Fall Clinical Trial
Official title:
Effects of Balance Training on Fall Risk and Mobility in the Elderly
Pakistan is a country devoid of health-care facilities and training programs on fall prevention. There is lack of research, awareness and implication of geriatric rehabilitation on elderly population addressing balance and fall risk assessment however very few cross-sectional studies of poor quality evidence are available on this issue. To best of investigators' knowledge, no interventional studies have been conducted in our country so far on this topic. . We aim to use a integrated method of balance training that uses patients judgment, visual feedback, proprioception and balance training with the help of new technology/devices to improve balance. And compare it to conventional treatment. We also aim to assess risk factors of fall in geriatric population, decreasing risks of falls and increasing awareness regarding geriatric rehabilitation and balance training.
Balance is use of multiple systems of the body including auditory, motor, visual, vestibular
and nervous to keep body staying inside limits of stability. It includes maintaining posture
under different conditions in standing or sitting, ability to facilitate movement and to
recover and stay in limits of stability after external (Trip, push, slip) and internal (body
movements) protuberance. Impaired balancing system of body results in increased risk of fall
which is major cause of mortality and morbidity in geriatric population.
A report of 2014 stated that Pakistan has 12.13 million population of Age 60 years and above
which is expected to rise to 17.53 Million by year 2025. According to a study 30-50 % of
population of age 65 years and above have some problems with balance. Another study states
that 75 % of people aging 70 years and above have balance impairments which leads to fall.
Additionally number of conditions including poly pharmacy, female gender, visual problems,
environmental problems and cognitive issue contribute to in fall risk and balance problems.
One of the major goal of Balance re-education is to decrease fall risk. Literature has
suggested that one of the most effective methods of reducing falls in geriatric population is
to prophylactically intervene on multiple risks factors of fall. This includes outpatient
balance training and fall risk assessment.
Force plate systems and mirrors which are the part of visual biofeedback are often used for
treatment of balance disorders but are found to have no difference in educating compared to
conventional management. In current era technology has advances to a great extend and new
systems that quantifies balance and provide a reliable and valid data regarding balance which
then can be used in formation of balance training plan. These systems can also be used for
treatment purposes and also have various visual feedback systems for more educational
benefits. One of these systems is Biodex balance system which is used for balance and
postural reduction, increase proprioception, somatosensory and neuromuscular control. It
incorporates patient data saving and printing system for record management and uses an
integrated system which involves patient in activities of re-education with relation to
visual feedback to accommodate body accordingly.
As mentioned earlier Falls result in high morbidity and mortality among geriatric population
which leads to increased costs and need for rehabilitation services. Falls are brought about
by detrimental effects of aging on postural control as a result of deterioration in
neuromuscular and sensory mechanisms, physical inactivity, pre-existing pathology and use of
medications. However, balance training and exercise interventions tend to decrease risk of
falling and eventually fall itself. Moreover, conventional balance training programs have
decreased adherence; hence, sensor-based training programs have been advocated. These
programs have quiet good advantages including visual feedback with interactive environment
and targeted interventions. This exercise system incorporates human-computer interface
providing a three-dimensional and real-time feedback.
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