Earticle

Purpose: The objective of this study was a virtual reality-based balance training program effective for improvement in physical function, examined the balance ability and fall efficacy of elderly women with experienced falls, intending to examine the program's usefulness as an exercise program to prevent the recurrence of a fall. Methods: The participants were 30 elderly women aged 65 or older who met the conditions. The participants were randomly assigned to either a balance training group (BT) or a virtual reality-based balance training group (VT) and received the training three times per week, 30 minutes per day, for six weeks. To measure static balance, the Tetrax Portable Multiple System (Tetrax Ltd, Israel) were used. To measure dynamic balance, the Berg Balance Scale (BBS) and functional reach test (FRT) was used, and regarding fall efficacy, the Korean Fall Efficacy Scale (K-FES) was used. Results: Tetrax significantly improved after the intervention in both the BT group and the VT group (p<0.05). The comparison between the two groups was not significantly. BBS and FRT result significantly improved after the intervention in both the BT and VT groups (p<0.001), while K-FES was significantly ameliorated in the VT group only (p<.05). Comparing the groups, there were more significant changes in the BBS (p<0.05) and FRT (p<0.01) result of the VT group than the BT group. Conclusion: A virtual reality-based balance training program is considered to be usable as an exercise program to prevent recurrence of falls in elderly women.

Objective: This study aimed to investigate the effects of fall-prevention exercise programs on fall efficacy, depression and health-related quality of life in elderly. Design: a randomized controlled trial Methods: A total of 57 participants over 65-years-old have been allocated to control and experimental groups. The experimental group received 8 weeks of fall-prevention exercises that included strengthening of lower extremities, balance and gait training. They received the exercises twice a week for 50 minutes as a group.Both groups were assessed using Modified Falls Efficacy Scale (MFES), Geriatric Depression Scale (GDS), and 36-Item Short-Form Health Survey (SF-36) prior and post to the intervention. The control group also received the same exercise program after the post evaluation. Results: The experimental group showed overall improvement in MFES, GDS, and physical components of SF-36 (p<0.05). The MFES was significantly increased in the experimental group after the intervention (p<0.05). The GDS was significantly decreased in the experimental group after the intervention (p<0.05). The SF-36, only physical Function, Role limitations due to physical health, general health, and energy and fatigue categories were improved in the experimental group after the intervention (p<0.05). Conclusions: The results showed 8 weeks of fall-prevention exercise programs can increase fall efficacy and physical related quality of life while reducing depression of elderly over 65.

Purpose: The purpose of this study was to determine the effects of bilateral visual feedback training with visual targets on the postural balance and fall efficacy of stroke patients with hemiparesis. Methods: A total of 24 stroke patients with hemiparesis were randomly assigned to either a bilateral visual feedback training (BVFT, n=8) group, unilateral visual feedback training (UVFT, n=8) group, or a control group (n=8). The BVFT and UVFT groups performed weight-bearing training on the bilateral (less-affected and affected side) or unilateral side (affected side) with visual feedback using visual targets. The control group performed squat training without visual feedback using visual targets. The training program was conducted in the form of 3 sets a day, 3 times a week, for 4 weeks. The participants were evaluated using the Berg balance scale (BBS), lateral reaching test (LRT), timed up and go test (TUG), and the activities-specific balance confidence scale (ABC). Results: In the intra-group comparison after the intervention, the BVFT group showed a significant difference in the BBS, TUG, affected and less-affected side LRT, and ABC (p<0.05). The UVFT group showed a significant difference in the BBS and ABC (p<0.05). In the inter-group comparison after the intervention, the BVFT group showed significant improvements in their BBS, affected side LRT, and TUG, when compared to the control group (p<0.05). Conclusion: These findings show that bilateral visual feedback training with visual targets during bilateral weight-bearing exercises can improve the postural balance function in stroke patients.

Purpose: This study investigated the effects of dual-task gait training on Parkinson's disease patients, emphasizing motor tasks on balance, gait ability, and fall efficacy, and examined whether dual-task gait training could serve as an intervention method providing physical and psychological benefits to patients. Methods: Twenty participants were initially enrolled and assigned randomly to the experimental or control group (10 in each group). Three participants from each group withdrew before completing the intervention, resulting in a final sample of 14 participants (seven in each group) who completed the four-week program. The experimental and control groups underwent 20 sessions over four weeks, with sessions conducted five times a week. During the 30-minute daily inpatient therapy sessions, traditional treatments such as ROM exercises, muscle exercises, and stretching were administered for 20 minutes. Following this, during the 10-minute walking therapy session, the experimental group engaged in dual-task gait training, while the control group underwent standard walking therapy. Results: The experimental group undergoing dual-task gait training showed greater improvements in gait ability, balance, and fall efficacy than the control group receiving conventional gait therapy (p<0.05). Conclusion: Dual-task gait training may be a beneficial intervention method for providing physical and psychological benefits to patients with Parkinson's disease compared to conventional gait therapy. These results are expected to provide useful insights for future research endeavors.

