- Email: [email protected]
Posturographic detection index of fear of falling in elderly – A limits of stability study – Pilot study
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Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
equipped with a balloon probe. Tongue volume was evaluated with T1-weighted MR imaging. Tongue lean muscle mass was evaluated with Dixon MRI. The Pearson analysis was used to calculate coefficients between tongue pressure and tongue volume/lean tongue muscle mass. Results The mean tongue pressure, tongue volume and lean tongue muscle mass were 29.9 ± 8.1 kPa, 66.8 ± 12.3 cm3 and 56.2 ± 10.4 cm3 . Tongue pressure was significantly correlated with tongue volume and lean tongue muscle mass (r = 0.60, P = 0.049 and r = 0.64, P = 0.035). Conclusion To our knowledge, this is the first study to investigate tongue muscle mass, lean tongue muscle mass and tongue pressure using MRI images. Tongue muscle mass and lean tongue muscle mass was significantly associated with tongue pressure. Compared with previous studies for healthy young adults (Utanohara, 2008; Fabrice, 2010), tongue pressure was decrease in spite of tongue volume was similar. Bassler (1987) suggested that the tongue volume after muscular atrophy is compensated by metaplasia of fatty tissue. We speculated that adipose might be an important factor for reducing tongue pressure and dysphagia. Keywords Sarcopenia of tongue; MRI Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.780 ISPR8-2154
The relationship between sleep duration and falls, muscle mass and mortality: A cohort study in Chinese, elderly population L. Fu 1,2,∗ , Q. Guo 1,2 TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Ti, Department of Rehabilitation Medicine, Tianjin, China 2 Tianjin Medical University, Department of Rehabilitation Medicine, Tianjin, China ∗ Corresponding author. E-mail address: [email protected] (L. Fu)
1
Introduction/Background Epidemiological studies report that more than half of people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the effects of sleep duration on muscle mass and function within a Chinese, community-dwelling elderly population. Material and method Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walk speed. We divided sleep duration into the following four groups: < 7 h, 7–8 h, > 8–9 h, > 9 h. Results A total of 902 participants completed the 3-year followup. We observed a U-shaped relationship between sleep duration and fall risk. Compared to the 7–8 h group, the fall risk within the < 7 h group was 3.58 (1.99, 5.24) times higher, and the fall risk within the > 9 h group was 2.23 (1.20, 3.13) times higher. After adjustment, muscle mass declined by −6.82% (−11.27%, −3.83%) in the < 7 h group. The > 9 h group exhibited a mortality risk that was 3.46 (1.37, 6.23) times higher the normal sleep group (7–8 h). Conclusion In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration have negative effect on muscle mass decline, and long sleepers have higher mortality within a Chinese, community-dwelling, elderly population. Keywords Muscle mass; Muscle function; Sleep Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.781
A6.04 Geriatrics – Risk of falls in the elderly ISPR8-1126
Can side predict the fall after discharge for the patients after surgery for proximal femoral fracture?
I. Kondo ∗ , K. Ito , E. Takano , N. Morioka , K. Sato , Y. Mizuno , N. Itoh National Center for Geriatrics and Gerontology, Rehabilitation medicine, Obu, Japan ∗ Corresponding author. E-mail address: [email protected] (I. Kondo) Introduction/Background Standing balance test for imbalance and disequilibrium (SIDE) was developed as a predictive measure for the fall prevention of the patients in hospital. Excellent predictive validity of SIDE was defined with the patients who admitted to reminiscence rehabilitation ward. On the other hand, the prevention of fall after discharge for the patients with fracture is essential to avoid recurrence of fracture. In this study, we use SIDE to predict fall event after the discharge for the patients after the surgery for proximal femoral fracture. Material and method Participants of this study were the patients who discharged and returned to home from reminiscence rehabilitation ward after the surgery for proximal femoral fracture during the period from April, 2014 to September 2016. They were 10 male and 35 female patients and their average age was 78.3 (SD: 8.9). We sent questionnaire about the fall event and recurrence of fracture. Multiple logistic regression analysis was performed with age, duration of admission, the result of Mini Mental State Examination, FIM, SIDE and comfortable gait velocity at discharge as the independent factor according to the fall event occurrence. Results The fall event was occurred for seven patients (15.6%). Two of them (4.4%) experienced recurrence of fracture at femoral neck and vertebral body. SIDE (P = 0.049) and comfortable gait velocity (P = 0.027) had the significant effect on fall event and their odds ratio and 90% confidential interval were 0.32 (0.11 − 0.99) and 1119.47 (2.18 − 574866.87), respectively. Conclusion In addition to comfortable gait velocity, SIDE was the significant factor to predict the fall event for the one year after discharge. Cutting point of comfortable gait velocity would be warranted to use it as predictive measure. Discreet selection of walking aids and modification of home environment are necessary for the patients with high fall risk detected by SIDE. Keywords Fall prevention; Predictive measure; SIDE Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.782 ISPR8-1717
