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    تاريخ التسجيل
    Nov 2016
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    Effects of hydrotherapy in balance and prevention of falls

    Effects of hydrotherapy in balance and prevention of falls among elderly women







    Nowadays, falls are one of the largest public health problems among elderly people due to the high morbidity, mortality and costs for the family and society. The main risk factors for falls in this population are related to functional limitations, history of falls, increasing age 1-4, muscle weakness, use of psychotropic drugs, environmental risks, the female gender and visual deficits. Researchers have reported that elderly women have a higher propensity for falls because of less lean body mass and muscle strength, a higher prevalence of chronic-degenerative diseases and exposure to domestic activities.
    To prevent falls, it is necessary to improve the reception conditions for sensory information from the vestibular, visual and somatosensory systems, so that the antigravity muscles are activated and balance is stimulated. One of the means applied for promoting the stimulation mentioned above is the practice of physical activities.
    Thus, it is recognized in the literature that physical activity practiced throughout life can diminish bone and muscle loss, and reduce the risk of fractures by up to 60%. In addition, physical activity promotes increased muscle strength, aerobic conditioning, flexibility and balance, and reduces the risk of falls and improves quality of life.
    Since long ago, hydrotherapy has been used as a resource for treating rheumatic, orthopedic and neurological diseases; however, it has only recently become the target of scientific studies. The physical proprieties of water, together with the exercises, can fulfill most of the physical objectives that are proposed in a rehabilitation program. The aquatic environment is considered safe and efficient for the rehabilitation of elderly people, because water acts simultaneously on musculoskeletal disorders and balance improvements.
    The multiplicity of symptoms such as pain, muscle weakness, balance deficits, obesity, arthritic diseases and gait disorders, among others, make it difficult for elderly people to perform exercises on the ground. The situation is different with exercises in an aquatic environment, where there is a reduction in joint overload and less risk of falls and lesions. In addition, floating allows individuals to perform exercises and movements that cannot be done on the ground.


    Methods
    This was a quasi-experimental pre/post study without a control group, carried out at the Elderly People's Association of Brazil, in Goiânia, State of Goiás. It was carried out following the ethical principles for research involving human beings, in accordance with Resolution 196/96 from the National Health Council. The study was approved by the Research Ethics Committee of the Universidade Católica de Goiás, under procedure number 0065.0.168.000-05.


    Procedures
    The evaluation started with an interview to collect information such as age, marital status, number of people living in the home, reports of diseases, use of medications and history of falls and fractures. After the interview, the elderly women underwent balance evaluation using the Berg Balance Scale – Brazilian version, and the Timed Up & Go test. In addition, the prognosis for the risk of falls, in relation to the Berg Balance Scale score, was evaluated in accordance with the model of Shumway-Cook et al. These tests were chosen because they are functional, validated, internationally accepted, easy to apply and low-cost.
    The Berg Balance Scale serves various purposes, such as quantitative description of functional balance ability, determination of risk factors for loss of independence and falls among elderly people, and evaluation of the effectiveness of interventions both in clinical practice and research. The scale evaluates static and dynamic balance based in 14 common items in daily life, such as reaching, turning around, moving away, standing up and getting up. The maximum score that can be attained is 56 points. It was applied in accordance with the procedures described by the authors who translated and adapted it for Brazil.
    The model for quantitative prediction of the risk of falls among elderly people, which establishes the relationship between the Berg Balance Scale and the risk of falls (10 – 100%), was also used as developed by Shumway-Cook et al. In this model, the sensitivity of the scale was 91% and the specificity was 82%. The likelihood of falls increases with decreasing scores on the Berg Balance Scale in a nonlinear relationship. For amplitudes from 56 to 54, each point lost is associated with an increase in the risk of falls of 3 to 4%. From 54 to 46, each one-point decrease is associated with an increase of 6 to 8%. Below 36 points, the risk of falls is nearly 100%.
    The Time Up & Go test provides rapid monitoring to detect balance problems that affect elderly people's ADLs. The shorter the time used to complete the test, the better the balance is. The time it took for the elderly women to get up from a chair, walk a distance of 3 meters, turn around, walk back to the chair and sit down again was measured in seconds. The elderly women did the test once to become familiarized with it and, on the second attempt, the time was recorded.
    The scales were applied before the treatment (pre-test) and after six weeks (post-test 6) and 12 weeks (post-test 12) of hydrotherapy. The arterial pressure (AP) was measured before and after the treatment sessions, with the aim of checking the individuals' conditions for performing the aquatic activities, without statistical intentions.
    The study lasted 12 weeks, with 40-minute sessions, twice a week (on Mondays and Wednesdays). The hydrotherapy for balance program was carried out with six elderly women per group and included adaptation to the aquatic environment, hydrokinesiotherapy and inclusion of aquatic exercises from other studies that challenge balance. Each session was divided into three phases: aquatic environment adaptation phase, stretching phase and a phase of static and dynamic exercises for balance. The intensity was low to moderate, with constant intensity, frequency and speed, for 12 weeks. Each series was performed continuously and between each one there was a one-minute rest. The program is described in the following and can be observed in Figures 1, 2 and 3.