Purpose: This study examined whether various lower extremity exercises using a Swiss ball in the standing position could improve balance, muscle strength, gait, and fall efficacy in stroke patients. Methods: Twenty-one stroke patients were randomly divided into three groups, each with seven participants. For four weeks, experimental group 1 performed various lower extremity exercises using a Swiss ball, while experimental group 2 executed the same exercises without a Swiss ball, and the control group underwent general physical therapy. The subjects' knee extensor muscle strength, balance, gait, and fall efficacy were evaluated before and after the intervention using portable muscle strength measurement, the Berg Balance Scale (BBS), G-walk, and the Korean Falls Efficacy Scale (K-FES). Results: Knee extensor strength increased significantly in all three groups after the intervention; in particular, a significant increase was seen in experimental groups 1 and 2 compared to the control group. Moreover, all three groups had significantly better BBS scores and higher cadence after the intervention; notably, experimental group 1 had better scores and increased cadence than the control group. Additionally, gait speed was significantly increased in the experimental group 1 than in the control group. The step length of the non-affected leg was also significantly higher in the same group. The K-FES score improved significantly in all three groups, but there was no significant difference between the groups. Conclusion: This study suggests that lower extremity exercises with or without a Swiss ball could be effective interventions to improve muscle strength, balance, gait, and fall efficacy in stroke patients.

본 연구는 FES가 낙상 경험을 예측하는 선별 기준값을 구하고 FES에 영향을 미치는 요인과 낙상 경험의 예측 인 자를 알아보고자 하였다. 연구방법 : 본 연구는 뇌졸중으로 인한 편마비 진단을 받은 69명을 대상으로 하였다. 발병 후 낙상을 경험한 횟수를 기록 하고 낙상 효능감 척도(Falls Efficacy Scale; FES)를 이용하여 설문지에 응답하도록 하였다. 인지 평가는 한국판 간이 정신 상태 검사(Mini Mental State Examination-Korean version; MMSE-K), 우울증은 한국판 노인 우울증 척도 (Geriatric Depression Scale-Korean version; GDS), 일상생활동작 수행 능력은 수정된 바델 지수(Modified Barthel Index; MBI), 하지 근력 측정은 앉아서 일어서기 검사(Sit to Stand test; STS), 상·하지 마비측 운동 기능은 퓨글마이 어 상·하지 운동 기능 평가(Fugl Meyer-Upper, Lower/Extremity; FM-U/E, L/E), 동적 균형 능력은 버그 균형 척 도(Berg Balance Scale; BBS), 기능적 이동성은 일어나 걸어가기 검사(Timed Up & Go test; TUG)를 이용하였다. 낙 상 예측의 FES 선별 기준값(cutoff value)을 결정하기 위해 수용자 작업특성곡선(Receiver Operation Characteristic curve; ROC curve)을 이용하였고 FES와 낙상 경험 예측에 영향을 미치는 요인을 알아보기 위하여 단계적 다중 회귀 분석(multiple linear regression analysis)과 로지스틱 회귀분석(logistic regression analysis-전진 wald)을 실시하였다. 결과 : 낙상 경험을 예측하는 FES의 선별 기준값이 14.5점 이상이면 낙상의 위험요소를 가졌음을 예측할 수 있는 기준점 이 되며, 14.5점 미만이면 비다발성 낙상자로 할 수 있다. FES에 영향을 미치는 요인으로는 TUG, 낙상 경험 예측에 영 향을 미치는 변수로 FES가 낙상군과 비낙상군을 선별하는데 가장 큰 영향력을 주는 변수임을 확인 할 수 있었다. 결론 : FES는 낙상의 두려움에 대한 낙상 관련 자기 효능감을 평가하고 기능적 수행 능력의 정도를 파악할 수 있으며, 낙 상 경험의 위험성을 예측하는데 신뢰할만한 평가 도구로 임상 지표로 활용이 가능할 것이다. 추후 개개 환자들의 낙상 위험요소를 포괄적으로 파악하기 위해서는 신체 기능을 평가하는 정량적인 분석과 더불어 심리학적인 요소가 추가된 연구가 필요할 것이다.

