Gait and balance disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1996
|
| Schriftenreihe: | Clinics in geriatric medicine
12,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XI S., S. 635 - 922 |
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| 650 | 2 | |a Équilibre locomoteur - Sujet âgé | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Equilibrium | |
| 650 | 4 | |a Gait | |
| 650 | 4 | |a Gait disorders in old age | |
| 650 | 4 | |a Musculoskeletal Equilibrium | |
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| adam_text | GAIT AND BALANCE DISORDERS
CONTENTS
Preface xi
Stephanie Studenski
Postural Control in the Older Adult 635
Brian E. Maki and William E. Mcllroy
Age related changes in the neural, sensory, and musculoskeletal
systems can lead to balance impairments that have a tremendous
impact on the ability to move about safely. The many complex
substrates of the posture control system subserve a common func¬
tional goal: regulation of the relationship between the center of
mass and the base of support. Traditional approaches, which have
focused on the control of the center of mass displacement, have
documented age related changes in feet in place responses: dur¬
ing quiet standing, during volitional movement, or in response to
applied perturbation. Recently, increasing attention has been di¬
rected toward the control of the base of support, that is, compen¬
satory leg and arm movement, as an important element of the pos¬
tural repertoire, and early results suggest profound age related
impairment in the control of compensatory stepping movements.
For both feet in place and stepping responses, control of lateral
stability appears to be a major problem associated with increased
risk of falling. In view of age related differences in ability to adapt
postural responses under predictable task conditions, future work
will likely benefit by mimicking, as much as possible, the varied
and unpredictable nature of the events that often precipitate falls
in daily life, in order to draw connections between the laboratory
or clinic and real life stability.
Effects of Age on the Biomechanics and Physiology of Gait 659
James Oat Judge, Sylvia Ounpuu, and Roy B. Davis III
There are significant changes in gait across the life span, but par¬
ticularly after the age of 70 years. This article reviews the physi
i CLINICS IN GERIATRIC MEDICINE
VOLUME 12 • NUMBER 4 • NOVEMBER 1996 V
ology of gait and the motor control challenges during gait. The
kinematics (motion) and the kinetics (moment and power) of nor¬
mal gait of a database of healthy young and older adults are com¬
pared. Older subjects generate significantly lower peak ankle plan¬
tar flexor power during gait. The clinical significance of the
reduction in ankle plantar flexion power is discussed.
Clinical Overview of Instability in the Elderly 679
Stephanie Studenski and Sally K. Rigler
Falling is often a multifactorial syndrome that can be viewed from
several perspectives, including pathophysiologic, biomedical,
functional, and ecologic models. The history, physical examination,
and performance testing are the cornerstones of evaluation. Diag¬
nostic testing in selected cases and environmental evaluation when
feasible are additional elements. Management is directed toward
correcting reversible problems, improving deficits amenable to
partial correction, and providing adaptation to fixed deficits.
Differential Diagnosis of Gait Disorders in Older Adults 689
Neil B. Alexander
The purpose of this review is to examine the causes of gait disor¬
ders in older adults, focusing specifically on the underlying dis¬
eases that are the primary causes of the disorder. A classification
system for these diseases is proposed. Thus far, interventions used
to reduce gait disorders yield only modest results and residual
disability is common.
Functional Assessment of Balance and Gait 705
Katherine Berg and Kathleen E. Norman
Individuals must be able to maintain an upright posture under a
variety of conditions and to move independently. These constructs
of balance and gait are fundamental components of physical func¬
tioning and should be incorporated into clinical assessment of
older adults. The primary objective, therefore, is to review existing
measures of functional balance and gait, concentrating on those
which are quantitative, practical for use in clinical settings, and
have demonstrated acceptable measurement properties. In addi¬
tion, we discuss the rationale for the functional assessment of bal¬
ance and gait, review essential measurement criteria, and discuss
the utility of valid standardized measurement in clinical practice.
Vi CONTENTS
Using Technology Based Techniques to Assess Postural
Control and Gait in Older Adults 725
Neil B. Alexander
Increasingly sophisticated instrumentation and techniques to as¬
sess gait and postural control in older adults are now available.
These technology based methods may be most useful in under¬
standing the mechanisms underlying age related and disease re¬
lated changes in gait and postural control. Further work is needed
to ensure that these methods: (1) are used in a hypothesis driven
manner; (2) are made more simple, portable, and user friendly; and
(3) are used in an appropriate and cost effective manner.
