Balance, Falls, and Functional Activity

Balance is a popular topic in rehabilitation and research today. Balance is a complex process, and defining the balance impairments specific to an individual can be intricate. The ultimate balance failure, a fall, can be devastating for older adults. Currently, falls are a major health issue for older adults and are getting attention from government agencies, such as the Centers for Disease Control and Prevention. The Safety of Seniors Act of 2007 ([S] .845) was passed in 2008 and authorizes new programs for fall prevention.

Identifying the best tests to identify balance impairments and the best interventions is vital to preventing falls. Much research has been done, but there is more we need to know, such as how tests perform in different populations and the appropriate type and dose of exercise. Also, there needs to be more education aimed at consumers that falls are not a normal part of aging.

In this issue, different topics related to balance are explored. Chou and Macfarlane investigate the relationship between performance-based and self-reported measures of lower extremity function in older Chinese women. An association between self-reported and performance measures has been established in populations that are different than the Chinese women in this study. The authors discuss cultural differences in Chinese women, including walking as the primary mode of transportation and underestimating functional abilities in self-report measures that may account for the results in this study.

Individuals who have had a stroke may have motor and/or cognitive deficits. In the article "Stress of Caregivers in Caring for People With Stroke: Implication for Rehabilitation," Louie et al investigate the relationship between functional and cognitive deficits and caregiver stress. Understanding this relationship has implications for advising the caregiver about strategies to manage stress.

Many older adults are not engaged in regular activity. In the article "The Comparison of Balance, Functional Activity, and Flexibility Between Active and Sedentary Elderly," Ceceli et al study the effect of upper and lower extremity range of motion exercises on specific balance and functional measures. The subjects performed the exercises 3 times a day for 4 months under the supervision of a physiotherapist. The authors discuss that low-intensity exercise of this type can improve functional ability, flexibility, and some aspects of balance.

Warnecke reports the findings of a literature review of normal pressure hydrocephalus. In the article "Analysis of Gait Before and After Cerebrospinal Fluid Lumbar Tap Test in Idiopathic Normal Pressure Hydrocephalus: A Literature Review and Case Report," the author uses a case study to describe the effects of a lumbar tap test on various measures. This case demonstrates how measurement of functional and cognitive measures before and after the procedure can affect clinical decisions regarding permanent shunt placement.

In "Comparison of Stretching Versus Strengthening for Increasing Active Ankle Dorsiflexion Range of Motion," Kasser et al investigate the effects of strengthening and stretching on ankle dorsiflexion range of motion compared to a control group. This study was done with normal subjects. The authors conclude that strengthening in addition to stretching exercises may be effective in increasing ankle dorsiflexion.

Anemia is a medical condition that is commonly seen in older adults. Witko's et al study the effect of anemia on activities of daily living, meeting rehabilitation goals, and length of stay. The article "Effects of Anemia on Rehabilitation Outcomes in Elderly Patients in the Post-Acute Care Setting" describes a retrospective study on patients in a rehabilitation unit. Anemia is not treated in some cases if the cause is unclear or if the patient is asymptomatic. The results of this study suggest that treating anemia can improve activities of daily living and decrease length of stay. This study highlights important results that warrant further investigation.

Horn discusses common vestibular pathologies in "Benign Paroxysmal Positional Vertigo in the Older Adult." This is a very common disorder in older adults and is easily treated when identified by healthcare providers.

Osteoporosis is another medical condition that is common in older adults. Exercise can reduce both osteopenia and osteoporosis, and it is important to choose exercises that will not increase the risk of fracture. Many types of exercise have been studied. Fishman describes the use of yoga in the article "Yoga for Osteoporosis: A Pilot Study." The yoga positions were modified as needed to ensure safety. This study suggests that 10 minutes of yoga daily can increase bone density, although more data are needed to make firm conclusions.

This issue in Topics in Geriatric Rehabilitation looks at balance in several different areas of the International Classification of Functioning, Disability, and Health Model1: pathology, body function and structure, and activity.

Our understanding of balance is enhanced when we consider all of these areas with our patients.

Linda B. Horn, PT, DScPT, MHS, NCS, Issue Editor

Rehabilitation Services Department, St Agnes Hospital, Baltimore, Maryland

REFERENCE