Preventing imbalance related injuries: outcomes of a pilot SimBase balance test

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Stephany McKenzie
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1 Ildiko, Dr.Szogedi Ph.D., National Institute for Quality - and Organizational Development in Healthcare and Medicines (GYEMSZI), Miklos, Dr. Zrínyi Ph.D., Teva Hungary Ltd., Attila, Dr. habil Forgacs Ph.D., Corvinus University of Budapest. Institute of Behavioural Sciences and Communication Theory, Budapest,Hungary. Abstract Preventing imbalance related injuries: outcomes of a pilot SimBase balance test Aims: In order to understand what differences in holding balance exist between left and right hemispheres of the body and to assess whether imbalances begin to show in certain age cohorts, we first performed a simple balance test followed by the age simulator test using the AGE suit. Methods: Fifteen participants were asked to hold their balance standing first on their right and then their left leg. The same exercise was performed again with dressing in a special suit that imitated movement limitations of older age. Measures in seconds were recorded for how long participants had been able to hold posture. Results: While no differences were found between the two legs before the AGE suit was applied, significant differences in holding balance for both legs emerged before and after participants tried on the AGE suit. There was no evidence for this sample to be different from normal population Conclusions: The AGE suit was a good proxy to show the limitations of older age. While participants performed no different from normal population values, trying on the AGE suit halved their ability to hold balance compared to their first attempt. Due to sample selection, we were unable to determine at what age differences emerge in holding balance. We recommend that our pilot research be extended to a comparative research design where an older sample is purposely measured against a sample of younger age. Problem statement and aims Preventing falls and falls-related traumas, especially in the elderly, is a major and growing concern in many populations. According to Fuller (2000), from 992 through 995, 47 million injury-related visits were made to emergency departments in the United States, and falls were the leading cause of external injury, accounting for 24 percent of these visits. Compared with children, elderly persons who fall were 0 times more likely to be hospitalized and eight times more likely to die as the result of a fall. Trauma related to loss of balance can have life threatening consequences: Approximately 9,500 deaths in older Americans are associated with falls each year in the United States. Fuller, G. F. (2000). Falls in the Elderly. American Family Physician; 6 (7):

2 The cost of fall related treatment can also be a significant burden on the health system. In 996, more than 250,000 older Americans suffered fractured hips, at a cost in excess of $0 billion. More than 90 percent of hip fractures were associated with falls, and most of these fractures occur in persons more than 70 years of age (Fuller, 2000). Causes of imbalance may have multiple roots. The most commonly cited factors that result in falls are: Demographic factors; acute or chronic illness; cognitive impairment; neuromuscular disorders; physical deficits and other causes, such as environmental and medication hazards. While there is no single cause one can pinpoint, prevention of falls in the elderly can focus on several strategies. Changing or altering the dosage of medications, restoring physical impairments (by surgery or by the use of appropriate assistive device), improving environmental support in the client s home are interventions that enhance patient safety and confidence in one s ability to avoid fall related traumas. However, physical training and exercise that aims to strengthen or restore balance lead to improved outcomes. Whether or not a person needs to participate in balance and gait training can be determined by performing the age simulation test, which assesses a person s ability to hold her balance in a standing position (which is a prerequisite to performing many daily activities, such as to put one's trousers on, walking on uneven ground or to reach something on a shelf). In order to understand what differences in holding balance exist between left and right hemispheres of the body and to assess whether imbalances begin to show in certain age cohorts, we first performed a simple balance test followed by the age simulator test using the AGE suit 2. Methods We performed the following test with a stop-watch. We asked the participant to stand straight in low-heeled, closed shoes and fold her arms across her chest. Then asked her to raise one of her legs, bend her knee to form an approximately 45-degree angle, started the stop-watch and she closed her eyes. We asked her to stay standing on one leg and we immediately stopped the stop-watch if she dropped her arms over 45 degrees, if her leg on which she kept standing had moved or if her leg which she kept elevated had reached the ground. We repeated the test standing on the other leg and compared performance with normal values at different ages as well with test result after dressing in the AGE suit. Age related references were the following: years of age: seconds years of age: 2 seconds years of age: 0 seconds years of age: 4 seconds Over 80: most of the people are unable to perform the test. The AGE suit The age simulation suit consists of a set of separate components. By their interaction an effect very similar to the impairments of the sensomotoric skills in old age can be achieved. Especially the age-related walk and the changed grip ability are simulated very close to reality by the age simulation suit. When healthy individuals dress in the age simulation suit, they will gain a better understanding of elderly persons' physical limitations. Altogether, 5, conveniently selected nursing students participated in this pilot sample. ed sample t-tests were performed to test hypotheses. Hypotheses assumed that ) significant differences will emerge for how long participants were able to hold their balance on the right 2 2