A Multifactorial Approach to Reducing Injurious Falls 745
Mary B. King and Mary E. Tinetti
Injuries, particularly fractures, are the most serious and costly con¬
sequence of falling for older people living in the community.
Rather than having a single cause, fall injuries are the result of a
combination of intrinsic, situational, and environmental factors. In
this article, the epidemiology of fall injuries is reviewed, the results
of observational and intervention studies are discussed, and a mul¬
tifactorial approach to reducing injurious falls is presented.
Exercise to Improve Physiologic and Functional
Performance in Old Age 761
Julie M. Chandler and Evan C. Hadley
The purpose of this article is to evaluate the impact of exercise in
elderly men and women. The type and intensity of exercise, the
health status of the participants, and the outcomes measured vary
widely across studies. In general, studies of exercise interventions
in older adults show positive physiologic effects in persons of all
ages. Musculoskeletal and cardiovascular systems, regardless of
age, can respond to both resistance and aerobic training as mea¬
sured by impairments such as strength and maximum oxygen up¬
take. The magnitude of physiologic effect may be dampened in
frailer individuals in response to lower intensity exercise stimuli.
In the most impaired elders, exercise may help to forestall further
decline in physiologic reserve rather than produce significant
gains. The extent to which exercise programs impact performance
and disability is less clear. Exercise programs in frailer individuals
appear to have greater effect on gait speed and chair rise time than
similar programs in healthier individuals. The impact of exercise
on measures of disability has not been widely reported. Studies
reviewed in this article suggest that exercise training in elders is a
CONTENTS Vii
potential means of reducing the burden of impairments and ulti¬
mately improving function.
Evaluation and Management of Dizziness in the Older Patient 785
Philip D. Sloane
The increased prevalence of dizziness with advancing age is the
result of specific disease processes superimposed on normal aging
physiology. The first step in evaluating dizziness in older persons
is a careful clinical history, focusing on the type, temporal pattern,
onset, associated symptoms, and the patient s overall physical
health. Common dizziness problems in this age group are postural
dizziness without postural hypotension, positional vertigo, cere
brovascular disease, a variety of acute and recurrent labyrinthine
problems, neck problems, physical deconditioning, and medica¬
tions. Often, multiple problems coexist, and secondary psychologic
disability results. Treatment should aim at identifying and man¬
aging remediable problems.
Visual Deficits and Mobility: Evaluation and Management 803
Joseph H. Maino
The prevalence of severe visual impairment increases with age.
Additionally, visually impaired elders are much more likely to
have mobility restrictions than their normal sighted peers. Specif¬
ically, individuals with visual impairment between 65 and 74 years
of age are three to four times more likely to have difficulty walking,
going outside, and getting in and out of bed. This article reviews
the eye and vision problems associated with aging and discusses
management options.
Disorders of Posture, Balance, and Gait in Parkinson s Disease 825
Mark W. Rogers
Disorders of movement function related to posture, balance, and
gait are common occurrences for many persons with Parkinson s
disease. Numerous studies have identified a broad variety and het¬
erogeneous distribution of postural and locomotor changes. These
alterations are often associated with diminished functional ability,
poor prognosis, and frequent falls. Present pharmacologic man¬
agement appears to have a limited influence on postural instability
and associated falls, and, despite anecdotal information, there is
scant information on the therapeutic effectiveness of physical in¬
terventions aimed at enhancing these functions. Future advances
would likely be facilitated by: (1) determining the nature and extent
of the specific involvement of postural and locomotor control
Viii CONTENTS
mechanisms; (2) coalescing findings on motor control processes
with clinical information to develop rehabilitation approaches that
target specific motor manifestations; and (3) conducting long term
clinical trials to demonstrate the efficacy of interventions.
Medications and Falls: Causation, Correlation, and Prevention 847
Mark Monane and Jerry Avorn
Both medication use and fall rates increase with advancing age.
The increased risk of falls conferred by drugs is clearest for psycho
active agents such as long acting benzodiazepines. The most frail
patients (those likeliest to fall) also are receiving the largest drug
burden, imposing considerable confounding by indication. None¬
theless, improving the drug regimen is probably one of the most
effective means of reducing fall risk, especially in the frail elderly.
