다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Diminished ability to maintain balance may be associated with an increased risk of falling. In older adults, falls commonly lead to injury, loss of independence, associated illness and early death. Although some exercise interventions with balance and muscle strengthening components have been shown to reduce falls it is not known which elements, or combination of elements, of exercise interventions are most effective for improving balance in older people. Objectives: To present the best evidence for effectiveness of exercise interventions designed to improve balance in older people living in the community or in institutional care. Randomised controlled trials and quasi-randomised trials testing exercise interventions designed to improve balance in older people were included. The authors excluded trials of interventions targeting individuals with specific conditions in order not to broaden the scope of this review too widely. Trials were included where participants were randomised to receive the following: a single exercise intervention or a multiple exercise intervention and a control group (usual activities or attention or recreational activity). Trials comparing two or more exercise interventions and a control group were also included. For the 34 included studies there were 2883 participants at entry. Statistically significant improvements in balance ability were observed for exercise interventions compared to usual activity. Interventions involving gait; balance; co-ordination and functional exercises; muscle strengthening; and multiple exercise types appear to have the greatest impact on indirect measures of balance. There was trend towards an improvement in balance with cycling on a static cycle. However, there was limited evidence that effects were long-lasting.

Exercise for improving balance in older people

Summary Movement disorders, which include disorders such as Parkinson's disease, dystonia, Tourette's syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed

/pdf/sensory-aspects-of-movement-disorders-2zi75mi1i7.pdf

Sensory aspects of movement disorders.

https://northumbria-test.eprints-hosting.org/id/document/270491

Gait and cognition: mapping the global and discrete relationships in ageing and neurodegenerative disease

Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.

https://www.dovepress.com/getfile.php?fileID=15335

Effects of balance training using a virtual-reality system in older fallers

http://phydatabase.med.miami.edu/Documents/Pub/Angeli.pdf

Balance sensory organization in children with profound hearing loss and cochlear implants.

Our aim in this study was to assess postural control adaptation quantitatively in unsteady elderly patients at risk of falls in open spaces and given balance training with a virtual-reality system reproducing environmental stimulation. Using a balance rehabilitation unit based on a virtual-reality system that changes sensory information (visual, vestibular, and somatosensory), we treated 26 elderly, unsteady patients who were prone to falling (age range, 73-82 years) and who were enrolled in a customized vestibular rehabilitation program. We assessed postural responses by posturography before and after 6 weeks in the vestibular rehabilitation program under two conditions: (1) standing, eyes open, static visual field, and (2) standing, eyes open, dynamic visual field through virtual-reality goggles, generating horizontal optokinetic stimulation (70 degrees per second angular velocity). We recorded postural responses with a platform measuring the confidential ellipse of the center-of-pressure distribution area and sway velocity with a scalogram analyzing postural behavior by wavelets. After 6 weeks of treatment, postural response confidential ellipse and sway velocity values were lower, evincing decreased amplitudes and sway frequency contents in the scalogram by wavelet under both stimulation paradigm conditions. These findings suggest postural adaptation under the two perceptual conditions when patients had static and dynamic visual fields. The possibility of treating elderly fallers with balance disorders using a virtual-reality environmental stimulation reproduction system is discussed.

/pdf/postural-adaptation-in-elderly-patients-with-instability-and-4z1zxc9uxg.pdf

Postural adaptation in elderly patients with instability and risk of falling after balance training using a virtual-reality system.

Objective—The aim of this study was to determine postural responses before and after a vestibular rehabilitation program (VRP) in 14 patients with central vestibular disorders (CVD). Material and Methods—The confidence ellipse (CE) of the center of pressure distribution area and the sway velocity (SV) were the parameters used for the quantitative assessment of postural control (PC). These two parameters were analyzed before and after a VRP for two visual conditions. Behavioral postural responses were studied by means of the time–frequency scalogram using wavelets and the sway frequency content was measured in arbitrary units of energy density. Results—Ten patients showed a significant decrease in the CE and SV after the rehabilitative treatment, thus improving their PC. Seven of these patients were assessed again after a period of 12±5 months, during which they had not received any physical training. All of them showed increases in the CE and SV, indicating an impairment of PC. Conclusions—Many CVD patien...

/pdf/changes-in-postural-control-parameters-after-vestibular-3qum6jmvk7.pdf

Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders.

Conclusion: This study showed that a population with benign paroxysmal positional vertigo related to mild head trauma (BPPVAT) was younger and more frequently presented with bilateral canalithiasis...

Clinical characteristics of positional vertigo after mild head trauma.

The description of the postural responses in Parkinson's disease patients when visual information changes from a stable to a moving visual field analyzing the impact on balance in these patients. METHODS (CLINICAL): Limits of Stability, Body center of pressure and balance functional reserve were measured by means of the force platform in 24 Parkinson´s patients in stages 1 and 2 of the Boher classification and 19 volunteers as a control group. Both groups were stimulated with 1-Static visual field and 2-horizontal optokinetic stimulation using a virtual reality system. Postural responses were analyzed using the inverted pendulum as mathematical model. RESULTS: While the control group didn't show significant differences on the postural control between the two sensory conditions (COP p=0.0017, BFR p=0.0025), Parkinson's patients presented significant differences in the area of the center of pressure and the balance functional reserve values between static visual field and optokinetic stimulation. (COP p=0.0017, BFR p=0.0025). CONCLUSIONS: The results support the hypothesis about the influence of the changes in the visual information in triggering balance control disorders in Parkinson's patients. It is discussed the interest of these fact in the assessment and the rehabilitation programs of this disease.

/pdf/balance-in-parkinson-s-disease-patients-changing-the-visual-56eg5e0kqw.pdf

Alejo Suarez

Papers

Balance sensory organization in children with profound hearing loss and cochlear implants.

Postural adaptation in elderly patients with instability and risk of falling after balance training using a virtual-reality system.

Changes in postural control parameters after vestibular rehabilitation in patients with central vestibular disorders.

Clinical characteristics of positional vertigo after mild head trauma.

Balance in Parkinson's disease patients changing the visual input