The change of gross motor function level using the Simple Motor Test for Cerebral Palsy (SMTCP) in children with cerebral motor disorders was investigated in 117 inpatients hospitalized together with their mothers and 277 outpatients at 12 hospitals and homes for physically handicapped children. A one-level improvement was observed mostly in the inpatient group hospitalized together with their mothers, indicating that reliable improvement can be expected by attentive and intensive care even in patients with advanced cerebral palsy. Although, depending on disease type and its severity, there are some variations in the ease of improvement in the gross motor function level, it is important to design a reasonable training program for elevating locomotion activity by 1 or 2 grades from the level of grade “0: not able”. On the other hand, aggravated cases were more frequently observed in the outpatient cerebral palsy group and less in the inpatient group. Necessary treatment for the aggravated outpatient group included attentive care giving appropriate instructions for daily achievable training and grasping the situation of every day living. Also, depending on the circumstances of the patients and their parents, an increased frequency of outpatient training or treatment with hospitalized intensive training sessions is considered necessary.

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The objective of this retrospective study was to investigate the effectiveness of preventive measures taken against escape from the ward or hospital. We compared two groups of brain injured patients who were admitted before and after preventive measures were taken. The number of patients included in this study was 140 for the before group and 107 for the after group. After preventative measures were taken, the percentage of patients who successfully escaped from the ward was reduced from 22.1% to 7.5% and the percentage of patients who mounted unsuccessful escape attempts increased from 7.9% to 15.0%. This indicates that our preventive measures worked effectively. On the other hand, the percentage of patients who successfully escaped from the hospital remained the same. This revealed a limitation of our measures. An analysis of ten patients who escaped from the hospital revealed the characteristics of the high-risk patients: they all could move independently on foot or with a wheelchair. Five escapes had severe cognitive dysfunction with disorientation and memory disturbances. However, the other five patients had only relatively mild cognitive problems.

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Fall prevention is one of the major issues in health care in our aging society. The aim of this review is to provide useful information for researchers and practitioners who plan to start fall prevention programs for elderly persons with various risk levels and in different settings. Fifty-three randomized controlled trials (RCTs) and several meta-analyses retrieved with extensive literature search formed the basis for this review. Available evidence suggests that several preventive strategies have been proven beneficial in fall prevention. For the community-dwelling elderly, two RCTs and one meta-analysis demonstrated that an individually tailored home exercise program provided by nurses or physical therapists could reduce the rate of falls and injuries. One RCT suggested that Tai Chi Chuan might have a high potential to reduce falls. Two large RCTs indicated that programs including group exercise classes could also reduce the number of fallers. For people with known risk factors living in the community, three RCTs showed that home visits to address multiple risk factor modification were an effective way to reduce falls. One RCT with a relatively small sample showed that psychotropic withdrawal reduced falls in elderly persons taking psychotropic medication. A subgroup analysis of one RCT showed that home hazard reduction at hospital discharge reduced subsequent falls in patients with a past history of falls. However, more evidence is needed to prove its effectiveness, because this effect was also observed outside of homes. Dual chamber pacemaker for elderly persons with hypersensitive carotid sinus, who were detected when investigated for undiagnosed falls, markedly reduced subsequent falls with or without syncope. In institutional settings, two RCTs showed that comprehensive risk assessment and modification reduced the rate of falls and fractures or the number of recurrent fallers. Three RCTs performed in hospital settings failed to show any effectiveness. However, a meta-analysis of 3 controlled trials and 7 cohort studies with a historical control suggested that fall prevention program in hospitals could be promising. There are some methodological problems in fall prevention research such as the definition, measures, and monitoring method of falls, inadequate sample size and a short follow-up period. In the future, we need research based on strong and comprehensive methodological designs.

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The second part of the review discusses some important issues associated with fall prevention and future perspectives on fall related research. Currently, many kinds of interventions are available for the treatment of patients suffering from osteoporosis, i. e. nutritional supports, medications acting on bone metabolism and exercise. However, a series of meta-analyses showed that only alendronate and risedronate have been proven to prevent non-vertebral fractures in persons with osteoporosis. Anaerobic and weight bearing exercises are known to have a positive effect on the bone mineral density of the spine. There is, however, no reliable data for fracture prevention with exercise alone. Also, the synergistic effect of a combination of these interventions has not been clearly proven. Although there is evidence that the use of hip protectors in institutional settings reduces the rate of hip fractures, this approach faces the problem of patient acceptance and compliance. Psychosocial problems related to falls such as fear of falling, post-fall syndrome and cost-effectiveness of the prevention programs are becoming increasingly important in elderly health care, but little evidence of such has been reported in the literature. In future perspectives on fall relared research, a theory-based approach for fall prevention needs to be included to explore more effective interventions. We must also consider the double-edged effects of interventions that may increase certain fall risk factors while reducing another. Especially, the relation between activities and incidence of falls is important to consider, because increased activity itself may increase the chance of falls. When applying exercise or rehabilitative approaches, the interaction between falls, activity levels, frailty, and injury must be studied much more carefully. In addition, one has to always think about what is the true aim of a program, because the aim of fall prevention goes beyond preventing falls. Although some research has so far been conducted in Europe and the U. S. A. by researchers and practitioners in various fields, the quantity and quality of fall prevention research are still lacking and the available data is therefore insufficient to suggest appropriate decision-making in clinical practice. Especially in Japan, there have been only a few RCTs to determine the effectiveness of fall prevention programs. Because there are many differences in the characteristics of our native population and health care systems vs those of Europe and the U. S. A., it is a critical issue for us to establish fall prevention programs suited to Japanese population and health care system.

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