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[099] PERFORMANCE-BASED PREVENTION/REHABILITATION OF FALLS IN ELDERLY VETERANS
Kevin M. Means, MD; Daniel E. Rodell, PhD; Patricia S.
O'Sullivan, EdD
Physical Medicine and Rehabilitation Service and Falls
and Mobility Disorders Program, VA Medical Center, North
Little Rock, AR 72114; Research, Social Work Service, John L.
McClellan Memorial VA Medical Center, Little Rock, Arkansas
72205; College of Nursing Research Center, University of
Arkansas for Medical Sciences, Little Rock, Arkansas 72205;
email: means.kevin@little-rock.va.gov;
rodell.daniel@little-rock.va.gov;
posullivan@con.uams.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E827-RA)
No report was received for this issue.
[100] RELIABILITY AND VALIDITY OF ACCELEROMETRIC GAIT AND BALANCE
Eric E. Sabelman, PhD; Carol H. Winograd, MD; Betty
Troy, MS; Deborah Kenney, MS, OTR; Sandra Dunn Gabrielli;
David L. Jaffe, MSEE; John W. Oehlert, MS; Wayne Phillips,
PhD
Rehabilitation R&D Center, VA Palo Alto Health Care
System, Palo Alto, CA 94304; Dept. of Functional
Restoration, Stanford University Medical School, Stanford CA
94305; Center for Research on Disease Prevention, Stanford
University, Stanford CA 94305
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E601-3RA)
PURPOSE--The sense of balance declines with age due to combined vestibular, proprioceptive, and visual losses, resulting in impaired mobility and increased risk of injurious falls. A wearable accelerometric instrument has been developed to record movements outside the laboratory, identify motion patterns that accompany loss of balance before a fall occurs, warn the individual of pre-fall behavior, and if necessary, signal that the wearer has fallen. Accelerometry is clinically useful as a diagnostic tool to quantify hitherto qualitative measures of balance, as a biofeedback device during therapy and as a fall-prevention aid and balance orthosis for fall-prone elderly individuals.
Researchers, clinicians, and potential industrial partners familiar with accelerometry have noted the need for rigorously testing the reliability and validity of this device before it can become a routine clinical tool. In this phase of the project, we will establish statistical reliability and validity by comparison of accelerometry with conventional laboratory gait and balance measures (force platform, goniometry, and video imaging) using subjects having well-defined gender, age, and mobility status.
METHODOLOGY--The accelerometric motion detection system consists of two small 3-axis sensors attached to both corners of eyeglass frames to measure head motion, and two sensors above each hip on a belt at the waist, along with a self-contained data acquisition package. An infrared remote control is used to command the wearable unit, so the wearer is unencumbered by cables. In a typical test, subjects perform tasks derived from qualitative balance assessment protocols, including: stand eyes open, then closed; ascend stairs, turn, then descend; rise from and sit in chair; normal walk 10 m; tandem (toe-to-heel) walk 3 m; walk over obstacles 1 m apart.
Among the factors that affect consistent interpretation of accelerometric data are: 1) mechanical and electronic stability, 2) installation and calibration (inter-rater reliability), 3) test-retest reliability, 4) accuracy vs. accepted techniques (concurrent validity), and 5) presentation of results derived from accelerometric data in a form comparable to currently accepted measures. We will enroll and test on at least three occasions 240 control subjects who are either fit or deconditioned. Subjects will be grouped by gender and age decade (60s, 70s, 80s); all will have stable mobility status. Overall differences between initial and retest values and differences between accelerometric and conventional measures will be compared using appropriate statistics.
PROGRESS--Work has continued on a second-generation device that incorporates pulse-output acceleration sensors, two semi-custom digital signal processing chips, and PCMCIA memory cards. Data from subject populations comprising stroke, Parkinson's disease, and hip arthroplasty patients, as well as controls induced to stumble in the laboratory, are being analyzed. An instructional videotape has been produced for self-teaching of nonlocal users of the system. Local collaborators have used the method in a study of therapeutic interventions in fall-prone elderly subjects, and nonlocal researchers have studied fatigue in walking by the elderly and standing balance in a variety of subjects. Collaborations have been established to develop special-purpose devices for identifying and preventing lateral falls likely to result in hip fracture and for combined head- and eye-tracking for vestibular research.
