Physical Therapies and Related Treatment in Falling and Rehabilitation in the Elderly

Background: Postural instability has a major impact on the mobility and daily life activities of Parkinson’s disease (PD) patients as it often leads to reduced mobility, insecure stance and falls. The aim of this study was to evaluate the effect of focal vibration on the static and dynamic balance of a group of Parkinson’s disease patients. Methods: Twenty-three idiopathic PD patients (14 M; 9 F), Hoehn and Yahr (HeY) stage II–III, underwent three weeks of focal muscle vibration applied to the quadriceps, soles of the feet and trapezius muscles bilaterally in addition to conventional physiotherapy. The static and dynamic balance was assessed at baseline (T0), after 3 weeks of treatment (T1) and after 1 month from the last treatment (T2) with the Tinetti scale and stabilometry evaluations. Results: There was a statistically significant improvement in the mean Tinetti score at T1, and in the Romberg area (CE/OE) of oscillation and oscillation velocity on the x-axis with the eyes closed at T2. Conclusions: Focal muscle vibration in conjunction with physiotherapy is a useful tool in the rehabilitation of gait and balance disorders of patients with Parkinson’s disease HeY stage II–III. Full article

Background: It is known that lower-limb muscle strength is easily maintained in elderly people who practice Tai Chi, although it is necessary to maintain lower-limb muscle strength even as age increases in order to prevent falls. However, the effect of long-term Tai Chi practice and age on lower-limb ability is unclear in middle-aged and elderly people. This research was designed to compare lower-extremity parameters during a countermovement jump between middle-aged and elderly individuals who frequently practice Tai Chi Chuan and individuals in the general population who constituted the healthy group. Methods: There were four groups, and each group included 12 participants. Ten Vicon motion system infrared cameras and two Kistler force plates were used. The data were standardized and analysed using independent-measure two-way ANOVA. Results: The statistical results showed that there was no interaction between the age factor and exercise type factor. The statistics of age factor also showed that age may decrease the jump height (36.36%), peak knee power (24.74%) and peak ankle power (21%) during the take-off phase. In the exercise type factor, long-term Tai Chi training significantly increased the jump height (60%), peak knee moment (19.80%), peak ankle moment (8.06%), peak hip power (29.80%), peak knee power (31.23%) and peak ankle power (16.88%) during the take-off phase. Conclusion: This study shows that long-term Tai Chi training can slow ageing-related functional decline. According to the results of this study, middle-aged and elderly people are encouraged to regularly perform Tai Chi exercises to increase the strength of various muscle groups in the lower limbs and slow the lower-limb muscle changes caused by ageing. Full article

Knee osteoarthritis (KOA) is one of the most common public health problems which cannot be cured and ultimately leads to disability. Current management is largely limited to the treatment of the symptoms. To avoid the late stages of KOA that lead to knee replacement, the key point is to control and reduce destructive processes using efficient pharmacological products combined with physiotherapy (PT). Herein, we perform a monocentric observational study to compare the effect of combining a multi-modal physiotherapy regime and intra-articular (IA) injection with hyaluronic acid (HA) on the non-surgical treatment of KOA. Patients with mild KOA were randomly assigned to two groups to receive an HA injection with PT or an HA injection only. The assessment tools for pain, clinical disease severity, and disability were the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (scores range from 0 to 96, with higher scores indicating worse pain, function, and stiffness), knee range of motion (ROM), pain on the visual analog scale (VAS), and muscle strength testing (MST). All tests were evaluated every 3 months up to 1 year from the baseline. The study enrolled 52 patients with ages between 47 and 61 years who were divided into two groups. Thirty-seven (n = 37) patients were randomized in the pilot group (PG) and received IA injections with the viscoelastic hyaluronic acid product (HA) combined with a multi-modal PT regime. The PT program included 10 sessions of transcutaneous electrical nerve stimulation, low-level laser therapy, ultrasound, physical exercise, and cryotherapy. Fifteen patients (n = 15) from the control group (CG) received the IA HA injections only. All patients were confirmed with mild KOA of Kellgren–Lawrence grade 2 on radiographs at the beginning of the treatment. The baseline characteristics, including the severity of pain and level of disability, were similar in the two groups. At baseline, the mean (±SD) WOMAC scores reported were 64.6 ± 4.08 in the CG and 64.5 ± 2.99 in the PG. Notably, at only 3 months into the study, the mean scores were significantly improved to 56.7 ± 5 in the CG and 48.27 ± 2.13 in the PG (mean between-group difference = 16.19 points; 95% confidence interval), finding favor for the combination of HA injections and physiotherapy. At the study’s endpoint (12 months), the scores were improved in both groups, with the mean between-group difference remaining significant (7.08 points, 95% confidence interval). A decrease in pain, as evaluated by the VAS scale, was reported for both groups, with the PG reporting a better VAS score that decreased from 5.7 to 2 when compared to the CG, which decreased from 5.7 to 3. The physical assessment parameters (ROM and MST) followed the same trend, with a rapid improvement in the ROM in the PG, changing from 98° to 115° in the first 3 months, and a slower and more steady evolution in the CG group, changing from 100° to 112° in 9 months. Herein, we report on the combination therapy of an intra-articularly administered HA viscoelastic product and a multi-modal physiotherapy regime, which can play a key role in the non-surgical treatment of KOA, effectively controlling pain, stiffness, and the ROM value and improving patients’ quality of life. Full article

Water-based rehabilitation is a well-known approach that is useful for the prevention and management of many conditions. Its application in the elderly is quite common in clinical practice, but scientific evidence is limited. We conducted a scoping review on geriatric water-based rehabilitation using a methodology borrowed from data science to investigate and discuss the extensive literature data. We searched the papers on PubMed and we used the abstracts to collect different data. We imported them into an electronic database and we used its filters to build different graphical representations. The filters allowed the selections of specific modalities of a variable and the following visualization of the values of the other variables linked to that selected modality. A total of 49 papers were found and they confirmed the safety and usefulness of water-based rehabilitation. Our analysis was able to show the relationships among the variables and the differences in the elements considered for the analysis. The current literature shows some limitations, especially concerning the article types in some specific diseases and the outcome measurements. Future research can overcome these limitations by collecting more data on the diseases that affect old people, even with the use of precise outcome measures. Our described methodology can be potentially beneficial and other studies may confirm its utility. Full article

A fall is an event where a person unintentionally and traumatically finds themselves on the floor or a lower level. Falls are very common, especially in the older adult population. One in four people falls at least once a year after age 65. Because of falls, there can be injuries, whereby there can be an impairment of health status. Fractures, reduced mobility, disability, and the need for institutionalization are potential consequences after falls. In older adult patients, especially frail ones, these types of complications are more common. There are several risk factors for falls. Falls generally result from a combination of factors operating simultaneously. Sarcopenia, cognitive impairment, or poly-pharmacotherapy are just a few examples of risk factors that are common in the older people. Through careful clinical evaluation, it is possible to identify risk factors and conditions predisposing to falls. In some cases, it is possible to correct these factors. Several types of treatment are available to restore the health status before the fall and prevent subsequent falls. Using multi-component interventions, the risk of falls can be effectively reduced. Aware that this review will not be exhaustive of such a broad topic, the purpose of this narrative review is to summarize relevant and recent evidence in the current literature to encapsulate fall-related risk factors, risk identification, fall prevention, and management, including various rehabilitation techniques. This article conforms to the Scale for Assessment of Narrative Review Articles (SANRA) guidelines. Full article