinic. Patient: A 43-yo AfricanAmerican woman with persistent hip pain after gunshot wound. Case Description: The patient suffered from a gunshot wound to her right hip. At admission, no evidence of trauma to bones, major vessels, or nerves was noted. She underwent bullet excision 2d after the injury. 2wk later in clinic, findings included right hip pain, hip flexion weakness, and a healed incision. Examination was otherwise unremarkable. Thereafter, the pain in her right hip persisted and worsened. However, she did not see a physician until 6mo later. At that time, she demonstrated an antalgic gait on the right. Palpation around the incision revealed an area of nodularity. Hip flexion was significantly decreased, and external rotation was also decreased. No neurologic deficits were noted. Pulses were palpable, and there was no evidence of adenopathy, venous insufficiency, or peripheral edema. Assessment/ Results: Plain radiographs revealed heterotopic bone surrounding the proximal right femur. Com-
2004 Academy Annual Assembly Abstracts
research grant from the Ministry of Science & Technology, Republic of Korea; Y. Kim, research grant from the Ministry of Science & Technology, Republic of Korea; P.K. Lee, research grant from the Ministry of Science & Technology, Republic of Korea; N. Kim, research grant from the Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea. Objective: To determine the stability parameters in posturography that can assess more sensitively age-related changes in posture control. Design: Descriptive study with repeated measures. Setting: Complex continuing care facility for geriatric population in Korea. Participants: 39 healthy geriatric people aged 60y and older who were free of neurologic and medical conditions that cause motor weakness, visual disturbance, and vestibular dysfunction. Interventions: Not applicable. Mean Outcome Measures: Subjects were divided into 3 groups by age (aged 60 – 69y, 70 –79y, ⱖ80y). Center of pressure (COP) parameters were obtained as total path distance, integration of total path, and mean frequency of sway in comfortable standing with eyes open and closed in each group. A visual feedback system (VFS) was added to posturography and then subjects were asked to move their COP into the target circle on a CRT monitor with active movement on forceplate. Clinical COP parameters (moving time to get in the circle, total path of deviation, elapsed time in the circle) were obtained with the VFS. Results: There was no difference in COP parameters in static posturography between age groups. Total path of deviation assessed by posturography with the VFS showed a significant difference between age groups (P⬍.05); significant correlations with a clinical balance test (Berg Balance Scale) were also found (correlation coefficient⫽⫺.471, P⫽.002). Conclusions: A posturographic balance assessment system with visual feedback was clinically useful in more sensitive evaluation of age-related change of balance control in healthy geriatric people. The therapeutic use of visual feedback as a tool of balance training may be a valuable subject of further study. Key Words: Feedback; Geriatrics; Posture; Rehabilitation. Poster 90 Modified Arnis de Mano as a Tool to Improve Balance in the Elderly: A Randomized Controlled Trial. Maria Luisa P. Santos, MD (Univ Santo Tomas Hosp, Manila, Philippines); Consuelo G. Suarez, MD; Joven Christopher T. Cerdenia, PTRP; Michael Jorge N. Peralta, PTRP, e-mail: [email protected]. Disclosure: M.P. Santos, None; C.G. Suarez, None; J.T. Cerdenia, None; M.N. Peralta, None. Objective: To determine the effectiveness of the Modified Arnis de Mano, a Filipino form of martial arts adopted as a form of exercise, in improving balance among the elderly. Design: Randomized controlled, single-blinded trial. Setting: A government-run home-for-the-aged community in the Philippines. Participants: Elderly men and women aged 60 to 84y. Interventions: The Modified Arnis de Mano and a standardized strengthening exercise protocol for the lower extremities geared toward improving balance. Main Outcome Measures: Functional performance measures done pre- and postintervention were the Timed Up & Go (TUG) test, Functional Reach Test (FRT), and 10-meter speed test (10MST). Results: 22 participants were randomly grouped into 2: 11 participants (mean age, 72.73⫾8.34y) were assigned in the Arnis group and the other 11 participants (mean age, 70.45⫾6.88y) were placed in the structured exercise group. 