Role of the Environment in Falls Prevention 859
Bettye Rose Connell
Environmental change offers an attractive approach to falls pre¬
vention, particularly as part of multidimensional intervention strat¬
egies. This article reviews and summarizes prior research that has
examined environmental factors in falls experienced by older peo¬
ple in community and long term care settings. Limitations of this
research as a basis for falls prevention activities also are discussed.
Studies that focused on environmental hazards as well as those that
examined the interaction of environmental conditions and envi¬
ronmental use activities from a situational perspective are in¬
cluded. The first group of studies suggests an approach to falls
prevention centered on hazard removal; the second group suggests
an approach centered on the provision of more supportive envi¬
ronments that reduce excessive environmental demands. Environ¬
mental change and falls prevention in long term care and com¬
munity settings, including common barriers to change among older
individuals living in the community, are discussed.
Falls and Fall Prevention in the Nursing Home 881
Laurence Z. Rubenstein, Karen R. Josephson, and Dan Osterweil
The mean incidence of falls in nursing homes is 1.5 falls per bed
per year (range 0.2 3.6). The most common precipitating causes
include gait and balance disorders, weakness, dizziness, environ¬
mental hazards, confusion, visual impairment, and postural hy¬
potension. The most important underlying risk factors for falls and
injuries include some of these same items as well as others: leg
weakness, gait and balance instability, poor vision, cognitive and
CONTENTS ix
functional impairment, and sedating and psychoactive medica¬
tions. A focused history and physical examination after a fall can
usually determine the immediate underlying cause(s) of the fall
and contributory risk factors. Many strategies for fall prevention
have been tried with mixed success. The most successful take into
account the multifactorial causes of falls, and include interventions
to improve strength and functional status, reduce environmental
hazards, and allow staff to identify and monitor high risk resi¬
dents. Regular evaluations in the nursing home can help identify
patients at high risk who can then be targeted for specific treatment
and prevention strategies. Strategies that reduce mobility through
use of restraints have been shown to be more harmful than bene¬
ficial and should be avoided. A number of promising fall preven¬
tion strategies, involving both specific quality assurance programs
and technologic devices, are being evaluated currrently.
Cumulative Index 1996 903
Subscription Information Inside back cover
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| spelling | Gait and balance disorders Stephanie Studenski, guest ed. Philadelphia [u.a.] Saunders 1996 XI S., S. 635 - 922 txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 12,4 Démarche - Sujet âgé Équilibre locomoteur - Sujet âgé Aged Equilibrium Gait Gait disorders in old age Musculoskeletal Equilibrium Older people Orientation and mobility Gleichgewichtsstörung (DE-588)4021230-0 gnd rswk-swf Gangstörung (DE-588)4195898-6 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Gleichgewichtsstörung (DE-588)4021230-0 s DE-604 Gangstörung (DE-588)4195898-6 s Studenski, Stephanie Sonstige oth Clinics in geriatric medicine 12,4 (DE-604)BV000019839 12,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007439897&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Gait and balance disorders Clinics in geriatric medicine Démarche - Sujet âgé Équilibre locomoteur - Sujet âgé Aged Equilibrium Gait Gait disorders in old age Musculoskeletal Equilibrium Older people Orientation and mobility Gleichgewichtsstörung (DE-588)4021230-0 gnd Gangstörung (DE-588)4195898-6 gnd |
| subject_GND | (DE-588)4021230-0 (DE-588)4195898-6 (DE-588)4143413-4 |
| title | Gait and balance disorders |
| title_auth | Gait and balance disorders |
| title_exact_search | Gait and balance disorders |
| title_full | Gait and balance disorders Stephanie Studenski, guest ed. |
| title_fullStr | Gait and balance disorders Stephanie Studenski, guest ed. |
| title_full_unstemmed | Gait and balance disorders Stephanie Studenski, guest ed. |
| title_short | Gait and balance disorders |
| title_sort | gait and balance disorders |
| topic | Démarche - Sujet âgé Équilibre locomoteur - Sujet âgé Aged Equilibrium Gait Gait disorders in old age Musculoskeletal Equilibrium Older people Orientation and mobility Gleichgewichtsstörung (DE-588)4021230-0 gnd Gangstörung (DE-588)4195898-6 gnd |
| topic_facet | Démarche - Sujet âgé Équilibre locomoteur - Sujet âgé Aged Equilibrium Gait Gait disorders in old age Musculoskeletal Equilibrium Older people Orientation and mobility Gleichgewichtsstörung Gangstörung Aufsatzsammlung |
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