FUTURE PLANS--In addition to its use as a diagnostic and therapeutic tool for balance-impaired elderly individuals, real-time accelerometric pattern analysis and feedback can be applied to prevention of reinjury following occupational rehabilitation, and to athletic training.
[101] AGE-RELATED CHANGES IN THE TRICEPS SURAE STRETCH REFLEX AND POSTURAL CONTROL
Steven L. Wolf, PhD, FAPTA; Richard L. Segal,
Ph.D.
Rehabilitation R&D Center, Decatur VA Medical Center,
Decatur, GA 30030; Department of Rehabilitation Medicine,
Emory University School of Medicine, Atlanta, GA 30322;
email: steve@spinal.emory.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E723-2RA)
PURPOSE--Hip fractures resulting from fall events in older veterans result in high costs for medical and surgical care, as well as in comprised quality of life. One method to enhance awareness of the location of the center of pressure and fostering controlled excursion through the weight-bearing surface is by providing pressure feedback as a vehicle to constrain or enhance vertical loading or body sway. These last sets of experiments were undertaken to determine whether feedback about vertical loading forces during dynamic angular perturbations among older individuals, both without past incidents of falls and among fallers, led to more substantial abilities to increase vertical loading compared to age-matched controls. Demonstration of increased loading might serve as a basis to facilitate stepping strategies among older people.
METHODOLOGY--All data were gathered using the NeuroCom Equitest device, from which absolute voltage values from force transducers positioned in the corners of a moveable platform were gathered and converted to forces. Each of 12 sessions consisted of 30 angular (66°/sec, 8° arc) toes-up perturbations, with each perturbation presented randomly but requiring subjects to demonstrate less than 1° of sway. After six sessions, subjects were randomly assigned to training or control groups. Training consisted of feedback displayed as a bar graph, the height of which was proportional to the magnitude of sway, starting at a median value of the first 6 sessions. Among nonfallers mean age was 72 for trainers and 73 for controls (total N=11), while among fallers, the mean ages for trainers and controls were 73.8 and 72, respectively. Loading responses were analyzed in 75 msec time bins, designated T1-3 to represent the time of occurrence of segmental, long latency, and integrative responses.
PROGRESS--Data analyses from nonfallers showed that trainers decreased vertical loading relative to baseline with the largest decline occurring in T3. No correlation was seen between loading values and clinical balance test performance. Thus, despite being trained to increase loading, subjects still seek to constrain their responses. To date, there appear to be no statistically significant differences among the two faller groups.
FUTURE PLANS--A more practical approach to using force feedback would be to train for changes in sway rather than vertical loading, and future efforts will be directed toward exploring this approach. In addition, our Tai Chi work has demonstrated that older people can delay the onset of falls with this intervention. We plan to examine whether Tai Chi forms can be better learned and retained through practice on balance devices from which older subjects can receive intermittent feedback.
[102] EXERCISE PROGRAM DESIGNS FOR OLDER ADULTS
Lisa Boyette, MEd; James E. Boyette, MS
Atlanta VA Medical Center, Rehabilitation Research and
Development Center, Decatur, Georgia 30033; email:
Boyette.Lisa_W@Atlanta.VA.gov
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E825-3RA)
PURPOSE--This 2-year study will develop an expert system that creates individualized exercise plans for older adults using factors, or determinants, that affect exercise initiation and adherence. These plans can be used by practitioners at VA hospitals and other health care facilities during regular physical examinations and routine medical visits of older adults to help them initiate and adhere to exercise programs. The expert system will focus on personal, environmental, and activity characteristics that act as incentives and barriers to exercise initiation.