9 participants completed the 4-wk strengthening exercise protocols and another 9 completed the 4-wk Arnis protocol. No participants were injured during the program. The overall dropout rate was 39%. Outcome measures showed improvement in the Arnis group on the FRT and a reduction in time on the 10MST and TUG test. Although the strengthening group also showed similar changes on the 3 outcome measures, 10MST times differed significantly between the 2 groups. Conclusions: Exercise programs done regularly improved balance among the elderly. Both the standard strengthening exercise protocol and the Modified Arnis de Mano exercise showed absolute change in clinical measurements but only the latter showed a positive effect in dynamic balance. Key Words: Balance; Elderly; Rehabilitation. Poster 91: Refer to Abstract 53 in the Rehabilitation II Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 92: Refer to Abstract 54 in the Rehabilitation II Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 93 Clinical Balance Test More Sensitive to Age-Related Changes and Correlation With Joint Motion. Juha An, MD (Samsung Med Ctr, Seoul, Republic of Korea); JiHye Hwang, MD, PhD; Young-keun Woo, MSPT; Yun-Hee Kim, MD, PhD; Peter K. Lee, MD, PhD; Nam-Gyun Kim, PhD, e-mail: [email protected]. Disclosure: J. An, None; J. Hwang, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; Y. Woo, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; Y. Kim, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea; P.K. Lee, None; N. Kim, research grant from Technologic Development Program for Intelligent Robotics, Ministry of Science & Technology, Republic of Korea. Objectives: To identify a balance test that can reflect more sensitively changes according to age and to investigate the test’s correlation with flexibility of joint. Design: Descriptive survey with repeated measures. Setting: Complex continuing care facility for a geriatric population in Korea. Participants: 39 healthy geriatric people aged 60y and older who were free of neurologic and medical conditions that cause motor weakness, visual disturbance, and vestibular dysfunction. Intervention: Not applicable. Main Outcome Measures: Subjects were divided into 3 groups by age (aged 60 – 69y, 70 –79y, ⱖ80y) and each group was evaluated with clinical balance tests (Berg Balance Scale [BBS], Functional Reach Test, Tinetti Performance Oriented Mobility Assessment [POMA]). Bilateral lower-extremity range of motion (ROM) was measured with goniometry to quantify the flexibility of whole joints. Results: The BBS was the most sensitive clinical balance test reflecting the changes by age (P⫽.002) and the POMA balance subtest was also more sensitive test than others (P⫽.022). Correlations between clinical balance tests and joint flexibility were found.
Arch Phys Med Rehabil Vol 85, September 2004
The strongest correlation existed between the BBS and bilateral ankle ROM inversion and eversion (correlation coefficient⫽.565, P⫽.000). Conclusions: Among the clinically validated balance tests, the BBS was the most sensitive test at reflecting the decline of balance performance related to aging. A correlation exists between ankle ROM and balance in healthy elderly people. Additional research is needed to determine whether treatment directed at increasing ankle ROM can improve balance. Key Words: Geriatrics; Posture; Range of motion, articular; Rehabilitation. Poster 94 Improvement in Lumbar Extensor Strength in Overweight Elderly Adults After 6 Months of Resistance Training. Kevin R. Vincent, MD, PhD (Univ Virginia, Charlottesville, VA); Heather K. Vincent, PhD; Randy W. Braith, PhD, e-mail: [email protected]. Disclosure: K.R. Vincent, None; H.K. Vincent, None; R.W. Braith, None. Objective: To measure lumbar extensor strength in overweight and nonoverweight (control) elderly adults before and after chronic resistance exercise. Design: Randomized controlled trial. Setting: Spine care center. Participants: Elderly adults 60 to 72y (N⫽62), grouped based on body mass index (BMI): control group (mean, 22.5kg/m2) and overweight group (mean, 29.2kg/m2). Interventions: 6mo of lumbar extensor resistance exercise using MedX equipment. Main Outcome Measures: Body fat and fat free mass, and isometric lumbar extensor strength in 12° increments in the 0° to 72° range of back flexion. Results: At baseline, the overweight group had 45% to 73% greater back extensor strength at positions 12° to 72° compared with the control group (P⬍.05). When expressed per unit of BMI, the overweight group had lower lumbar extensor strength compared with the control group at 12° to 48° (P⬍.05). After resistance exercise training, the increase in isometric lumbar