Posturographic detection index of fear of falling in elderly – A limits of stability study – Pilot study
J. Michalska ∗ , A. Kamieniarz , M. Pawłowski , W. Marszałek , M. Sowa , G. Juras , K. Słomka The J. Kukuczka Academy of Physical Education, Human Motor Behavior, Katowice, Poland ∗ Corresponding author. E-mail address: [email protected] (J. Michalska) Introduction/Background Elderly people often use a smaller percentage of their base of support during maximal weight shifting, which leads to balance instability, that can lead to frequent falls and serious injuries. Even the most active people cannot reach theoretical limits of stability, therefore the need to investigate the
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
functional BOS i.e. the real stability boundary and the factors that can affect this ability. Aim The new index of anterior stability limit (IASL) explaining the functional base of support (BOS) in sagittal plane (while participants voluntarily displace their COP in the front direction) that can assess fear and risk of falling. Material and method Twenty five students of the University of the Third Age voluntarily participated in the study. The force plate measurements allowed to investigate functional limit of stability in addition to clinical tests (BBS, Duncan, TUG). The FES-I questionnaire was used to evaluate fear of falling. Additionally, the anthropometric parameters of the foot were measured. The IALS is proportion between range of COP displacement during maximum forward lean and distance from the ankle joint to the head of first metatarsal bone. The Pearson’s linear correlation between FES-I, BBS, Duncan test, TUG test and IASL was conducted. Results High negative correlation was observed between IASL and main scores of FES-I (r = −0.64, P < 0.05) and also between IASL and TUG test (r = −0.76, P < 0.05). Positive correlation was noticed between IASL and Duncan test (r = 0.66, P < 0.05), as well as BBS (r = 0.6, P < 0.05). Conclusion The use of IASL indicate that elderly people used on average 70% of their functional BOS. Use of smaller functional BOS determines increase the fear of falling. Lower values of IASL correlate with clinical test, which assess risk of falling. IASL has potential as screening tools for fear and risk of falls. Keywords Postural control; Fear and risk of falling; Index of anterior stability limit Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.783 ISPR8-2228
The added value of combined functional tests on predicting future falls in Chinese community-dwelling elderly L. Wang 1,∗ , Q. Guo 2 TEDA International Cardiovascular Hospital, Rehabilitation Medicine, Tianjin, China 2 Tianjin Medical University, Department of Rehabilitation Medicine, Tianjin, China ∗ Corresponding author. E-mail address: [email protected] (L. Wang)
1
Introduction/Background Falls are one of the major causes of mortality and morbidity in older adults, which needs a practical fall risk assessment tool to predict future falls. Recent researches suggested various functional tests produce more power than a single test in many aspects. So we aimed to determine whether combined functional tests could increase predictive ability of future falls, especially recurrent-falls, which may result in stronger adverse impacts. Material and method This was a prospective cohort study (N = 875) among residents of Hangu area of Tianjin, China, who were ≥ 60 years old. Falls were ascertained after one year. Meanwhile, sociodemographic information, medical history and physical performance data were also collected. The Timed Up and Go Test (TUGT), walking speed (WS) and grip strength (GS) are more recommended as tests targeting on balance, mobility and muscle strength by many studies. Therefore, we selected these three tests to clarity our hypothesis. Results The mean age was 67.1 years; 58.6% were women. According to ROC area, the cutoff point of TUGT, GS and WS of falls is 10.31 s, 0.3742 kg/kg and 0.9467 m/s, respectively. Therefore we defined good performance on the tests as “ + ”, and poor performance as “ − ” with the cutoff point. Towards any-falls, combination of “TUGT−, GS−, WS + ” was most correlated with its
e335
occurrence, with odds ratio (OR) 2.197, 95% CI: 1.204–4.009. Meanwhile, combined “TUGT−, WS + ” (OR: 2.103, 1.367–3.235) and combined “TUGT−, GS+, WS − ” (OR2.071, 1.124-3.814) were also more related to any-falls than a single test, like TUGT− (OR: 1.676, 1.170–2.401). However, compared with a single test (TUGT−, OR: 2.192, 1.225–3.922), only the combination of “TUGT−, GS−,WS + ” (OR: 2.536, 1.025–6.272) was a more stronger predictor. Conclusion A simple tool using TUGT, GS and WS has better predictive power on future falls. Based on this result, individuals who show poor ability in TUGT and WS but have good grip strength ought to be more concerned about the high-risk of future falls, especially the likelihood of recurrent-falls. Keywords Combined functional tests; Falls; Elderly Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.784 ISPR8-0195