METHODOLOGY--A knowledge base of factors and recommended strategies that affect exercise in older adults will be compiled by extensive literature review and critiqued by local and national professionals with expertise in the fields of medicine, exercise physiology, health promotion, exercise psychology, psychometry, and gerontology. Using case study analyses, these professionals will develop a rule base to define the relationships between the determinants and the recommended strategies. The knowledge base will then be translated into a diagnostic questionnaire and implemented as a computerized expert system to be validated by local and national experts.
Case studies of older adults will be analyzed using the expert system. The analyses will focus on examination of the exercise plans created by the expert system in response to each case study subject's profile on exercise initiation and adherence determinants. A priority ordering will be assigned to the determinants based on their importance in creating recommended strategies. Discrepancies between recommended strategies in the plan and expert opinion will be cross examined until group consensus is reached concerning the appropriateness of the exercise plan developed for each older adult.
PROGRESS--A Physical Exercise Profile (PEP) questionnaire has been expanded to assess 29 determinants that relate to exercise behavior in older adults. The output of the expert system includes a client's report consisting of a customized exercise prescription, recommended strategies, and an exercise knowledge sheet. Another system output is the practitioner's report consisting of the client's exercise prescription, summary of determinants, and exercise preferences.
FUTURE PLANS--We plan to measure the effectiveness of the exercise expert system on exercise habits by examining exercise patterns of two groups of ambulatory elderly individuals, one group receiving the exercise assessment and counseling protocol (EACP). The key behavioral outcome, adherence to an exercise regimen, will be investigated by self-report data using the EACP and by testing of strength, aerobic, and flexibility measures. The second objective is to measure the impact of the EACP on quality of life, health maintenance, and functional status.
[103] BEHAVIORAL AND FUNCTIONAL PROBLEMS IN DEMENTIA PATIENTS WITH SENSORY LOSS
Bettye Rose Connell, PhD
Rehab R&D Center on Aging, Atlanta VA Medical Center,
Decatur, GA 30033; email: BRConnell@aol.com
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E2044-2RA)
PURPOSE--This 2-year study will describe the functional and behavioral problems experienced by demented nursing home residents with sensory impairments, analyzing the relationships among cognition, vision, hearing, functional status, and behavioral disturbance in this population. Interventions with the potential to reduce excess disability in self-care functioning and dementia-related behavioral disturbance will be identified. Long-term study results will be used to focus controlled intervention studies.
METHODOLOGY--The familiarity of nursing home staff with the health status and daily functioning of their residents will be coupled with clinical testing to characterize cognitive and sensory status, along with functional and behavioral problems. Quantitative analyses will isolate the relative contributions of cognitive and sensory status, providing an empirical base for expectations about the magnitude of effect of different interventions and laying the groundwork for controlled intervention studies. Observations of the staff regarding possibly efficacious interventions will be identified through the use of focus group methods and combined with expert opinion based upon the empirical findings of the study to identify promising interventions that deserve further study. The project team has particular interest in environmental interventions that will improve the functioning and well-being of residents with dementia and vision loss, as well as in strategies for staff that will enable them to assist individuals in maximizing the benefit they achieve from existing environmental resources. All subjects will be recruited from the ECRC at the Durham VAMC and the ECRC and geripsychiatric program at the Salisbury VAMC. Geriatric and vision researchers at both sites who also have clinical experience with the study population will collaborate in the study.
PROGRESS--The research staff has been trained in data collection protocols. Interrater reliabilities are being established. Current resident populations are being screened to identify the pool of eligible subjects.
INITIAL RESULTS--No data have been collected at this time.
[104] EVALUATION OF INTERVENTIONS TO PREVENT ELOPEMENT AMONG NURSING HOME PATIENTS
Bettye Rose Connell, PhD; Jon A. Sanford, MArch
Rehab R&D Center on Aging, Atlanta VA Medical Center,
Decatur, GA 30033; email: BRConnell@aol.com;
JASanf@aol.com
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E759-3RA)
PURPOSE--This study evaluates electronic wanderer alarm systems and access to secure outdoor space--widely used environmental interventions to control elopement or exiting among dementia patients in long term care settings. Questions examined are: Do less aversive alarm signals (voice message) and access to a secure outdoor space affect the frequency of actual or attempted elopement incidents? Is there a difference in the average time that elapses between an incident and staff response with alarms with conventional and less aversive auditory signals? And do less aversive alarm system signals and access to a secure outdoor space impact resident mood and behavior and staff ratings of job stress?
