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To evaluate the association between balance function and asymmetry of knee extension strength in an elderly Korean population.
The strength of the knee extensors in each leg was measured in 306 community-dwelling elderly subjects (age, 76.70±4.85 years) and 25 young healthy subjects (age, 34.23±8.93 years). Based on the difference in strength of both legs, the elderly subjects were divided into symmetric (n=128) and asymmetric (n=178) strength groups using an asymmetry cutoff 20%. We determined the postural control ability of the subjects using InBody posturography, Berg Balance Scale (BBS), Timed Up and Go test (TUG) and Short Physical Performance Battery (SPPB). The sway index (SI) of the subjects in four positions was assessed using posturography.
The group with asymmetric strength presented a significantly higher SI than the group with symmetric strength, in the normal position with eyes open and eyes open on pillows. In the normal position with the eyes closed and in postures with the eyes closed on pillows, the statistical analysis revealed no significant differences between the two groups. The three tests for physical performance (BBS, TUG, and SPPB) show no statistically significant difference between the two groups.
The asymmetric strength group showed a significantly lower balance than the group with symmetric strength based on several posturographic parameters. Ambulatory elderly individuals with asymmetry in knee extension strength, showed deficits in balance control even in normal clinical tests.
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To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population.
A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests.
SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers.
This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.
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Aging has become an important topic for scientific research because life expectancy and the number of men and women in older age groups have increased dramatically in the last century. This is true in most countries of the world including the Republic of Korea and the United States. From a rehabilitation perspective, the most important associated issue is a progressive decline in functional capacity and independence. Sarcopenia is partly responsible for this decline. Many changes underlying the loss of muscle mass and force-generating capacity of skeletal muscle can be understood at the cellular and molecular levels. Muscle size and architecture are both altered with advanced adult age. Further, changes in myofibers include impairments in several physiological domains including muscle fiber activation, excitation-contraction coupling, actin-myosin cross-bridge interaction, energy production, and repair and regeneration. A thorough understanding of these alterations can lead to the design of improved preventative and rehabilitative interventions, such as personalized exercise training programs.
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To investigate the effect of gastrocnemius muscle fatigue on postural control ability in elderly people.
Twenty-four healthy elderly people participated in this study. The postural control ability of single leg standing was evaluated with Health Improvement & Management System (HIMS) posturography before and after fatiguing exercises. After evaluating initial postural control ability, the maximal voluntary contraction (MVC) of ankle plantarflexion was assessed using a surface electromyogram from the medial belly of the gastrocnemius muscle. After a 5-minute resting period, subjects began submaximal isometric ankle plantarflexion (40% MVC) until 40% of MVC was dropped below 95% for 5 seconds, or subject couldn't continue working out due to muscle fatigue. And postural control ability was assessed after fatiguing exercise. The mean deviation of center of pressure (COP), length of COP movement, occupied area of COP were measured, and analyzed by paired t-test.
Mediolateral deviation, length of COP movement, and area of COP occupied were increased after fatiguing exercise of the gastrocnemius muscle. Anteroposterior deviation and length of COP movement were also increased, but had low statistical significance.
These findings suggest that the gastrocnemius muscle fatigue affects mediolateral stability and accuracy during single leg standing in elderly people. Therefore muscle endurance training is necessary to prevent falls in elderly people.
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To assess the effect of lower limb strength on falls and balance in community-dwelling elderly persons by a health status questionnaire, evaluation of lower limb strength and balance.
A total of 86 subjects (age 69.8±5.3) were categorized into one of two groups, "Fallers" and "Non-fallers". Thirty one participants who had reported the experience of having fallen unexpectedly at least once in the past year were assigned into the group "Fallers", and the remaining 55 subjects having no fall history in the past year, "Non-fallers". A self-assessment questionnaire was taken. Lower limb strength was measured by a "Chair stand test". Balance was measured by the stability index of the fall risk test protocol of Balance System SD® (Biodex, New York, USA). The differences between the two groups were compared and the correlation between lower limb strength and balance were analyzed.
