The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting (original) (raw)
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Executive functioning and predictors of falls in the rehabilitation setting
Archives of Physical Medicine and Rehabilitation, 1998
Rapport LJ, Hanks RA, Millis SR, Deshpande SA. Executive functioning and predictors of falls in the rehabilitation setting. Arch Phys Med Rehabil 1998;79:629-33. Objective: To examine the incremental utility of executive function tests in the prediction of inpatient falls.
Physiotherapy Canada, 2014
Purpose: The mechanisms linking cognition, balance function, and fall risk among older adults are not fully understood. An evaluation of the effect of cognition on balance tests commonly used in clinical practice to assess community-dwelling older adults could enhance the identification of at-risk individuals. The study aimed to determine (1) the association between cognition and clinical tests of balance and (2) the relationship between executive function (EF) and balance under single-and dual-task testing. Methods: Participants (24 women, mean age of 76.18 [SD 16.45] years) completed six clinical balance tests, four cognitive tests, and two measures of physical function. Results: Poor balance function was associated with poor performance on cognitive testing of EF. In addition, the association with EF was strongest under the dual-task timed up-and-go (TUG) test and the Fullerton Advanced Balance Scale. Measures of global cognition were associated only with the dual-task performance of the TUG. Postural sway measured with the Standing Balance Test, under single-or dual-task test conditions, was not associated with cognition. Conclusions: Decreased EF was associated with worse performance on functional measures of balance. The relationship between EF and balance was more pronounced with dual-task testing using a complex cognitive task combined with the TUG.
Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards
Geriatrics & Gerontology International, 2009
Background: Confusion and cognitive impairment, are risk factors for falls in hospital. Evidence for reducing falls in cognitively-impaired patients is limited and to date no intervention has consistently been shown to reduce falls in this group of patients. We explored characteristics associated with falls in cognitively-impaired patients in a rehabilitation setting.Methods: In a prospective observational study, 825 consecutive patients were studied. Patient characteristics were assessed on admission. Factors predisposing to falls in cognitively-impaired patients were identified.Results: Cognitively-impaired patients were more likely to be fallers or recurrent fallers and more likely to sustain an injury than cognitively intact patients. They had a higher incidence of nursing home discharges and a significantly higher mortality. Logistic regression analysis showed that an unsafe gait (P < 0.001; 95% confidence interval, 0.13–0.57) was the only independent risk factor for falls in this group of patients. There was a cumulative higher risk of falling associated with an unsafe gait demonstrable throughout the patients' stay.Conclusion: Unsafe gait was the only significant independent risk factor for falls among cognitively-impaired patients in a rehabilitation environment. Interventions that improve gait patterns or that enhance safety for patients with abnormal gait are required if fall reduction in this group of patients is to be achieved.
PLoS ONE, 2012
Background: Recent findings suggest that executive function (EF) plays a critical role in the regulation of gait in older adults, especially under complex and challenging conditions, and that EF deficits may, therefore, contribute to fall risk. The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up. Secondary objectives were to assess whether single and dual task walking abilities, an alternative window into EF, were associated with fall risk.
Post-Stroke Cognition as a Fall Predictor During Inpatient Rehabilitation
2013
Accidental falls are common among persons admitted for inpatient stroke rehabilitation, and they can cause serious physical and psychological consequences. The role of post-stroke cognitive function in the occurrence of falls after stroke is not clear. The purpose of this dissertation was to evaluate the extent to which post-stroke cognition predicts falls during inpatient rehabilitation, and to explore the nature of the relationships among impaired balance, hemineglect, activities of daily living (ADL) performance deficit, executive cognitive dysfunction, and falls during inpatient rehabilitation after stroke. Data were pooled from five simultaneously occurring studies at five of the UPMC Rehabilitation Institute's inpatient units. The Chedoke-McMaster Stroke Assessment Postural Control Scale (balance impairment), Line Bisection Test (hemineglect), motor Functional Independence Measure (ADL performance deficit), Repeatable Battery for the Assessment of Neuropsychological Status and Delis-Kaplan Executive Function System (non-executive and executive cognitive function, respectively) were administered to 180 participants shortly after admission to inpatient rehabilitation, and subsequent occurrence of participant falls was recorded. Using logistic regression and controlling for relevant sociodemographic and clinical covariates, we found no significant predictive relationship between post-stroke cognition and falls, and no significant interaction between post-stroke executive cognitive function and other
Executive Functions Are Associated with Fall Risk but not Balance in Chronic Cerebrovascular Disease
Journal of Clinical Medicine, 2020
Background: Older people’s deficits in executive functions (EF) have been shown to lead to higher fall risk, postural sway, and reduced speed. Crucially, EF impairments are even more pronounced in individuals with chronic cerebrovascular disease (CVD), namely vascular cognitive impairment. Methods: In this retrospective cross-sectional study, we used a complete neuropsychological battery, including the Trail Making Test (TMT) and physical measures, such as the Morse fall and EQUI scales, to assess 66 individuals with chronic CVD. Linear regressions, Bayesian analyses, and model selection were performed to see the impact of EF, global cognition, and vascular parkinsonism/hemiplegia on physical measures (fall risk and balance). Results: The TMT part B and BA correlated (r = 0.44 and r = 0.45) with Morse fall scale. Only EF significantly explained fall risk, whereas global cognition and vascular parkinsonism/hemiplegia did not. These findings were confirmed by Bayesian evidence and par...
Physiological Fall Risk Factors in Cognitively Impaired Older People: A One-Year Prospective Study
Dementia and Geriatric Cognitive Disorders, 2012
operating characteristic curve for the PPA model including tests of vision, proprioception, knee extension strength, reaction time, postural sway and leaning balance was 0.75 (95% confidence interval: 0.68-0.83). Conclusion: These findings indicate poor performance on physiological fall risk factors, particularly balance, increases the risk of falls in older cognitively impaired people.
Sport i Turystyka. Środkowoeuropejskie Czasopismo Naukowe, 2018
Aim. The aim of the study was to determine the relation between the severity of cognitive impairment and the risk of falling among the elderly. Methods. study included persons with the Mini-Mental State Examination (MMSE) score below 27 (average (PPA). The correlation of MMSE results with PPA results was analyzed. Results. separate PPA tests, there was a significant negative moderate correlation of MMSE scores with on strength (0,61). Conclusion. The strong correlation of cognitive impairment with the physiological profile among elderly shows that the higher the cognitive deficit, the higher the likelihood of a fall incident in this group. When creating fall prevention programs, it is worth paying attention to improving the muscular strength of the lower limbs and general reaction time, because these two elements may particularly affect the increased fall risk of people with cognitive impairment.