Factors associated with the risk of fall in stroke inpatients T. Enishi 1,∗ , N. Yamasaki 1 , A. Matsumoto 1 , T. Higuchi 2 , M. Takeuchi 2 , M. Kashima 2 , S. Yoshioka 2 , M. Nakamura 2 , S. Nakano 2 1 Tokushima Municipal Hospital, Rehabilitation Medicine, Tokushima, Japan 2 Tokushima Municipal Hospital, Orthopedics, Tokushima, Japan ∗ Corresponding author. E-mail address: [email protected] (T. Enishi) Introduction/Background Falls are popular and major problem for stroke patient during their hospital stay. The aim of this study is to reveal the factors associated with the risk of fall in stroke inpatients. Material and method Retrospective study carried out with stroke hospitalized patients. Thirty-four stroke patients who fell and 34 stroke patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with fall. The control subjects were matched for age, height, body weight, body mass index (BMI), and primary diagnosis. Potential variables related to fall risk factors were collected from medical records. A conditional logistic regression was performed to calculate odds ratios using SPSS. Clinical data were collected from January to December 2016. “An unexpected displacement of the body to a lower level than the initial position without loss of consciousness” was regarded as fall. Results Nutrition status, evaluated with modified CONUT score at admission, was significantly associated with fall risk (odds ratio = 3.11, 95% CI: 1.18–9.94). There were no statistically significant differences in the other candidate factors (e.g. sarcopenia, activities of daily living, and rehabilitation intervention) between the two groups. Conclusion Our findings demonstrated that nutrition status was associated with fall risk in stroke hospitalized patients. Further studies are needed to reveal that nutritional intervention can contribute to falls prevention in stroke patients. Keywords Fall prevention; Nutrition; Stroke Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.785
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
equipped with a balloon probe. Tongue volume was evaluated with T1-weighted MR imaging. Tongue lean muscle mass was evaluated with Dixon MRI. The Pearson analysis was used to calculate coefficients between tongue pressure and tongue volume/lean tongue muscle mass. Results The mean tongue pressure, tongue volume and lean tongue muscle mass were 29.9 ± 8.1 kPa, 66.8 ± 12.3 cm3 and 56.2 ± 10.4 cm3 . Tongue pressure was significantly correlated with tongue volume and lean tongue muscle mass (r = 0.60, P = 0.049 and r = 0.64, P = 0.035). Conclusion To our knowledge, this is the first study to investigate tongue muscle mass, lean tongue muscle mass and tongue pressure using MRI images. Tongue muscle mass and lean tongue muscle mass was significantly associated with tongue pressure. Compared with previous studies for healthy young adults (Utanohara, 2008; Fabrice, 2010), tongue pressure was decrease in spite of tongue volume was similar. Bassler (1987) suggested that the tongue volume after muscular atrophy is compensated by metaplasia of fatty tissue. We speculated that adipose might be an important factor for reducing tongue pressure and dysphagia. Keywords Sarcopenia of tongue; MRI Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.780 ISPR8-2154
The relationship between sleep duration and falls, muscle mass and mortality: A cohort study in Chinese, elderly population L. Fu 1,2,∗ , Q. Guo 1,2 TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Ti, Department of Rehabilitation Medicine, Tianjin, China 2 Tianjin Medical University, Department of Rehabilitation Medicine, Tianjin, China ∗ Corresponding author. E-mail address: [email protected] (L. Fu)
1
Introduction/Background Epidemiological studies report that more than half of people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the effects of sleep duration on muscle mass and function within a Chinese, community-dwelling elderly population. Material and method Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walk speed. We divided sleep duration into the following four groups: < 7 h, 7–8 h, > 8–9 h, > 9 h. Results A total of 902 participants completed the 3-year followup. We observed a U-shaped relationship between sleep duration and fall risk. Compared to the 7–8 h group, the fall risk within the < 7 h group was 3.58 (1.99, 5.24) times higher, and the fall risk within the > 9 h group was 2.23 (1.20, 3.13) times higher. After adjustment, muscle mass declined by −6.82% (−11.27%, −3.83%) in the < 7 h group. The > 9 h group exhibited a mortality risk that was 3.46 (1.37, 6.23) times higher the normal sleep group (7–8 h). Conclusion In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration have negative effect on muscle mass decline, and long sleepers have higher mortality within a Chinese, community-dwelling, elderly population. Keywords Muscle mass; Muscle function; Sleep Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.781
A6.04 Geriatrics – Risk of falls in the elderly ISPR8-1126
Can side predict the fall after discharge for the patients after surgery for proximal femoral fracture?