The questionnaire demonstrated no significant differences between two groups. The "Chair stand test" showed a significantly less for the "Fallers" (p<0.05). The stability index was significantly greater in the "Fallers" group (p<0.05). There was a moderate negative correlation between the "Chair stand test" and the "Stability index" (R=-0.576, p<0.01).
This study suggests that the "Chair stand test" is a useful screening process for lower limb strength which correlates to risk for falls and balance in the elderly.
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Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study
To assess the effect of dominant and non-dominant vision in controlling posture in quiet stance.
Twenty-five healthy elderly subjects aged over 60 years old and twenty-five young subjects aged under 30 years old were assessed by computerized dynamic posturography. Postural stability was measured in two conditions; dominant eye open and non-dominant eye open. We used the sensory organization test (SOT) for evaluating sensory impairment. A SOT assessed the subject's ability to use and integrate somatosensory input, vision, and vestibular cues effectively to maintain balance. The SOT was conducted 3 times, and the average value of the 3 trials was used for data analysis. Equilibrium scores reflected the subject's anteroposterior sway. The highest possible score was 100, which indicated that the subject did not sway at all, and a score of 0 indicated a fall from the footplate. Determination of ocular dominance was performed by a hole-in-the card test.
For the twenty-five young subjects in this study, equilibrium score in two conditions did not differ. However, for elderly subjects over 60 years, the equilibrium score in dominant vision was higher than in nondominant vision (p<0.05).
In young subjects, there were no significant differences in postural control between dominant vision and non-dominant vision. However, in elderly subjects, postural control in non-dominant vision was significantly impaired. Therefore, the evaluation of a dominant eye should be considered in rehabilitation programs for elderly people.
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The increment of the proportion of elderly population has been very rapid not only in the developed country but also in South Korea during the second half of the 20th century. This demographic change attracts an interest in the field of the Gerontology and Geriatric Medicine and also need for the specialists in this field has been increased. There are different terminologies which are related each others; Gerontology which is the scientific study of the problems of aging in all their aspects- clinical, biological, historical, and sociological and Geriatrics which is the branch of medicine which treats all problems peculiars to old age and the aging, including the clinical problems of senescence and senility. The elderly who is the object of geriatrics, usually is defined by age (for example, over 65) or by physical condition and disability. The characteristics of elderly comparing with young are vague presenting symptoms and chronicity and progressively deteriorating. Geriatrician has an ability to be a comprehensive and know the importance of multidisciplinary approach. By far, the assessment the function of the elderly patient are an important tool for diagnosis and planning the treatment. The one of the most important goal of elderly is to keep the function to live independently as long as possible. (J Korean Acad of Rehab Med 2002; 26: 367-369)
Since average life expectancy has improved in the last century, the percentage of the elderly population has been gradually increased. The World Health Organization makes a statement that health is a state of not only the absence of disease, but also complete physical, mental or social well being. For this reason, exercise is broadly recommended for almost all the elderly.
The benifits of exercise for the elderly include a significant reduction in risk of coronary heart disease, hypertension,
diabetes, obesity, osteoporosis, and a improvement of cardiovascular fitness, independency in activities associated with daily living, and the quality of life.
This article gives an account of the benifits and considerations of regular exercise in the elderly, and critically reviews the literature on proper intensity, duration, frequency, and type of exercise at both aerobic/endurance training and strength/resistance training prescribed in older adults. (J Korean Acad Rehab Med 2002; 26: 121-126)
Objective: To determine whether ankle plantar flexors stretching exercise affects functional reach in elderly men.
Method: Twenty elderly men with an average age of 78.2 years were selected for this study. A active range of motion of ankle dorsiflexion and a functional reach (FR) distance were measured before and after ankle stretching exercise. The ankle dorsiflexion was measured by goniometer in knee extended position. The FR distance was measured in standing position. Ankle plantar flexors stretching exercises were carried out by physical therapist 4 times per week for 4 weeks. At 4 weeks after the stretching exercise, we retested the active range of motion of ankle dorsiflexion and the FR distance using the same method.
Results: At 4 weeks after the stretching exercise, the active range of motion of right ankle dorsiflexion was increased from 2.81⁑3.26o to 5.98⁑4.34o, and the left ankle dorsiflexion was increased from 3.15⁑3.77o to 6.35⁑2.45o. The FR distance was increased form 12.22⁑7.54 cm to 19.69⁑8.59 cm after the stretching exercise.