extensor strength was greater in the overweight compared with the control group at positions 0° (46 vs 16Nm) and 12° (52 vs 20Nm) of flexion (P⬍.05). The differences in lumbar extensor strength per unit BMI were not present after training. Conclusions: Low back pain (LBP) was associated with excess body mass and decreased lumbar extensor strength. These study results showed that overweight adults have greater baseline lumbar extensor strength when compared with nonobese adults and displayed greater strength gains with lumbar extensor training. However, although their lumbar extensor strength was greater, it may be inadequate to prevent LBP caused by the increased mechanical demands associated with excess body mass. Despite greater absolute force production, the lumbar extensor may not have the endurance to counteract the mechanical strain of excess body mass throughout an entire day. Improvements in lumbar extensor strength, particularly in the obese group, after resistance exercise indicate that this form of rehabilitation may be used to enhance lumbar support and attenuate weight-related complications such as LBP and lordosis. Key Words: Elderly; Lumbar region; Rehabilitation. Poster 95 Efficacy of Acute Inpatient Stroke Rehabilitation in an Asian Geriatric Population. Swee Long Chong, MD (Singapore Gen Hosp, Singapore, Singapore); Yee Sien Ng, MD; Peter A. Lim, MD, e-mail: [email protected]. Disclosure: S. Chong, None; Y. Ng, None; P. Lim, None. Objective: To determine if geriatric patients can benefit from an acute inpatient stroke rehabilitation program. Design: Database review. Setting: Rehabilitation unit in a tertiary teaching hospital. Participants: 140 geriatric (defined as age ⬎64y) and 166 nongeriatric patients admitted consecutively for stroke rehabilitation. Interventions: Not applicable. Main Outcome Measures: FIM instrument, length of stay (LOS), and discharge disposition. Results: Mean ages were 73.3⫾5.8y and 52.0⫾13.3y for the geriatric and nongeriatric groups, respectively. There were no significant differences in gender distribution (P⫽.220) or ethnicity with Chinese being the largest proportion (P⫽.198), followed by Malays and Indians. Geriatric FIM scores were lower than nongeriatric scores in all categories at admission and discharge, but there was no significant difference in quantum of overall FIM gains (19.88⫾12.74 vs 22.14⫾14.64; P⫽.156). Mean rehabilitation LOS was 21.9⫾10.2d in the geriatric group and 22.7⫾13.5d in the nongeriatric group (P⫽.60). 127 (90.7%) of the geriatric patients and 157 (94.6%) of the nongeriatric patients were discharged home (P⫽0192). Only 7 (5 geriatric, 2 nongeriatric) patients were discharged to nursing homes. Although family members remained the main caregivers in both groups, there was greater reliance on hired live-in caregivers in the geriatric group (28.6%, P⬍.001). Conclusions: The benefits of a rehabilitation program have comparable benefits for both geriatric and nongeriatric patients in an Asian setting. Age per se should not be the sole determinant for inpatient rehabilitation. Home discharge rate was not significantly lower in geriatric patients, although there was a significantly higher demand for assistance from hired live-in caregivers. Key Words: Geriatrics; Rehabilitation; Stroke.
Musculoskeletal Poster 96 Persistent Hip Pain After Gunshot Wound: A Case Report. Jay S. Patel, MD (Univ Virginia, Charlottesville, VA); David S. Rubendall, DO, e-mail: [email protected]. Disclosure: J.S. Patel, None; D.S. Rubendall, None. Setting: Community hospital and university-based outpatient clinic. Patient: A 43-yo AfricanAmerican woman with persistent hip pain after gunshot wound. Case Description: The patient suffered from a gunshot wound to her right hip. At admission, no evidence of trauma to bones, major vessels, or nerves was noted. She underwent bullet excision 2d after the injury. 2wk later in clinic, findings included right hip pain, hip flexion weakness, and a healed incision. Examination was otherwise unremarkable. Thereafter, the pain in her right hip persisted and worsened. However, she did not see a physician until 6mo later. At that time, she demonstrated an antalgic gait on the right. Palpation around the incision revealed an area of nodularity. Hip flexion was significantly decreased, and external rotation was also decreased. No neurologic deficits were noted. Pulses were palpable, and there was no evidence of adenopathy, venous insufficiency, or peripheral edema. Assessment/ Results: Plain radiographs revealed heterotopic bone surrounding the proximal right femur. Com-