MyMedR

Displaying all 4 publications

Abstract:

Sort:

Normal motor nerve conduction studies using surface electrode recording from the supraspinatus, infraspinatus, deltoid, and biceps

Buschbacher RM, Weir SK, Bentley JG, Cottrell E

PM R, 2009 Feb;1(2):101-6.
PMID: 19627883 DOI: 10.1016/j.pmrj.2008.08.002

Proximal peripheral nerve conduction studies can provide useful information to the clinician. The difficulty of measuring the length of the proximal nerve as well as a frequent inability to stimulate at 2 points along the nerve adds a challenge to the use of electrodiagnosis for this purpose. The purpose of this article is to present normal values for the suprascapular, axillary, and musculocutaneous nerves using surface electrodes while accounting for side-to-side variability.
Falls and Fear of Falling After Stroke: A Case-Control Study

Goh HT, Nadarajah M, Hamzah NB, Varadan P, Tan MP

PM R, 2016 12;8(12):1173-1180.
PMID: 27268565 DOI: 10.1016/j.pmrj.2016.05.012

BACKGROUND: Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population.
OBJECTIVE: To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors.
DESIGN: Case-control observational study.
SETTING: Primary teaching hospital.
PARTICIPANTS: Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested.
METHODS: Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling.
MAIN OUTCOME MEASURES: Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments.
RESULTS: Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group.
CONCLUSIONS: Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke.
LEVEL OF EVIDENCE: III.
Effects of Attentional Loadings on Gait Performance Before Turning in Stroke Survivors

Manaf H, Justine M, Goh HT

PM R, 2015 Nov;7(11):1159-66.
PMID: 25978943 DOI: 10.1016/j.pmrj.2015.05.007

Attentional loadings have significant impacts on turning performance in individuals with stroke. Improper gait modification before turning may contribute to falls after stroke. Therefore, examination of the changes in temporal-spatial gait parameters before turning may reveal important deficits in gait control when stroke survivors are challenged by dual-tasking.
Effect of modified Otago exercises on postural balance, fear of falling, and fall risk in older fallers with knee osteoarthritis and impaired gait and balance: A secondary analysis

Mat S, Ng CT, Tan PJ, Ramli N, Fadzli F, Rozalli FI, et al.

PM R, 2018 03;10(3):254-262.
PMID: 28827207 DOI: 10.1016/j.pmrj.2017.08.405

BACKGROUND: Osteoarthritis (OA) is considered an established risk factor for falls. Published studies evaluating secondary falls prevention strategies among individuals with OA are limited.
OBJECTIVE: To evaluate the effect of a personalized home-based exercise program to improve postural balance, fear of falling, and falls risk in older fallers with knee OA and gait and balance problems.
DESIGN: Randomized controlled trial.
SETTING: University of Malaya Medical Centre.
PARTICIPANTS: Fallers who had both radiological OA and a Timed Up and Go (TUG) score of over 13.5 seconds.
MAIN OUTCOME MEASURE: Postural sway (composite sway) was quantified with the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) under 4 different sensory conditions: eyes open on firm surface, eyes closed on firm surface, eyes open on unstable foam surface, and eyes closed on unstable foam surface. Participants were asked to stand upright and to attempt to hold their position for 10 seconds for each test condition. The average reading for all conditions were calculated.
METHODS: Participants randomized to the intervention arm received a home-based modified Otago Exercise Program (OEP) as part of a multifactorial intervention, whereas control participants received general health advice and conventional treatment. This was a secondary subgroup analysis from an original randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT) (trial registration number: ISRCTN11674947). Posturography using a long force plate balance platform (Balancemaster, NeuroCom, USA), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the short-form Falls Efficacy Scale-International (short FES-I) were assessed at baseline and 6 months.
RESULTS: Results of 41 fallers with radiological evidence of OA and impaired TUG (intervention, 17; control, 24) were available for the final analysis. Between-group analysis revealed significant improvements in the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Limits of Stability (LOS), and short FES-I scores by the intervention group compared to the control group at 6 months. No significant difference in time to first fall or in fall-free survival between the intervention and control groups was found.

CONCLUSION: Home-based balance and strength exercises benefited older fallers with OA and gait and balance disorders by improving postural control, with no observable trend in reduction of fall recurrence. Our findings will now inform a future, adequately powered, randomized controlled study using fall events as definitive outcomes.

LEVEL OF EVIDENCE: I.