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• W2950931461 abstract "Where Are We Now? The current study by Sharabiani and colleagues [1] offers a fascinating perspective on the prevention of falls. The authors analyzed postural stability by measuring the patient’s activation of the anterior tibialis and medial gastrocnemius on both stable and unstable surfaces. They also examined the ability of concurrent physical or intellectual tasks (both simple and complex) to mitigate postural instability on these surfaces. The authors compared patients between the ages of 45 and 64 who had a distal radial fracture with uninjured age-matched controls and found that those who had distal radial fractures were more likely to demonstrate postural instability standing on unstable surfaces than were their uninjured counterparts. The authors also found that there was no difference between groups while standing on stable surfaces. Importantly, they determined that the performance of concurrent tasks seemed to improve the stability of these patients. These findings suggest that patients at risk can be coached to perform concurrent tasks that may decrease their susceptibility to falling. The other fascinating conclusion from the study was that patients with a previous injury from a fall (distal radial fracture in this study) were more likely to demonstrate instability on uneven surfaces implying that the fear of falling contributed to the likelihood of falling. Where Do We Need to Go? Sharabiani and colleagues [1] noted that patients activated the tibialis anterior and the medial gastrocnemius to maintain postural control. These muscles are responsible for the “ankle strategy” that individuals utilize to maintain posture. When negotiating unstable conditions, we also use “hip strategy” through the firing of trunk muscles to maintain balance and postural control. Future studies should compare how an injured population uses both hip and ankle strategies to maintain posture versus age-matched controls. Since motor units in the hip and ankle both contribute to postural stability, an analysis of how these work together would be insightful. Since most fractures caused by falls occur in the elderly, more work should be performed to determine whether the performance of concurrent tasks decreases the risk of fall in patients older than 65-years-of-age. One could imagine that concurrent tasks could potentially distract certain people and potentially increase their risk of falling. More studies involving older patients should be performed before these findings can be extrapolated to all patient groups. The combination of fear and anxiety is another contributor that deserves study. We often assume that patients fall because of weakness or balance issues, when in fact, they may fall from factors associated with the fear of becoming hurt. The current study demonstrated that patients who had sustained a previous distal radial fracture demonstrated more postural instability on uneven ground [1]. Since these groups were evenly matched, it seems that the fear of sustaining another injury from a fall may actually contribute to the propensity of a person to actually fall on uneven terrain. The current study excluded patients with a fear of falling as determined using a questionnaire about that purpose. If this population could be aided by the exercise of performing concurrent tasks while on unstable surfaces, the likelihood of falling and sustaining an injury would be decreased, and the impact on the quality of life of these individuals could be substantial. But the biggest question that stuck with me was: How can the results of this study be effectively applied to decrease the risk of falling in the population at risk? How Do We Get There? Although it seems intuitive, simply instructing patients to perform simple or complex cognitive tasks while ambulating on unstable surfaces may be naïve and premature. A large, controlled study evaluating the impact of concurrent tasks on gait stability during activities of daily living in at-risk patients could help us determine whether this approach can reduce the risk of falling in these patients. The actual application of these findings may be challenging, since it would require active constant surveillance of patients to ensure that they were utilizing the techniques of cognitive distraction to reduce the incidence of falls. I have faith that our rehabilitative colleagues could potentially design a study to research this effect. Large, prospective, comparative trials need to be performed comparing the use of ankle and hip strategies, both with and without concurrent tasks, in patients older than 65-years-of-age. Rehabilitative specialists, specifically physical therapists and physiatrists, will need to determine how to effectively educate and reinforce these behaviors in the at-risk population. These professionals would need to educate and persuade patients that using these distractive techniques will actually decrease their risk of falls. Additional studies refining these techniques are essential. Determining which strategies are the most effective at helping patients increase postural stability is integral since once we have that information, it can be easily incorporated into the rehabilitative protocols in injured patients across the spectrum." @default.
• W2950931461 created "2019-06-27" @default.
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• W2950931461 date "2019-05-30" @default.
• W2950931461 modified "2023-09-26" @default.
• W2950931461 title "CORR Insights®: Can Postural Instability in Individuals with Distal Radius Fractures Be Alleviated by Concurrent Cognitive Tasks?" @default.
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• W2950931461 doi "https://doi.org/10.1097/corr.0000000000000840" @default.
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