    Phase I – Aquatic environment adaptation.
    Exercise 1: Respiratory control.
    Positioning: Semi-seated position without posterior support, with immersion to the shoulder level. Shoulders at 90º flexion and with extended elbows.
    Activity: Slow and prolonged expiration through the mouth over the water, then with the mouth immersed, and subsequently with both mouth and nose immersed (2').
    Phase II – Stretching. Each stretching exercise was maintained for 30 seconds.
    Exercise 2: Stretching of the hamstring muscles
    Positioning: Orthostatic position with back supported against the wall.
    Activity: Elevation of one of the lower limbs, maintaining knee extension and ankle dorsal flexion.
    Exercise 3: Stretching of the triceps surae and iliopsoas muscles
    Positioning: Orthostatic position with hands on the edge of the pool.
    Activity: Taking a large step forward, while maintaining the anterior knee in flexion, the posterior knee in extension, and feet in contact with the bottom of the pool.
    Phase III – Static and dynamic exercises for balance. The speeds and frequencies indicated were approximate averages.
    Exercise 4: Walking in circles hand-in-hand with sporadic changes of direction
    Activity: Walking sideways, facing forwards and backwards, alternating the direction from clockwise to anticlockwise, three times in each kind of walk (once for each kind of walk, speed: 0.40 m/s).
    Exercise 5: Walking in line
    Positioning: Hands supported on the waist of the individual in front.
    Activity: Moving in the pool making circles and changes in direction. The activity was conducted by the physical therapist (Three times, speed: 0.40 m/s).
    Exercise 6: Walking forward pushing lower members vigorously
    Activity: Walking with higher speed and propulsion (45 meters, speed: 0.50 m/s).
    Exercise 7: Walking backwards. (45 meters, speed: 0.50 m/s)
    Exercise 8: Lateral walk with large steps. (45 meters, speed: 0.55 m/s)
    Exercise 9: Walking with one foot in front of the other
    Activity: Walking supporting one foot immediately in front of the other, and so on successively (45 meters, speed: 0.20 m/s).
    Exercise 10: Walking with trunk rotation
    Activity: Walking forwards taking hand to opposite knee in flexion, alternately (45 meters, speed: 0.30 m/s).
    Exercise 11: Walking with one-leg support pauses
    Activity: Walking and, at the physical therapist's command, maintaining one-leg support with the opposite knee in flexion for 10 seconds (12 pauses in 45 meters, speed: 0.50 m/s).
    Exercise 12: Bilateral shoulder flexion-extension
    Positioning: Semi-seated position.
    Activity: Performing shoulder flexion and extension, while keeping the elbows in extension. Starting with maximum shoulder hyperextension and going until 90º flexion (10 repetitions, frequency: 12 repetitions per minute).
    Exercise 13: Bilateral horizontal shoulder abduction-adduction
    Positioning: Semi-seated position, shoulders flexed at 90º, extended elbows.
    Activity: Starting in adduction and going until 90º of horizontal abduction (10 repetitions, frequency: 12 repetitions per minute).
    Exercise 14: Ankle pumping
    Positioning: Orthostatic position, with immersion up to the xiphoid process level.
    Activity: Extension of the knees associated with plantar flexion, maintaining this position for 5 s, and then knee flexion associated with dorsiflexion, also maintaining this for 5 s (10 repetitions, frequency: 3 repetitions per minute).


    Statistical Analyses
    For comparisons over the course of time for the measurable variables, the Student t test for paired data and the Wilcoxon test were used, by means of comparing scores or times after the treatment with corresponding results for the same individual from the preceding evaluation. The data have been shown as mean differences and standard deviations of the difference. The analysis was carried out with the aid of the "Minitab" software. The significance level adopted was a= 0.01.


    Results
    According to the initial interviews, the elderly women demonstrated the following characteristics: predominant age group between 70 and 79 years (64%), 28% were married and 28% lived alone. The mean number of diseases reported per individual was 2.2: predominantly controlled arterial hypertension (60%) and osteoporosis (28%). The mean number of regularly used medications was 1.76 per individual. Twenty% of the elderly women had already experienced fractures as a consequence from falls, and 76% had history of falls. Regarding arterial pressure, there were no variations from before to after the sessions.
    According to the obtained results, the hydrotherapy program promoted significant increases in the elderly womens' balance, as observed by means of the Berg Balance Scale. The increase occurred after the sixth week (p< 0.001), after the twelfth week (p< 0.001) and between the sixth and twelfth weeks (p< 0.001) (Table 1).
    Likewise, the Timed Up & Go test showed that there was a significant decrease in the elderly women's times taken to perform the tests after the hydrotherapy program, after the sixth week (p< 0.001), after the twelfth week (p< 0.001) and between the sixth and twelfth weeks (p< 0.001), which indicated an increase in their balance (Tables 2 and 3).
    The results show that the hydrotherapy program promoted a significant reduction in the risk of falls among these elderly women, after the sixth week (p< 0.001), after the twelfth week (p< 0.001), and between the sixth and twelfth weeks (p< 0.001). These results are in agreement with the prediction given by the model of Shumway-Cook et al.21 applied to the Berg Balance Scale scores (Table 4).



    ****all the figures and table you will find it at the reference

    Reference-
    To read more about this study check this link
    http://www.scielo.br/pdf/rbfis/v12n1/en_11.pdf
    Effects of hydrotherapy in balance and prevention of falls among elderly women




    Amena mogarbil
    ID NO. 100285
    التعديل الأخير تم بواسطة Amena mogarbil ; 11-29-2016 الساعة 10:59 PM

 

 

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