METHODOLOGY--A single subject, multiple baseline methodology was used to collect baseline data, followed by step-wise implementation of two interventions. During the baseline, a wanderer alarm with conventional signal (loud and aversive) was in operation. One intervention entailed modifying the wanderer alarm system signal to a less aversive sound (i.e., verbal announcement that a fictitious staff has a visitor). The second intervention provided wanderers with access to a secure outdoor space adjacent to the unit. Intervention order was varied across sites. The frequency of actual and attempted elopement incidents as well as staff response times were documented by automated video recording at exits from the unit. Standardized instruments were used to measure other dependent variables. The project is being completed at three sites.
PROGRESS--Data collection has been completed at two sites and is underway at the third site. Data coding, including screening videotapes for observational data, and input has been completed at two sites. Data have been reviewed for accuracy, and preliminary data analysis has been completed for one site.
INITIAL RESULTS--Preliminary data on the frequency of incidents and other subject ratings are reported here for the three subjects at one site. The total number of incidents observed for the subjects ranged widely (N= 37, 329, and 868) over the 8 mo of observation. The frequency of incidents was compiled by weeks and compared across phases for each subject. Comparison was by visual inspection of graphed frequencies and examination of mean frequencies and associated 95 percent confidence intervals (box and whisker plots) for each phase by subject. There was a decline in the absolute number of incidents across phases for all subjects. However, box and whisker plots indicate that there was no meaningful decline in the frequency of incidents between the baseline and the first intervention (access to outdoor space) for any of the subjects. For the two most frequent elopers, there was a decline in frequency of incidents between the baseline and the second intervention (verbal message) and between the first and second interventions. These two subjects' gait, balance, and mobility, as rated by clinical staff, changed little during the observation period, suggesting that the observed declines in incidents are not explained by loss of ambulatory function. Although introduction of the interventions appear to have been related to an overall reduction in the frequency of elopement for these subjects, they do not appear to be related to any substantive changes in other domains of disruptive behavior during the observation period. In conclusion, the replacement of an aversive alarm signal with a verbal message appears to be a promising intervention, at least for some demented wanderers. However, it should be noted that the outdoor space feasible at this site lacked some characteristics that are believed to be important in attracting residents at risk of elopement to the space and away from exits.
[105] QUANTITATIVE POSTUROGRAPHY: AGE-RELATED CHANGES IN POSTURAL STABILITY
James J. Collins, PhD; Ann E. Pavlik, BS; Carlo J. De
Luca, PhD; D. Casey Kerrigan, MD; Lewis A. Lipsitz,
MD
NeuroMuscular Research Center and Department of
Biomedical Engineering, Boston University, Boston, MA 02215;
Spaulding Rehabilitation Hospital and Harvard Medical
School, Boston, MA 02114; Hebrew Rehabilitation Hospital and
Harvard Medical School, Boston, MA 02131; email:
collins@enga.bu.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E720-3RA)
PURPOSE--Older adults exhibit problems in posture and balance. These disorders predispose the elderly to falls, which are a common cause of trauma and the largest single cause of accidental deaths among the aged. Despite the severity and frequency of this problem, postural instability in the elderly remains a poorly understood phenomenon. In this study, our objective was to study how the natural aging process affects the neuromuscular mechanisms involved in balance control.
METHODOLOGY--We examined 200 healthy subjects (aged 19-90 years) under quiet-standing conditions. Males and females were included. Each subject's postural stability was evaluated using a force platform to measure the displacements of the center of pressure (COP) under the feet. The COP time series were analyzed as one-dimensional and two-dimensional random walks, according to stabilogram-diffusion analysis. Stabilogram-diffusion analysis leads to the extraction of repeatable COP parameters that can be directly related to the resultant steady-state behavior and functional interaction of the neuromuscular mechanisms underlying the maintenance of upright posture.