3 and left leg; 2) that participants were able to hold their balance longer before they dressed in the AGE suit; and 3) that study participants will hold their balance equal to normal population Results Of the total sample, 20% was 42 years or older (50 years of age being the oldest), the rest was 34 years or younger. Table shows the difference for how long participants kept balance on right and left legs (in seconds). We found no significant difference in this respect between the two measures. Table. ed Samples Statistics: differences between both legs before AGE suit Mean N Std. Deviation right leg, before 24, ,86356 left leg, before 24, ,64692 ed Samples Test - left leg, before,4000,459,670 Table 2 shows the difference in holding balance on the right leg before and after applying the AGE suit. Significant differences emerged; participants were able to hold their balance longer before dressing in the suit. Table 2. ed Samples Statistics: difference between right leg before and after GERT suit right leg, after Std. Error Mean N Std. Deviation Mean 24, ,86356, , ,40832,07703 ed Samples Test - right leg, after, ,933,000 Table 3 shows the difference in holding balance on the left leg before and after applying the AGE suit. We found significant differences again; participants were able to hold their balance longer before trying on the suit. 3

4 Table 3. ed Samples Statistics: difference between left leg before and after GERT suit left leg, before left leg, after Std. Error Mean N Std. Deviation Mean 24, ,64692,63095, ,6795,96954 ed Samples Test left leg, before - left leg, after 3,2000 9,73,00 And last, table 4 displays results for how long participants stood on right and left leg compared with the normal population No significant differences were observed between the study sample and the normal population. Table 4. ed Samples Test: differences between sample and population - normal population values -,2000 -,232,828 Table 4. ed Samples Test: differences between sample and population left leg, before - normal population values -,6000 -,497,646 Conclusions The aim of this pilot study was to confirm whether applying a special equipment that imitates the limitations of older age results in significantly worse outcomes concerning holding one s balance either on right or left leg. What researchers found was that while no significant differences had been observed for right and left leg before dressing in the AGE suit, results showed a major decrease in the ability to hold posture after the suit was applied. This is especially important because it confirms that even when the same, younger subjects are tested, limitations in mobility can cause severe uncertainty for holding a balanced position. These results held for both legs, no differences were observed between the two legs. Therefore, it is 4

5 reasonable to conclude that the AGE suit is a good proxy for the limitations of older age and that it demonstrates how disabilities can alter muscular responses even in younger participants. When we compared results of this sample with the normal population values, we found no differences. This confirms that no study participant was yet in need of balance training at the time of the research. As for the hypotheses, we could not hypotheses 2 and 3 but rejected, as we found no evidence for any difference between right and left leg posture times. This also raises the question whether body hemispheres play a role in predicting how falls emerge. Due to the nature of the sample selection we were unable to decide at what age differences in holding balance would emerge. However, the literature suggests that injuries due to losing balance begin to occur around age 70 or above. We recommend that our pilot research be extended to a comparative research design where an older sample is purposely measured against a sample of younger age. Limitations of this pilot study included sample size and selection. Post hoc power analysis indicated that even with a small sample, due to the relatively large effect size, a power of 0.93 was achieved. 5

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