I. Kondo ∗ , K. Ito , E. Takano , N. Morioka , K. Sato , Y. Mizuno , N. Itoh National Center for Geriatrics and Gerontology, Rehabilitation medicine, Obu, Japan ∗ Corresponding author. E-mail address: [email protected] (I. Kondo) Introduction/Background Standing balance test for imbalance and disequilibrium (SIDE) was developed as a predictive measure for the fall prevention of the patients in hospital. Excellent predictive validity of SIDE was defined with the patients who admitted to reminiscence rehabilitation ward. On the other hand, the prevention of fall after discharge for the patients with fracture is essential to avoid recurrence of fracture. In this study, we use SIDE to predict fall event after the discharge for the patients after the surgery for proximal femoral fracture. Material and method Participants of this study were the patients who discharged and returned to home from reminiscence rehabilitation ward after the surgery for proximal femoral fracture during the period from April, 2014 to September 2016. They were 10 male and 35 female patients and their average age was 78.3 (SD: 8.9). We sent questionnaire about the fall event and recurrence of fracture. Multiple logistic regression analysis was performed with age, duration of admission, the result of Mini Mental State Examination, FIM, SIDE and comfortable gait velocity at discharge as the independent factor according to the fall event occurrence. Results The fall event was occurred for seven patients (15.6%). Two of them (4.4%) experienced recurrence of fracture at femoral neck and vertebral body. SIDE (P = 0.049) and comfortable gait velocity (P = 0.027) had the significant effect on fall event and their odds ratio and 90% confidential interval were 0.32 (0.11 − 0.99) and 1119.47 (2.18 − 574866.87), respectively. Conclusion In addition to comfortable gait velocity, SIDE was the significant factor to predict the fall event for the one year after discharge. Cutting point of comfortable gait velocity would be warranted to use it as predictive measure. Discreet selection of walking aids and modification of home environment are necessary for the patients with high fall risk detected by SIDE. Keywords Fall prevention; Predictive measure; SIDE Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.782 ISPR8-1717
Posturographic detection index of fear of falling in elderly – A limits of stability study – Pilot study
J. Michalska ∗ , A. Kamieniarz , M. Pawłowski , W. Marszałek , M. Sowa , G. Juras , K. Słomka The J. Kukuczka Academy of Physical Education, Human Motor Behavior, Katowice, Poland ∗ Corresponding author. E-mail address: [email protected] (J. Michalska) Introduction/Background Elderly people often use a smaller percentage of their base of support during maximal weight shifting, which leads to balance instability, that can lead to frequent falls and serious injuries. Even the most active people cannot reach theoretical limits of stability, therefore the need to investigate the
Y.G. Yi et al. / Annals of Physical and Rehabilitation Medicine 61S (2018) e309–e433
functional BOS i.e. the real stability boundary and the factors that can affect this ability. Aim The new index of anterior stability limit (IASL) explaining the functional base of support (BOS) in sagittal plane (while participants voluntarily displace their COP in the front direction) that can assess fear and risk of falling. Material and method Twenty five students of the University of the Third Age voluntarily participated in the study. The force plate measurements allowed to investigate functional limit of stability in addition to clinical tests (BBS, Duncan, TUG). The FES-I questionnaire was used to evaluate fear of falling. Additionally, the anthropometric parameters of the foot were measured. The IALS is proportion between range of COP displacement during maximum forward lean and distance from the ankle joint to the head of first metatarsal bone. The Pearson’s linear correlation between FES-I, BBS, Duncan test, TUG test and IASL was conducted. Results High negative correlation was observed between IASL and main scores of FES-I (r = −0.64, P < 0.05) and also between IASL and TUG test (r = −0.76, P < 0.05). Positive correlation was noticed between IASL and Duncan test (r = 0.66, P < 0.05), as well as BBS (r = 0.6, P < 0.05). Conclusion The use of IASL indicate that elderly people used on average 70% of their functional BOS. Use of smaller functional BOS determines increase the fear of falling. Lower values of IASL correlate with clinical test, which assess risk of falling. IASL has potential as screening tools for fear and risk of falls. Keywords Postural control; Fear and risk of falling; Index of anterior stability limit Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.783 ISPR8-2228
