Biomedical subjects

K M Means

Publications and source records attributed to K M Means.

11 recordsLinked to original sources

PubMed1998

Obstacle course performance and risk of falling in community-dwelling elderly persons.

OBJECTIVE: To determine the efficacy of obstacle course performance scores in predicting persons at risk for falls, after adjusting for age, sociodemographic, health-status, and physiologic variables. DESIGN: Correlational descriptive study design utilizing a logistic regression model. SETTING: Community setting. PATIENTS OR PARTICIPANTS: A convenience sample of 352 community-dwelling elderly individuals at sites in a metropolitan area. MAIN CRITERION MEASURE: Number of falls reported prospectively during a 2-year follow-up period. RESULTS: Obstacle course performance, fall history, symptoms of balance dysfunction, and activity level distinguished those who fell and those who did not 12 and 18 months later. At 24 months, range of motion and number of medications also were significant. In multivariate logistic regression, only history of a fall was a significant predictor of future falling at 12 and 18 months; at 24 months, the presence of balance dysfunction symptoms was the significant predictor of those who fell. CONCLUSIONS: The obstacle course, as a predictor of future falls, is not superior to the question of whether or not an individual has fallen in the previous year, and is not recommended to predict future falls. The obstacle course may be better as a short-term indicator of response to a rehabilitation program for balance and mobility.

Accidental Falls↗

PubMed1998

Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway.

BACKGROUND: Older adults commonly experience falls because of balance and mobility problems. Better assessment methods are needed to understand and correct balance and mobility disorders. METHODS: We used a low technology, functional obstacle course (FOC) to measure balance and mobility in 352 community-dwelling elderly participants. To establish concurrent validity of the FOC, we compared performance on the FOC with two established measures of balance and mobility: performance on the Tinetti Index (TI) and postural sway area measured on a force platform. RESULTS: Bivariate correlation analyses revealed significant inverse correlations between FOC completion time, the TI balance and gait subscores, and the TI total score (r = -.73 to -.78). The FOC quality scores and TI balance and subscores gait and TI total scores (r = .76 to .82) were significantly positively correlated. FOC time had significant, but small, positive correlations with sway area with eyes open (r = .18) and closed (r = .17) and nonsignificant correlation with sway area with visual feedback. FOC quality also had significant, but smaller, inverse correlations with sway area with eyes open (r = -.024) and closed (r = -.015), and nonsignificant correlation with sway area with visual feedback. Regression analysis showed that TI gait and balance measures accounted for most of the variance found in FOC performance. CONCLUSIONS: Our findings support the position that the FOC and the TI measure dynamic balance, whereas postural sway measures a different aspect of balance. Advantages of the FOC include the evaluation of environmentally influenced falls and balance problems.

Accidental Falls↗

PubMed1996

Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program.

OBJECTIVE: The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear. The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls. DESIGN: Pretest-posttest experimental design with repeated measures at baseline, immediately postintervention, and 6 months postintervention. To assess the effect of repeated exposure to our main outcome measure (the obstacle course), half of the participants (randomly selected) were allowed to practice on the obstacle course. SETTING: A veterans affairs medical center. PARTICIPANTS: Elderly, ambulatory, community-dwelling volunteers recruited from among local outpatients at our medical center. INTERVENTION: Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching, postural control, endurance walking, and coordination exercises designed to improve balance and mobility. Participants were divided into 2 groups: 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practiced on the obstacle course in addition to their otherwise identical exercise program. MAIN OUTCOME MEASURES: Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries. RESULTS: No significant performance differences were found between the two groups. After intervention, mean qualitative obstacle course scores improved modestly (5%) and mean obstacle course completion time decreased by 15% from baseline. These postintervention pairwise performance differences were clinically important but not statistically significant. Relative to baseline levels, postintervention falls and injuries did not change significantly. CONCLUSIONS: Our exercise intervention may have the potential to improve functional performance. However, some modifications are necessary to enhance efficacy. The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting.

Accidental Falls↗

PubMed1996

The obstacle course: a tool for the assessment of functional balance and mobility in the elderly.

Many conventional methods employed in the assessment of balance and mobility in the elderly are expensive, difficult to administer, rely heavily on complex technology, or provide limited functional information so essential to the planning and implementation of rehabilitation interventions. The author has developed a functionally oriented obstacle course for use in the rehabilitation setting, to aid in the evaluation of elderly subjects with balance and mobility dysfunction. The obstacle course consists of 12 simulated functional tasks. Qualitative and quantitative individual task and overall scores are given for each obstacle course performance. A description of the design and rationale for the obstacle course is presented. For demonstration purposes, nonexperimental obstacle course performance data from a small group of elderly volunteers is included. With further validation studies, the obstacle course has potential to become a useful tool in the evaluation and rehabilitation of balance and mobility disorders, in order to aid in the prevention of falls and fall-related injuries in the elderly.

Accidental Falls↗

PubMed1993

Geriatric rehabilitation. 1. Social, attitudinal, and economic factors.

This self-directed learning module highlights the social, attitudinal, and economic factors that are important in the rehabilitation of the older adult. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on the epidemiology of aging and disability, geriatric rehabilitation treatment environments, social support systems, reimbursement issues, and ageism.