PROGRESS/RESULTS--Our findings concerning healthy young subjects (<30 yrs) and healthy elderly subjects (>70 years) were consistent with our earlier studies. In general, we found that the steady-state behavior of the open-loop postural control mechanisms in the elderly is more positively correlated and therefore perhaps more unstable: the output of the overall system has a greater tendency to move or drift away from a relative equilibrium point over the short term. In contrast with this result, we also found that the steady-state behavior of the closed-loop postural control mechanisms in the elderly is more negatively correlated and therefore perhaps more stable: over the long term, there is an increased probability that movements away from a relative equilibrium point will be offset by corrective adjustments back toward the equilibrium position. In addition, we found that the elderly utilize open-loop control schemes for longer time intervals and correspondingly larger COP displacements during periods of undisturbed stance. This finding suggests that in the elderly the threshold at which postural feedback mechanisms are called into play is elevated.
[106] RANDOMIZED CONTROLLED TRIAL OF UPPER-EXTREMITY EXERCISE TRAINING IN PATIENTS WITH COPD
David Sparrow, DSc; Daniel Gottlieb, MD; Steven
Lieberman, MD; Eric Garshick, MD; Richard Schwartzstein, MD;
Bartolome Celli, MD
VA Medical Center, Boston and Brockton/West Roxbury, MA;
email: sparrow.david@boston.va.gov
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E2010-RA)
PURPOSE--Randomized controlled trials have demonstrated that lower-extremity (LE) exercise training leads to improved exercise tolerance and decreased dyspnea in persons with chronic obstructive pulmonary disease (COPD) and is therefore routinely included in rehabilitation programs. Physiologic data suggest that those with COPD may benefit from the addition of upper-extremity (UE) training because of its effect in strengthening shoulder-girdle musculature that serves as accessory muscles of respiration. These muscles are particularly important in COPD patients, whose diaphragmatic function is impaired by lung hyperinflation. Because of the key role of UE activities in daily life and the important contribution of shoulder-girdle musculature in COPD subjects, we hypothesize that UE training may substantially enhance the quality of life (QOL) and functional status of many individuals with COPD. We further hypothesize that these benefits may be greatest in the elderly, whose initial level of fitness is expected to be lower than that of younger persons. The overall goal of the proposed project is to test these hypotheses by means of a randomized controlled trial.
METHODOLOGY--In this trial, clinically stable COPD patients aged 50-79 years are randomized to an experimental group receiving LE exercise training plus unsupported UE exercise training or to a control group receiving LE exercise training alone. Subjects are recruited from the Boston and Brockton/West Roxbury VAMCs. Each training program consists of three 40-min sessions per week for 8 weeks; it is recommended that subjects continue to exercise upon completion of the 8-wk training session. The primary outcome variables include measures of disease-specific QOL, baseline and exertional dyspnea values, and results of a simulated activities of daily living (ADL) test. Other outcome variables of interest include the 6-min walk distance, determinations of maximal O2, and anaerobic threshold.
PROGRESS--To date, study activities have focused on screening and enrollment.
PRELIMINARY RESULTS--No preliminary information is available yet.
FUTURE PLANS--Approximately 100 subjects will be randomized in this study during the enrollment period. Outcomes will be assessed at three time points: at entry into the study, immediately after the 8-wk exercise program, and 6 mo after completion of the exercise program.
[107] RISING FROM THE FLOOR IN OLDER ADULTS
Neil B. Alexander, MD; Jessica Ulbrich, BS; Aarti Raheja;
Dwight Channer, MS
Geriatrics Center, University of Michigan, Ann Arbor MI
48109-0926; GRECC, VA Medical Center, Ann Arbor MI, 48105;
email: nalexand@umich.edu
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #E2023-RC)
PURPOSE--Difficulty in rising from the floor after a fall is common in older adults; it is associated with substantial morbidity and tends to be underappreciated. Many are unable to get up after a fall without assistance, even though they have not sustained a major injury. Thus, the inability to get up after a fall is not simply a consequence of a fall-related injury. Despite the high risk of difficulty in getting up, few therapists teach older adults how to do it. The purpose of the present study was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ according to initial body positions and with or without the use of an assistive device. We hypothesized that with increased age and physical impairment, success in rising would decrease, and in successful rises, the rise speed would decrease. We also hypothesized that starting from a hands and knees position and using a low-lying piece of furniture for support would increase floor rise success and decrease the time of successful rises. These data can serve as the basis for understanding how rising from the floor changes with age and with underlying disease-associated impairments and for developing training methods to improve floor rise ability.