The added value of combined functional tests on predicting future falls in Chinese community-dwelling elderly L. Wang 1,∗ , Q. Guo 2 TEDA International Cardiovascular Hospital, Rehabilitation Medicine, Tianjin, China 2 Tianjin Medical University, Department of Rehabilitation Medicine, Tianjin, China ∗ Corresponding author. E-mail address: [email protected] (L. Wang)
1
Introduction/Background Falls are one of the major causes of mortality and morbidity in older adults, which needs a practical fall risk assessment tool to predict future falls. Recent researches suggested various functional tests produce more power than a single test in many aspects. So we aimed to determine whether combined functional tests could increase predictive ability of future falls, especially recurrent-falls, which may result in stronger adverse impacts. Material and method This was a prospective cohort study (N = 875) among residents of Hangu area of Tianjin, China, who were ≥ 60 years old. Falls were ascertained after one year. Meanwhile, sociodemographic information, medical history and physical performance data were also collected. The Timed Up and Go Test (TUGT), walking speed (WS) and grip strength (GS) are more recommended as tests targeting on balance, mobility and muscle strength by many studies. Therefore, we selected these three tests to clarity our hypothesis. Results The mean age was 67.1 years; 58.6% were women. According to ROC area, the cutoff point of TUGT, GS and WS of falls is 10.31 s, 0.3742 kg/kg and 0.9467 m/s, respectively. Therefore we defined good performance on the tests as “ + ”, and poor performance as “ − ” with the cutoff point. Towards any-falls, combination of “TUGT−, GS−, WS + ” was most correlated with its
e335
occurrence, with odds ratio (OR) 2.197, 95% CI: 1.204–4.009. Meanwhile, combined “TUGT−, WS + ” (OR: 2.103, 1.367–3.235) and combined “TUGT−, GS+, WS − ” (OR2.071, 1.124-3.814) were also more related to any-falls than a single test, like TUGT− (OR: 1.676, 1.170–2.401). However, compared with a single test (TUGT−, OR: 2.192, 1.225–3.922), only the combination of “TUGT−, GS−,WS + ” (OR: 2.536, 1.025–6.272) was a more stronger predictor. Conclusion A simple tool using TUGT, GS and WS has better predictive power on future falls. Based on this result, individuals who show poor ability in TUGT and WS but have good grip strength ought to be more concerned about the high-risk of future falls, especially the likelihood of recurrent-falls. Keywords Combined functional tests; Falls; Elderly Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.784 ISPR8-0195
Factors associated with the risk of fall in stroke inpatients T. Enishi 1,∗ , N. Yamasaki 1 , A. Matsumoto 1 , T. Higuchi 2 , M. Takeuchi 2 , M. Kashima 2 , S. Yoshioka 2 , M. Nakamura 2 , S. Nakano 2 1 Tokushima Municipal Hospital, Rehabilitation Medicine, Tokushima, Japan 2 Tokushima Municipal Hospital, Orthopedics, Tokushima, Japan ∗ Corresponding author. E-mail address: [email protected] (T. Enishi) Introduction/Background Falls are popular and major problem for stroke patient during their hospital stay. The aim of this study is to reveal the factors associated with the risk of fall in stroke inpatients. Material and method Retrospective study carried out with stroke hospitalized patients. Thirty-four stroke patients who fell and 34 stroke patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with fall. The control subjects were matched for age, height, body weight, body mass index (BMI), and primary diagnosis. Potential variables related to fall risk factors were collected from medical records. A conditional logistic regression was performed to calculate odds ratios using SPSS. Clinical data were collected from January to December 2016. “An unexpected displacement of the body to a lower level than the initial position without loss of consciousness” was regarded as fall. Results Nutrition status, evaluated with modified CONUT score at admission, was significantly associated with fall risk (odds ratio = 3.11, 95% CI: 1.18–9.94). There were no statistically significant differences in the other candidate factors (e.g. sarcopenia, activities of daily living, and rehabilitation intervention) between the two groups. Conclusion Our findings demonstrated that nutrition status was associated with fall risk in stroke hospitalized patients. Further studies are needed to reveal that nutritional intervention can contribute to falls prevention in stroke patients. Keywords Fall prevention; Nutrition; Stroke Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.785