Conclusion: The FR distance was significantly increased after the ankle plantar flexors stretching exercise (p＜0.01). This results suggest that the ankle plantar flexors stretching excercise may be capable of increasing the FR distance in elderly.
Objective: To obtain the mean value of physical parameters of those over 65- years of age.
Methods: Physical parameters including body weight, height, chest circumference, length of upper limb and lower limb, hand power, and range of motion of cervical, thoracic, lumbosacral spines and other major joints were measured in two hundred fourteen elderly subjects.
Results: Subjects were divided into three groups according to age (group 1, 65∼74 years; group 2, 75∼84 years; group 3, above 85 years) and sex (male; female). Descriptive statistical analysis of data provided the following results. 1) Mean measurement in order of group 1-men, group 2-men, group 3-men followed by women of each group: Body weight (kg) - 60.2, 59.6, 54.9, 56.8, 51.6, 47.2; Standing height (cm) - 156.7, 160.8, 156.6, 151.2, 146.9, 142.2; Sitting height (cm) - 99.8, 100.8, 103.1, 100.9, 104.9, 97.0; Chest circumference (cm) - 91.5, 93.5, 91.4, 92.1, 89.5, 86.4; Upper limb length (cm) - 72.3, 72.5, 71.3, 67.1, 66.9, 65.4; Lower limb length (cm) - 82.3, 82.1, 81.4, 77.3, 76.1, 74.6. 2) The hand power of grasping, tip pinch, lateral pinch, palmar pinch showed a decreasing trend in older age group in both sexes. 3) The range of motion of cervical, thoracic, and lumbosacral spine in group 1 had limitation of about 50% compared to normal range. 4) Of the major joints, limitation of motion or deformity was most common in the shoulder and knee joints.
Conclusion: These data and knowledge of physical parameters of the elderly can aid in design of living environment and assistive devices for elderly.
Objective: To determine whether electrophysiologic findings of mild diabetic neuropathy in elderly patients is due to age or diabetic mellitus itself.
Method: Electrophysiologic examination was performed in patients with diabetes mellitus and in normal control subjects over the age of 60. Electrophysiologic results of 55 diabetic neuropathy patients and the normal control subjects were compared.
Results: 1) Effect of age or diabetes mellitus on the electrophysiologic parameters: In normal controls over 60 years of age the motor and sensory parameter demonstrated a significant difference compared to those under 60. In diabetic patients, motor and sensory parameters demonstrated a significant difference compared to the control group.
2) Interaction of age and diabetes mellitus: Concerning the effect of age, significant differences were observed in amplitude in both motor and sensory responses. Regarding the effect of diabetes, significant differences were observed in latency or velocity in the motor and sensory nerves compared to the control group.
Conclusion: Eletrophysiologically, prolonged latency is the result of the diabetic process, whereas decreased amplitude is thought to be due to the effect of age. In diagnosing mild diabetic neuropathy in elderly patients, we should consider the differential effects of age itself and diabetes mellitus.
The purpose of this study was to collect the informations on the current status and the needs of the physically disabled elderlies in the rural community along with the prevalence rate of these population. One study group for the study of disability status evaluation was 139 physically disabled elderlies living in the main island of Kangwha, and the other group for the study on prevalence of disability was 542 elderlies living in Songhae myun. The prevalence of physical disability was 6.5% in Songhae myun. The neurologic disorder was the most frequent diagnosis among the physically disabled elderlies followed by the musculoskeletal disorder. The time for the medical service delivery was delayed; 45.3% of the subjects received medical service more than one month after the onset of disability. Only 18.0% of the disabled elderlies received the public disability service, and 15.8% of the subjects was waiting for further service. The most common need from the subjects was the medical service, followed by the service from the institution such as a nursing home and the financial support. Registration rate of the disabled was very low(7.7%). There were only three physical therapists for the rehabilitation services in studies areas.
This study revealed that the public concepts for the disability and the rehabiltation service were inadequate. We hope that this basic data can be used for the planning of rehabilitation services in this community.
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