METHODOLOGY--We videotaped young adult controls (YA: 12 male, 12 female, mean age 23), healthy older adults (HO: 12 male, 12 female, mean age 73), and congregate housing older adults (CO: 32 female, 6 male, mean age 80) as they rose from a variety of starting positions on the floor. The HO females (n=12, mean age 75) and a subset of the CO females (n=27, mean age 81) were identified for further analyses. Subjects rose from controlled initial body positions (supine, on side, prone, all fours, and sitting), either with or without the use of furniture support. Outcomes included whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position.
RESULTS--Older persons had more difficulty rising from the floor than YAs: HOs took twice as long to rise (HO range 2.4-6.4 s, YA 1.4-3.1 s), while COs took two to three times as long as the HOs (CO range 6.4-15.5 s). While all YAs and HOs rose from every position, a subset of the COs were unable to rise from any position, 24 percent when attempting to rise without a support and 13 percent when attempting to rise with a support. COs were most likely to be successful when rising from a side-lying position while using furniture support. The more able COs, as well as the other groups, rose more quickly and admitted to least difficulty when rising from the all fours position.
IMPLICATIONS--The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.
[108] MINIMIZING FALLS IN THE ELDERLY
Michael L. Boninger, MD; Charles J. Robinson, DSc, PE;
Susan Whitney, PhD; Mark S. Redfern, PhD; Mark C. Musolino,
BS
Department of Orthopaedic Surgery, Division of Physical
Medicine and Rehabilitation, University of Pittsburgh
Medical Center, Pittsburgh, PA 15213-3221; Human Engineering
Research Laboratories, Veterans Affairs Medical Center,
Pittsburgh, PA 15206; Departments of Rehabilitation Science,
Technology, and Physical Therapy, Schools of Health and
Rehabilitation Science, Departments of Otolaryngology and
Industrial Engineering, Schools of Engineering and Medicine,
University of Pittsburgh, Pittsburgh, PA 15261
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #A831-2RA)
PURPOSE--Almost one-third of all ambulatory people over the age of 65 and not in nursing homes fall each year. Such falls are a major source of serious injury, morbidity, and mortality in the elderly population. Even in cases that do not cause injury, the fall itself may result in an increased sense of fear, less independence, curtailed activity, and a higher morbidity rate associated with inactivity. In previous studies, peripheral neuropathy, decreased proprioception, increased reaction time, and decreased strength have all been independently associated with an increased risk of falling. In addition, separate, but related, research has shown that taping the ankle can improve reaction time and strength in young athletic subjects with a history of ankle sprain. The aim of the present study is to determine the efficacy of two different ankle wrapping techniques as interventions to falling.
METHODOLOGY--A commercially available elastic ankle wrap, and a common method of ankle taping were used on two different groups of elderly subjects: fallers (those who have fallen two or more times during the 6-mo period prior to testing) and nonfallers. The neuromuscular condition of the legs was evaluated for each subject prior to testing. This evaluation consisted of a nerve conduction study as well as a physical examination. Subjects performed a series of tests designed to allow measurement of physical parameters that have been correlated to falling, including:
Measures of sway were made, using a commercially available platform equipped with force transducers, designed to monitor center of pressure data. Muscle responses were measured for the gastroc, peroneus longus, anterior tibialis, and gluteus minimus muscles, and recorded through a series of four surface electrodes placed accordingly. Comparisons of the measured parameters were made among the ankle wrap, the tape, and a control group (no ankle support at all) to determine which of these wrapping techniques, if either, may act as an effective intervention to falling in the tested population.