This study was designed to evaluate the clinical utility of the Fall Efficacy Scale (FES) for the prediction of falls in stroke patients. We demonstrated whether the FES can measure the standards for the screening of risk factors for falling by stroke patients. In addition, we identified the factors the affect the FES and the predictive factors of falling. Methods : The subjects included 69 inpatients with hemiparesis who can walk independently. We surveyed the number of falls and used the FES to identify their fear of falling. and conducted an evaluation on their cognitive function and depression using the Mini Mental State Examination, Korean version (MMSE-K) and Geriatric Depression Scale, Korean version (GDS-K). The assessments on their functional performance measured their activities of daily living (Modified Barthel Index; MBI), strength of their lower limbs (Sit to Stand Test; SIT), limb paresis (Fugl-Meyer Upper/Lower Extremity; FM-U/E, L/E), balance (Berg Balance Scale; BBS), and mobility (Timed Up & Go test; TUG). A receiver operation characteristic curve was utilized to investigate the optimum cutoff value of the FES on the prediction of falling, and a multiple linear regression analysis and logistic regression analysis were used to identify the main factors for FES and the prediction of falling. Results : A cut-off score of ≥14.5 on the FES was the standard value for the prediction of risk factors of falling, and <14.5 was used for those with a low incidence of falling. The most affective factors of FES were the TUG variables, and we identified that FES as a psychologic factor exists in terms of a discrimination between the falling group and non-falling group. Conclusion : FES is able to assess the self-efficacy related the fear of falling, and identify the functional performance ability. In addition, FES may be used as part of an initial assessment tool to identify the related falling risk. To comprehensively understand the related risk of falling in individual patients, further study is needed, including a quantitative analysis evaluating the patient's physical function, and should include psychologic factors.

The purpose of this study is to investigate the effect of exercising pro-gram utilizing proprioceptive neuromuscular facilitation integration pat-tern (PIP), which is effective in improvement of the physical function, on the fall efficacy and gait ability of the elders who experienced injuries from falls. Also, this study aims to investigate he applicability of exercise program as methods for fall reoccurrence prevention and physical functions enhancement. The subjects of the study were 30 elders in the local community with experience of injuries from falls. The period of the study was 4 weeks with 12 exercise sessions. The subjects were ran-domly allocated to 2 groups where 15 elders were allocated to PIP and the rest 15 elders were allocated to general exercise (GE) group. Fall ef-ficacy scale (FES) and GAITRite were used for the measurements in this study. Paired t-test was used to analyze the differences within the group while independent t-test was used to analyze the difference be-tween two groups. In the comparison of measurements before and af-ter exercise program, FES, velocity, cadence, and stride length were shown to be significantly increased in both PIP group and GE group. Also, in the comparison between two groups after the exercise pro-gram, the measurements of FES, cadence, stride length, and step length in PIP group were shown to be significantly increased compared to the GE group. Therefore, the PNF combined pattern is judged to be applica-ble to as methods for fall reoccurrence prevention and physical func-tions enhancement of the elders with experience of being fallen.

The fear of falling is a common psychological consequence of falling, especially for elderly individuals. Fear of falling can lead to activity re-striction and medical problems. The primary purpose of this study was to examine the correlation between fall efficacy and physical fitness factors in elderly women. We assessed physical fitness factors and in-vestigated the Korean version of the Fall Efficacy Scale-International (KFES-I) in 173 participants. We investigated the correlation between physical fitness factors and fall efficacy. When the subjects were divid-ed into four groups according to physical fitness level, subjects with high 6-m walk, 30-s chair stand test, 30-s arm curl test, chair sit and reach test, 8-foot up and go test scores and high grip strength had low fall efficacy. Physical fitness factors were strongly associated with de-creased fall fear, suggesting that physical fitness improvements play an important role in preventing or reducing the fear of falling.