Aged↗

PubMed1993

Geriatric rehabilitation. 2. Diagnosis and management of acquired disabling disorders.

This self-directed learning module highlights the diagnosis and rehabilitation management of acquired disabling disorders. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on the physiology of aging; rehabilitation management of pathologic conditions of the older adult affecting the cardiovascular, pulmonary, skeletal, connective tissue, and neurologic systems; rehabilitation issues relating to psychologic functioning of the older adult; pharmacologic concerns of the older adult; and response to illness with aging.

Aged↗

PubMed1993

Geriatric rehabilitation. 4. Assessment, preservation, and enhancement of fitness and function.

This self-directed learning module highlights the assessment, preservation, and enhancement of fitness and function in the older adult. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on functional assessment, deconditioning, exercise testing and physiology, gait disorders and falls, sports injuries, and industrial injuries in the older adult.

Accidental Falls↗

PubMed1990

Accessory nerve conduction in neck dissection subjects.

Evaluation of the accessory nerve and trapezius muscle was performed on eight subjects with neck dissection secondary to oropharyngeal/laryngeal cancer. The latencies and amplitudes of the upper, middle, and lower trapezius muscle in neck dissection subjects were compared to those in healthy subjects similar in age. Subjects after neck dissection showed abnormalities of evoked responses and abnormal spontaneous discharges in electromyographic studies of the upper trapezius. Future serial studies that seek prognostic indicators of shoulder dysfunction common to neck dissection patients are warranted.

Accessory Nerve↗

PubMedDate not supplied

Use of an obstacle course to assess balance and mobility in the elderly. A validation study.

An obstacle course, consisting of a series of 12 simulated functional tasks, has been developed to aid in the evaluation of rehabilitation interventions for elderly individuals with balance and mobility dysfunction. The validity of the obstacle course as a measure of balance and functional mobility was tested by comparing obstacle course performance scores of a sample of 237 community-dwelling veterans, aged 67 to 93 yr, with clinical indicators of balance and mobility including age, history of falls, symptoms of balance dysfunction, medication use, orthostatic blood pressure changes, neurologic examination abnormalities, muscle strength, joint range of motion, self-reported activity level, and functional status. Significant correlations were found between obstacle course scores and all clinical indicators except blood pressure changes and age. Multiple regression analysis of selected variables showed that activity level and neurologic abnormalities best determined both qualitative and quantitative obstacle course performance. Non-fallers performed significantly better on the obstacle course than fallers. These results suggest that the obstacle course is valid and has potential as a useful tool in the evaluation of older persons with balance and mobility impairment.

Aged↗

PubMedDate not supplied

Balance, mobility, and falls among elderly African American women.

OBJECTIVE: To compare balance, mobility, recent falls, and injuries among elderly African American and white women. DESIGN: This was a nonexperimental study. Participants, who were older than 65 yr of age, able to walk at least 30 ft, not residing in a nursing home, and with no acute medical problems, were recruited from 17 senior citizens' community centers. RESULTS: Compared with white women (n=180), African American women (n = 118) took fewer medications, had greater body mass indexes, had less muscle strength, and had more medical conditions and neurologic abnormalities. Additionally, these women were less active and had poorer performances on an obstacle course. The two groups had a similar histories of falls and injuries. For both groups, activity level and neurologic findings were predictors of obstacle course performance. For white women, muscle strength was an additional predictor of obstacle course performance. An additional predictor for African American women was range of motion. CONCLUSION: The poorer balance and mobility of African American women compared with white women may have consequences such as their functional dependence, resulting in their greater use of hospitals and formal and informal health services.

Accidental Falls↗

PubMedDate not supplied

Modifying a functional obstacle course to test balance and mobility in the community.

A previously reported functional obstacle course (FOC) developed to assess elderly persons with and without balance and mobility impairment was used in a hospital-based study of 237 participants. A new modified version of the FOC was developed for use in a community-based study, by placing some obstacles next to walls instead of between parallel bars. These modifications eliminate the need for parallel bars or for extra personnel to interchange the obstacles. We were concerned that the modifications could affect performance scores, because touching or holding onto the now eliminated parallel bars could influence FOC scores under the original scoring system. To determine the effect of these modifications on FOC performance, we tested 36 volunteers, (18 fallers [falls within last year] and 18 non-fallers), on the modified parts of the old and new versions of the FOC. Random testing order and inter-trial rests were used. For both the old and new FOC versions, we summed quality and task completion time scores from the six modified obstacles (artificial turf, carpet, pine bark, sand, up ramp and down ramp) to create scores for quality and time. Our hypothesis was that there would be no performance difference between the original and modified obstacle course. Using a two-factor repeated-measures analysis of variance, we found no difference in quality scores between the two FOC versions and no effect of an interaction between faller status and the course versions. We did find that the time was approximately 2 seconds longer for the new version; however, the time increase was the same for fallers and non-fallers. These data show that fallers and non-fallers have comparable performance on both versions of the FOC; however, to compare the two obstacle courses we recommend an adjustment of 2 seconds in time scores. The obstacle course modifications will facilitate more extensive and efficient use of the obstacle course as a research tool to assess balance and mobility.

Accidental Falls↗