PROGRESS--Thirty-nine subjects have been tested. The protocol was modified after testing the first, and again after testing the second. As such, these two were considered trial subjects and have therefore been excluded from the main testing groups. Of the remaining 37 subjects, there are 17 fallers and 20 nonfallers; all completed the entire testing procedure.
PRELIMINARY RESULTS--Preliminary analysis shows a greater incidence of nerve conduction studies abnormalities in the falling group when compared to the nonfallers. Although not unexpected, if this finding proves to be statistically significant it will be the first time it has been shown in a prospective fashion. Preliminary analysis also indicates that taping the ankle may improve measures of sway in fallers who have normal nerve conduction studies.
FUTURE PLANS--We plan on completing the analysis of all of our data. We expect to learn more about nerve function in fallers and the effect of nerve function on measures of balance. We plan on using the experimental and clinical data to design and test a low cost orthosis that more closely mimics the effects of tape and thus may help prevent falls.
[109] LONG-TERM EVALUATION OF MAXILLARY SINUS BONE GRAFTS WITH DENTAL IMPLANTS
Jon Tom McAnear, DDS; Marden E. Alder, DDS; Pirkka V.
Nummikoski, DDS
South Texas Veterans Health Care System, Audie L. Murphy
Memorial Veterans Hospital Division, San Antonio, Texas
78284-0001
Sponsor: Department of Veterans Affairs, VA
Rehabilitation Research and Development Service, Washington,
DC 20420
(Project #A649-3RA)
PURPOSE--Dental implants can greatly improve oral function. However, many candidates for implants have resorbed too much bone to support maxillary implants. Our initial studies were designed to determine if autologous cortico/cancellous bone grafts from the ilium to the maxillary sinuses will mature (consolidate) and support titanium cylindrical implants, which will in turn support a fixed prosthesis that can withstand the masticatory forces of a similar prosthesis in the mandible. It is expected that this protocol will determine whether the bite force will be less than, remain the same, or improve over that documented in our prior study and if the bone density at implant/graft bone interface will be less than, equal to, or greater than at implant/native bone interface. Bone loss (height) at implant/bone interface will be measured.
METHODOLOGY--An attempt to recruit the 20 subjects who have completed the treatment protocol in our prior studies will be made. Each participating subject will have an axial computed tomography scan, from which bony dimensions, volume and density of the grafts will be measured using the Image Analysis Workstation at the UTHSCSA Dental School. These scans will be accomplished during the first and third years of the protocol. Periapical radiographs will be taken with standardized projection geometry method in the Longitudinal Radiographic Assessment clinic at UTHSCSA and analyzed with digital image analysis methods. Bite force will be determined utilizing a gnathodynamometer with bilateral cross-arch bite element with results recorded on an X-Y plotter and reported in pounds force.
PROGRESS--All 20 subjects were contacted; 18 agreed to take part in this 3-year protocol. Fifteen have finished their first year evaluations; the other three are scheduled.
RESULTS--No data have been analyzed.
FUTURE PLANS--We will finish the required measurements, start the evaluation of the data obtained, and present for publication.
[110] A STUDY OF POLICY BARRIERS IMPEDING USE OF ASSISTIVE TECHNOLOGY BY PERSONS AGING WITH DISABILITIES
Phoebe S. Liebig, PhD; Debra J. Sheets, RN; Mary
Froehlig, BA
Andrus Gerontology Center, University of Southern
California, University Park, Los Angeles, CA
90089-0191
Sponsor: Rehabilitation Research and Training Center on Aging with Disabilities, Rancho Los Amigos Medical Center, Downey, CA
PURPOSE--The two primary objectives of the study are the investigation of the adequacy of current policies on AT for persons aging with or into disability and the identification of the need, if any, for policy changes. In addition, project staff are providing assistance in the analysis of consumer data on AT that will describe current patterns of AT use and recent changes in patterns of use; examine the impact of AT on health status and on quality of life issues; and identify the barriers, both attitudinal and financial, which may limit access to AT.
