Concussion and medicine
Dominic Malcolm in The Concussion Crisis in Sport, 2019
A second founding principle has been for these statements to provide guidance on the signs and symptoms of ‘acute concussion’. The earliest statement identified a range of cognitive features, typical symptoms, and physical signs (see Table 4.1). However, by 2009 these were expanded to five categories: symptoms (somatic and emotional); physical signs; behavioural changes; cognitive impairment; and sleep disturbance. Most recently (2017) a sixth category – balance impairment – was included, although essentially this is a recategorization rather than expansion of signs and symptoms. Evidence of any one of these can be taken to be indicative of the possibility of concussion. Implicitly, therefore, there is relatively little emphasis on the chronic signs and symptoms of concussion.
Biomechanical studies for understanding falls in older adults
Youlian Hong, Roger Bartlett in Routledge Handbook of Biomechanics and Human Movement Science, 2008
Perturbations of larger magnitudes will require a step to recover balance. Successful balance recovery is dependent on step length, step direction, step execution time, and leg strength. Older adults, particularly those with balance impairment, step more frequently in response to a given perturbation compared to young and often require multiple steps before balance is recovered. In taking multiple steps, older adults are more likely to contact the contralateral limb, further increasing the risk of a fall (Maki et al., 2000). Older adults step sooner, yet fail to properly arrest their momentum, partly due to the inadequate length of the step and a more laterally directed foot placement. In general, it seems that older adults and particularly those with balance impairment do not properly use the sensory information to determine when and how a step should be taken following an unexpected perturbation. As concluded by Mille et al. (2003), it may be that waiting to receive the necessary information for an appropriate step is a luxury afforded only by the young and that early stepping in older people is a necessary adaptation to diminished sensorimotor acuity.
Balance impairment
Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein in Pulmonary Rehabilitation, 2020
The mechanisms underlying the balance deficits in COPD are complex and multifactorial and remain an active area of research. Severity of COPD has not been shown to be associated with balance impairment (10). There are, however, some data to suggest a role for oxygen desaturation and/or hypoxaemia as a possible mechanism. Mild hypoxaemia in COPD has been shown to be associated with balance impairments and falls (47) and use of supplemental oxygen has been shown to distinguish fallers from non-fallers with COPD (1,11). These data notwithstanding, the clinical factors associated with balance with by far the most evidence to date are muscle strength, physical activity and exercise capacity. In a recent meta-analysis, there was evidence for a weak-to-moderate association between balance impairment and reduced quadriceps muscle strength in COPD (10). Physical activity has been shown to be similarly correlated to balance impairment, with both step count and self-reported physical activity showing moderate-to-strong associations with static and dynamic balance scores (2,10,48). Poorer performance on the 6-minute walk test (47–49) and fatigue after exercise (8,47) are two other factors that show consistent evidence of an association with balance impairment in COPD. Finally, although additional factors such as inspiratory muscle strength (6), dyspnoea (46), anxiety and depression (44) and inflammatory markers (44,45) have been implicated, further study is required to confirm these results.
Association between trunk core muscle thickness and functional ability in subacute hemiplegic stroke patients: an exploratory cross-sectional study
Published in Topics in Stroke Rehabilitation, 2022
Jee Hyun Suh, Eun Chae Lee, Joo Sup Kim, Seo Yeon Yoon
Stroke is the second leading cause of death and the third most common cause of lost disability-adjusted life years worldwide.1 After stroke, impairments of motor control and strength, spasticity, language disorder, dysphagia, and cognitive impairment may appear. Furthermore, impairment of trunk control and balance function could occur due to paralysis of the limb and trunk muscles and proprioception impairment after stroke.2,3 Balance impairment is a major health problem in patients after stroke. Balance impairment increases the risk of falls in stroke patients.4 The fall incidence rates in stroke patients are 1.3–6.5 per year, much higher than in the general population of older people.5,6 Falls could result in serious sequelae, such as fractures, and fear of falling, which in turn is related to balance and gait deficits and reduced physical activity and deconditioning.6
Stall the Fall: Training Non-Clinical Caregivers to Prevent Falls in Community-Dwelling Older Adults
Published in Journal of Community Health Nursing, 2020
Erin E. Montgomery, Yvonne Harris Smith
Care was taken to explain to non-clinical caregivers the definition of polypharmacy, which included over-the-counter medications. Medications such as sedative and anti-depressants were explicitly mentioned for causing balance impairment. Orthostatic hypotension is a known factor contributing to fall risk, as the associated disequilibrium from cerebral hypoperfusion due to postural changes can exacerbate fall risk (Finucane & Kenny, 2017). Orthostatic hypotension was defined and described in layman’s terms as “when your blood pressure goes down when you change positions-like from lying down to sitting up” and “it can cause that lightheaded feeling you get when you stand up too fast.” Caregivers were taught to educate older adults on changing positions slowly. Additionally, caregivers were educated on home hazards causing falls such as throw rugs, clutter, broken or uneven steps, lack of grab bars, and poor lighting.
Augmented visual feedback-aided interventions for motor rehabilitation in Parkinson’s disease: a systematic review
Published in Disability and Rehabilitation, 2019
Elaine Kearney, Sanjana Shellikeri, Rosemary Martino, Yana Yunusova
A number of participant factors may have played a role in the treatment outcomes but were often not accounted for in the included studies. First, the RCTs rarely sex-matched experimental and control groups, or statistically controlled for sex in the analyzes, even though previous studies suggested sex differences in the clinical presentation of PD [69–71], which may have affected participants’ performance. Another consideration is that an increased familiarity with technology before treatment may have benefitted participants, yet only three studies considered this factor by excluding participants who had experience playing the Wii. Further, while intact vision is an important pre-requisite of using visual feedback systems, only half of the studies specified normal or corrected-to-normal vision as an inclusion criterion. Finally, when assessing balance parameters in an older population, it is pertinent to remember that hearing loss occurs in 45% of adults over 60 years of age and is associated with an increased risk of balance impairment and falls [72]. The balance impairment, therefore, may be confounded by a comorbid hearing impairment. Three studies excluded participants with auditory impairment, but did not document how the participants were screened (e.g., by patient report or audiometric testing).
Related Knowledge Centers
- Atrophy
- Cognition
- Inner Ear
- Lightheadedness
- Proprioception
- Vestibular System
- Visual System
- Hippocampus
- Sense of Balance
- Magnetic Resonance Imaging