This study aimed to examine the effects of exercise interventions devel-oped over the past 10 years to prevent falls among older adults. Co-chrane, PubMed, and Embase databases were systematically searched on November 3, 2022, using the following keywords: “elderly” or “aged” and “fall prevention exercise” and “randomized controlled trial.” A total of 918 articles were retrieved, and finally, 18 studies were included in the meta-analysis. main conclusions were as follows: fall prevention exercises showed moderately positive effects on balance, gait, mobility, physical function, lower limb power, and strength, but low effects on proprioception, vision, and reaction speed. The effect sizes were high-est when the intervention period was 1–24 weeks, time was 31–60 min, and frequency was thrice per week. Place of intervention (home, com-munity, laboratory) and age (>75 years, <75 years) showed similarly moderate effect sizes. A combined program that includes balance, co-ordination, and resistance exercises is appropriate to improve fall-relat-ed fitness and fall efficacy in community-dwelling older individuals.

The purpose of this study was to evaluate the effects of 12-week aqua walking and jogging program on muscle function, ankle range of motion (ROM), balance and fell efficacy in degenerative lumbar spinal stenosis (DLSS) patients. Six patients (2 males, 4 females) with DLSS participat-ed in aquatic exercise program 3 times per week with each session of 60 min (warming-up, aqua walking, aqua jogging and cool down) at 1 m 20 cm-1 m 30 cm deep pool. Janda’s muscle function test, ankle ROM, Berg balance scale (BBS) and fall efficacy scale (FES) were analyzed before and after the training intervention. We found significant increas-es in balance, muscle function, ankle ROM and fall efficacy after train-ing intervention. In conclusion, aquatic exercise seems to affect physi-cal function and fall efficacy positively in elderly DLSS patients.

Purpose: To investigate the effects of transcranial direct current stimulation combined with robot-assisted gait training on gait, balance, and fall efficacy in patients after stroke. Methods: Twenty-four patients after stroke were selected as study participants and were randomly divided into a transcranial direct current stimulation combined robot-assisted gait training (experiment) group and robot-assisted gait training (control) group. All participants underwent general neurological physical therapy for 30 min, and robot-assisted gait training alone or combined with transcranial direct current stimulation according to the group, 5 times a week for 30 min for a total of 8 weeks. Gait, balance, and fall efficacy function was analyzed before the intervention, and analysis between groups was performed by re-measuring the above items equally after 8 weeks of intervention. Results: The transcranial direct current stimulation combined with robot-assisted gait training group showed significant differences in gait, balance, and fall efficacy function compared to the control group. Conclusion: Transcranial direct current stimulation combined robot-assisted gait training is more effective for gait, balance, and fall efficacy function . Based on this finding, this training can be proposed as an effective program not only for patients after stroke but also for patients with brain injury. Moreover, based on the study findings, future studies on muscle changes related to gait, balance, and function are warranted.

With the increasing number of aged individuals, research pertaining to their cognitive functions and physical-motor has become exponentially imperative. The purpose of the study was to investigate the effect com-bined aquatic and cognitive training on quality of life (QoL), fall self-effi-cacy and motor performance (static and dynamic balance) in aged with varying cognitive status levels. Thirty participants were assigned to a high cognitive status group (n=10), low cognitive status group (n=10), or nonintervention control group (n=10). Participants completed a 6-week motor-cognitive training regime with increasing intensity. QoL, fall self-efficacy, static balance, and dynamic balance were assessed. Preliminary results suggest proof-of-concept significant (P<0.05) im-provements were found in both the high and low cognitive status groups for static and dynamic balance and fall self-efficacy. However, QoL was only found to be significantly improved in the low cognitive status group. Aqua training along with cognitive training can effectively be used to prevent falls in the elderly and to improve their physical-motor perfor-mance. However, when attempting to improve QoL, the cognitive status of the individual should be considered.

The objectives of this study were to evaluate the effects of communi-ty-based walking training (CWT) on the walking ability and fall-related self-efficacy of chronic stroke patients and compare the effects of CWT to the conventional walking programs in stroke patients. Previous stud-ies focused on walking speed, walking endurance, and balance. How-ever, no studies have examined the changes in fall-related self-efficacy after CWT. In order to achieve purpose of this study, 45 chronic stroke patients, who were hospitalized at National Rehabilitation Center, were randomly divided into the CWT group (CWTG, n=15), the treadmill walk-ing training group (TWTG, n=15), and the control group (CG, n=15). The treatment was conducted 3 times per week (30 min each) for 4 weeks. CWT was carried out by gradually increasing the difficulty level in vari-ous environments outside the hospital room. The results revealed that the CWTG was more effective in enhancing the walking ability and fall-related self-efficacy than the TWTG and the CG. These findings demonstrated that the CWTG increased the walking ability and fall-re-lated self-efficacy of chronic stroke patients. Therefore, we suggest that adding CWT to standard rehabilitation might be an effective meth-od for improving walking ability and fall-related self-efficacy in chronic stroke patients.

