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Disorders of the low back are among the most common musculoskeletal problems in the United States. [1] Kelsey et al, [2] in 1979, reported that, of approximately 18.9 million people [...]

Muscle coordination is essential to the maintenance of posture and balance. Loss of balance in the elderly results in serious falls and can lead to illness, while fear of falling can lead to self-protective immobility. The elderly are known to have weaker trunk and hip muscles, but the relationship between muscular weakness and loss of balance has not been thoroughly studied. Heel-toe and one-legged balance, each with eyes open or shut, and hip musculature strength were measured in 54 healthy men, aged 60 to 90 years. There was a positive correlation between hip muscle strength and balancing ability. The heel-toe position with eyes open was not a challenge. Hip muscle strength was most strongly related to one-legged standing with eyes closed. More active men (based on self-description) tended to have stronger hip musculature. Postural balance and hip muscle strength decreased with increasing age. The results demonstrate the importance of maintaining physical activity in the elderly, and suggest that exercises to improve hip muscle strength should be part of the treatment of elderly patients with balance problems. Further study is needed to clarify the relationships among activity level, muscle strength, and balance in the older population. (Consumer Summary produced by Reliance Medical Information, Inc.), The purpose of this study was to collect and analyze balance and muscle performance data obtained from 54 men aged 60 to 90 years. Balance was tested using the sharpened Romberg test (SR) and the one-legged stance test (OLST) on each foot with eyes open and eyes closed. A strain-gauge-based quantitative muscle tester (QMT) was used to measure force production. All torque values were normalized as a percentage of body weight. A self-report of activity level also was recorded. The results indicated that OLST scores and normalized torques of the hip flexors, extensors, and abductors had a positive correlation and that SR scores and normalized torques of the hip extensors and right hip abductors had a positive correlation. Subjects who considered themselves to be very active had a significantly higher SR eyes-closed balance time as compared with those who rated themselves as less active. Subjects who considered themselves to be very active also had significantly higher normalized torque values for most muscle groups tested. Negative relationships were shown between age and balance time and between age and force production. [Iverson BD, Gossman MR, Shaddeau SA, et al. Balance performance, force production, and activity levels in noninstitutionalized men 60 to 90 years of age. Phys Ther. 1990; 70:348-355] Key Words: Aging, Equilibrium; Kinesiology/biomechanics, general; Muscle performance, measurement; Tests and measurements, functional., Balance Performance, Force Production, and Activity Levels in Noninstitutionalized Men 60 to 90 Years of Age We often take balance for granted. Our ability to maintain an upright posture is [...]

Falls by the elderly are common and can be very serious. An increase in falls may indicate a decline in health. Falls may be associated with decreased walking ability and balance, but there is little research with quantifiable data, or using methods that the physical therapist can use in practice. The authors wished to determine differences in age, balance, and width of step between elderly women with a history of falling and similar women with no such history. They also studied the relationship between balance and width of step. Based on a questionnaire, the authors grouped fallers, those people reporting a fall once within the last year, and nonfallers, those reporting no falls in the last year. Data were obtained from 110 women between the ages of 60 and 89 who were living in the community, i.e. not in hospitals or nursing homes. Balance was evaluated using the Sharpened Romberg Balance Test, and the one-leg stance balance test. Both tests were done with eyes opened and closed. First try and best performance in each category were recorded. Information on gait was obtained by studying foot prints made by the subjects on a 30 foot piece of paper. There was no significant difference in age, width of step or balance between the those with a history of falling and those without a history of falling. There were small negative relationships between balance and step width. On each of the different balance tests both groups of women had lower mean scores on the first balance trials than they did on the best-performance trials of balance. This study demonstrates methods of measuring balance and walking gait that can be carried out fairly easily by the physical therapist. The study also provides comparative data which may be used by other physical therapists., The purposes of this study were to compare age, static balance performance, and step-width variables between elderly noninstitutionalized women with and without a history of falls and to determine the relationship between balance performance and step width. Each subject performed a maximum of three timed trials on the sharpened Romberg and one-legged stance tests with eyes open and with eyes closed. The first and best trial measurements were used for analysis. Each subject walked on paper walkways making ink prints for step-width measurements. The mean and the variability of each subject's step-width measurements were used for analysis. Data from 110 women, aged 60 to 89 years, were analyzed. The fallers (n = 26) had significantly lower values than the nonfallers (n = 84) on the best trial of the sharpened Romberg test in the eyes-open condition (t = 1.98, df = 108, p [is less than] .05). No significant differences between fallers and nonfallers were revealed in age, the mean and variability of step width, the first trials of the balance tests, and the best trials on the other balance tests. For the total group, the mean measurements on the first trials were significantly lower than those on the best trials for each balance test. Small, but statistically significant (p [is less than] .05), negative relationships existed between balance performance and the means and variability of step width. The results of this study indicate that the methods of measuring balance and step width are clinically applicable, and the data of patients from a similar population sample may be compared with the data established in this study. [Heitmann DK, Gossman MR, Shaddeau SA, et al: Balance performance and step width in noninstitutionalized, elderly, female fallers and nonfallers. Phys Ther 69:923-931, 1989], Balance Performance and Step Width in Noninstitutionalized, Elderly, Female Fallers and Nonfallers Falls and subsequent injuries are common occurrences among the elderly population. One third to one half of the [...]