METHODOLOGY--Both state- and consumer-level policy research is being conducted drawing upon a variety of methods, including review of existing federal, state, and consumer-level policy reports and research; interviews with key informants; additional analyses of national survey data; and conducting additional project studies to identify consumer issues and investigate state policy efforts.
PROGRESS--Accomplishments to date include: 1) a nationwide survey of state rehabilitation agencies that will identify the extent to which state rehabilitation agencies are knowledgeable about the AT needs of, and serve as providers for, middle-aged and older adults; 2) a study of 10 State Units on Aging (SUAs) in states identified as having high levels of effort in AT and home modifications (HM); 3) a nationwide survey of state legislative analysts about a variety of state policies affecting AT; 4) an analysis of RESNA consumer data on adults age 40 and older to determine particular problem areas, unmet needs, types of problems encountered, and receipt of AT information and referral services; 5) an analysis of AT data from the 1990 National Health Interview Survey (NHIS) to examine the types and use of AT among older adults and identify barriers to access; and 6) an analysis of data from a study of SUA and State Tech Act Projects conducted in 1995 by the American Society on Aging.
RESULTS--State-level policy analyses indicate that much remains unknown about the AT activities of individual states. Some states do, however, stand out as leaders in the area of AT and a survey of aging agencies in exemplary states was conducted to gain an understanding of why this is the case. Preliminary consumer-level analyses suggest that significant changes in function occur over time among people aging with long-standing disabilities and that AT needs change correspondingly. Additional analyses are planned to identify barriers to use of and access to AT.
FUTURE PLANS--Three studies will be completed during 1997/98. First, analyses are underway using data from the survey "Changing Needs and Life Circumstances of Persons Aging with Disabilities." Our section of the survey focuses on policy relevant issues including information-seeking related to acquisition of AT; use and abandonment of devices; funding patterns; changing needs over time, and unmet needs for AT. Approximately 350 surveys have been completed. Second, data from the national "Survey of State Rehabilitation Agencies" have been collected. Analyses are underway to examine AT issues including agency policies, interagency networks, state initiated AT policies and programs, agency decisionmaking, budget allocations affecting provision of AT, and organizational structures. Third, data from a survey of 10 SUAs in states identified for their exemplary efforts in the area of AT/HM are being analyzed to gain insight into efforts to meet the needs of older adults with disability.
[111] ACCESS TO PRODUCTS FOR CONTINUED INDEPENDENCE FOR ELDERLY AND DISABLED PERSONS
Geb Verburg, MA; Bianca Stern, BSc, OT; Hans Kunov, PhD,
PEng
Bloorview MacMillan Centre, Toronto, ON Canada M4G 1R8;
Baycrest Centre for Geriatric Care, Toronto, Ontario,
Canada; Institute of Biomedical Engineering, University of
Toronto, Toronto, Ontario, Canada
Sponsor: None listed
PURPOSE--This project will develop and evaluate software programs called Intelligent Assistive Device Identifier (IADI), and Remote Computer Accessibility Assessment (RCAA).
The IADI is a self-description and activity limitation description program which allows a person or their caregiver to describe themselves in terms of their disabling conditions and/or the activities they wish to perform, but have difficulties accomplishing. The objectives of the system are to promote freedom of choice and independence, enabling people to define their own functional problems and be presented with a product listing from which to select assistive technology products for maximizing their independence; to provide information to the public to overcome the barriers of access to information about assistive devices and technology (AT); to provide information to health professionals that will save them time and enhance their ability to recommend the appropriate AT for specific and complex disabilities; and to provide information to public and private insurers to aid in their cost/benefit assessment procedures for AT coverage.
The second program, RCAA, will provide a specialized assessment protocol to determine computer input needs. The RCAA will guide the user through a series of ever more specific questions regarding the user's abilities, resulting in information and recommendations for input technologies.
PROGRESS--A consortium consisting of Baycrest Centre
for Geriatric Care, University of Toronto, and Bloorview
MacMillan Centre was established to seek commercial and
other sponsors for this project.
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Last revised Fri 04/30/1999