We investigated the postural control ability during perturbation in the elderly with dementia. Ten elderly with dementia and seven without dementia participated in this study. The perturbation was given randomly with the velocity of 100 mm/s and the amplitude of 50 mm five times. Center of pressure (COP) displacement in the anteroposterior direction and electromyography (EMG) of the tibialis anterior (TA) and the rectus femoris (RF) muscle were measured with the sampling rate of 2000 Hz. The length and the duration of the COP displacement, the latency of the muscle response and %IMEG (0-500 ms and 500-1000 ms after those latencies) of TA and RF were compared between the subjects with dementia and those without dementia. The length of COP displacement and %IEMG TA 500-1000 ms were significantly smaller in the elderly with dementia than those without dementia. On the other hand, the duration of COP displacement, the latency of TA and RF, %IEMG TA and RF 0-500 ms, and %IEMG RF 0-500 ms were not significantly different between those two groups. These results indicated that the subjects with dementia reacted to the perturbation without a delay compared to the subjects without dementia. However, the subjects with dementia kept their balance with the smaller displacement of COP and less contraction of TA compared to the subjects without dementia.

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The purpose of this study was to investigate the relationship between estimation error of perceived reachability and the number of falls among patients with hemiparesis. Subjects consisted of thirty-two chronic stroke inpatients (mean age 68.9±12.6 years) who were admitted to rehabilitation unit. Both perceived reachability and maximal reach distance of non-affected arm applying the functional reach test were measured at admission, and then absolute value of error distance between estimated and actual distance was calculated. The number of falls during hospitalization was obtained from the medical record, and the relation between fall and error distance was explored. Other assessments included age, sex, maximal reach distance, gait score of Functional Independence Measure (FIM), Brunnstrom's recovery stage, severity of sensory disturbance, and fear of falling. As a result a significant correlation was found between error distance and the number of falls (r=0.70, p<0.01). If subjects were divided into two groups (19 in non faller group, 13 in faller group), error distance of faller group was significantly larger than that of non faller group (p<0.01). In the stepwise logistic regression analysis, sex (odds ratio (OR)=0.62), gait score of FIM (OR=0.40) and error distance (OR=1.64) were detected as risk factors of fall. Discriminate analysis using regression model revealed a 85% correct prediction rate for fall. Moreover, 92% of subjects in faller group presented over 6cm error distance. These results suggest an estimation error of reach might be a simple and useful measure for discriminating high-risk falls in inpatients with hemiparesis.

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This study investigated the immediate effect of chest mobilization techniques in patients with chronic obstructive pulmonary disease (COPD). We measured pulmonary function, chest expansion, oxygen saturation (SpO₂),pulse rate and breathlessness in 16 COPD patients (13 male and 3 female, mean ± SD age 72.2 ± 6.2 yrs) before and after treatment. Chest expansion, defined as the difference in chest girth between the maximal inspiration and maximal expiration, was measured at three levels: the axilla, xiphoid and 10th rib. Breathlessness was measured with a visual analogue scale (VAS). Patients were treated with chest mobilization comprising rib rotation, chest wall rotation. lateral flexion of the chest wall, chest wall extension, and pectoralis major muscle stretch by expert physical therapists. Chest expansion at the level of 10th rib showed a significant improvement and pulse rate was significantly decreased after treatment. However, chest expansion at the other levels, pulmonary function, SpO₂ and breathlessness were unchanged. In the patients who also demonstrated a restrictive ventilatory impairment (vital capacity<80% predicted: n=11), chest expansion at the level of axilla, xiphoid and 10th rib all significantly improved and pulse rate was significantly lower after treatment. These results suggest that flexibility of the respiratory muscles and mobility of the costovertebral joints, facet joints and sternocostal joints may improve flowing chest mobilization. We recommend the use of chest mobilization technique in COPD patients, in particular those with a restrictive ventilatory impairment.

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