The seemingly simple act of maintaining balance or equilibrium is a complex neurophysiologic event that involves the integration in the brain of data from eyes, ears, tendons and joints. The brain is responsible for assessing all incoming sensory data and developing a neurological output to the muscles of the body. The result of this coordination is balance maintenance, or equilibrium. Elderly women over the age of 65 are especially vulnerable to falls resulting from impairment of equilibrium. Obviously, not every loss of balance results in a fall and injury, but the number and level of serious complications resulting from loss of balance in this group of people is significant. Many pathologic changes have been linked to problems of balance, including inner ear disorders, neurologic complications, injuries, hypertension and circulatory abnormalities. In addition, the use of more medications by this age group leads to side effects that may include loss of balance and dizziness, which can lead to increased risk of injury. There are several simple diagnostic tests that can be used to evaluate the level of equilibrium in an individual, and they are evaluated in this project. A group of 71 healthy women between 60 and 86 years of age volunteered to be subjected to balance tests. The methods used to measure balance in this study revealed a deterioration of balance with age. The womens' performances became much worse when they tested with their eyes closed. The ease of administering the tests to this aged group was also assessed. The data suggest that clinicians must take age into account when assessing the level of equilibrium in a patient., Descriptive data were collected regarding static standing balance of 71 noninstitutionalized elderly women as they performed two timed balance tests. All subjects performed the sharpened Romberg test and the one-legged stance test on each foot in four test conditions: 1) eyes open, 2) eyes closed, 3) shoes on, and 4) shoes off. Subjects were grouped and analyzed according to the following age ranges: 1) 60 to 64 years, 2) 65 to 69 years, 3) 70 to 74 years, 4) 75 to 79 years, and 5) 80 to 86 years. The best time of three trials was used for data analysis. The maximum balance time for the sharpened Romberg test was 60 seconds. For the one-legged stance test, a maximum balance time was 30 seconds. No significant difference was found between right and left or dominant and nondominant limbs while performing the one-legged stance test. No significant difference was found in mean balance time between subjects who had fallen versus those who had not fallen, nor between shoes-on and shoes-off test performance. Subjects' performance on the eyes-open test was consistently superior to their eyes-closed test performance (p [is less than] .0001). The one-legged stance test mean balance time decreased significantly as age increased. More subjects reached the maximum balance time on the sharpened Romberg test than on the one-legged stance test. The results of this study indicate that additional research is needed in the area of balance maintenance among the elderly population. [Briggs RC, Gossman MR, Birch R, et al: Balance performance among noninstitutionalized elderly women. Phys Ther 69:748-756,1989], Balance Performance Among Noninstitutionalized Elderly Women Maintaining balance in the human body is an intricate process. Visual, vestibular, and other somatosensory stimuli contribute information about the body's position in space [...]