Purpose: The study evaluated the effects of a fall prevention program in a Korean rural area. Methods: A single pretest-posttest design group was studied. Thirty nine residents in the same rural area participated in a program comprised of education and exercise. The 5-week fall prevention program was performed for 60 minutes, once a week. Results: Fall Efficacy Scale (FES) score and Activities-specific of Balance Confidence Scale (ABC) score were significantly increased after the program, but the pre-and posttest FES and ABS scores were not significantly different between the fall experience group and non-fall experience group. Conclusion: The fall prevention program can improve rural residents' FES and ABS, and is recommended as a fall prevention intervention.

Background: The aim of this randomized controlled pilot study was to determine the effect of trunk training in wheelchair on fall efficacy, fall risk and activities of daily living in acute stroke patients. Design: Randomized controlled pilot trial. Methods: The study included 18 patients with acute stroke who were randomly allocated to an experimental group (EG) (n=9) and a control group (CG) (n=9). Patients in the EG group received general rehabilitation therapy combined with trunk training in wheelchair for 20min, whereas CG group received general rehabilitation therapy combined with bicycle training for 20min. Both groups performed the exercise 5 times a week for 3 weeks. Outcomes were assessed using Korean-Fall Efficacy Scale (K-FES), Fullerton Advanced Balance Scale (FAB) and Korean-Modified Barthel Index (K-MBI). Results: After 3 weeks of training, both groups showed significantly improved K-FES, FAB and K-MBI (p<.05 in both groups). However, the K-FES, FAB and K-MBI in the experimental group was significantly improving than in the control group (p<.05). Conclusion: These findings indicate that trunk training in wheelchair may be effective at decreasing fall risk and improving activities of daily living in acute stroke patients. Therefore, trunk training in wheelchair may be recommended as an intervention in reducing the incidence of fall risk in acute stroke patient.

Purpose: The purposes of this study was to develop a comprehensive community-based fall prevention program and to test the effects of the program on the muscle strength, postural balance and fall efficacy for elderly people. Methods: The design of this study was a nonequivalent control group pretest-posttest design. There were 28 participants in the experimental group and 29 in the control group. The program consisted of balance exercises, elastic resistance exercises and prevention education. The program was provided five times a week for 8 weeks and each session lasted 90 minutes. Data were analyzed using ${\chi}^2$-test, independent t-test and paired t-test using the SPSS program. Results: Muscle strength of the lower extremities, postural balance and fall efficacy scores significantly improved in the experimental group compared to the control group. Conclusion: These results suggest that this program can improve lower extremity muscle strength, postural balance and fall efficacy in elders. Therefore, this program is recommended for use in fall prevention programs for elders living in the community.

Purpose: This study aimed to verify the effects of a community-based fall prevention exercise program for older adults on lower extremity muscle strength, balance ability, and fall efficacy. Methods: This study recruited 30 participants, and the program was conducted for 10 weeks. The program included sessions on strength and balance exercises, conducted for 50 minutes a day and at least three times a week. The collected data were analyzed using non-parametric (Wilcoxon signed-rank test, generalized estimated equation) and parametric statistics (paired t-test, rmANOVA). Results: After 12 weeks of exercise program, lower extremity muscle strength and static-dynamic balance ability significantly increased. The fall efficacy increased from an average score of 2.48 points before the test to an average score of 2.91 points after the test. Regarding general characteristics, there were no significant differences in effect before and after the program, except for fall efficacy. Conclusion: The above results showed that the intervention of a community-based fall prevention exercise program for older adults was effective. Therefore, it is suggested that this exercise program be organized regularly within the center to provide periodic and long-term services.

Background: The purpose of this study is to provide basic data on physical therapy intervention by comparing the physical ability and fall efficacy and depression of elderly and hospitalized elderly. Method: This study was carried out with 22 hospitalized elderly who can live in Y-Hospital and 22 elderly people in Busan. We measured body mas index, time up & go test, function reach test, 10m walking test, bracket lifting test, fall efficacy and geriatric depression scale. The data collection period was from November to December 2017. The collected data was analyzed using SPSS Win 18.00 program. Results: There was a significant difference between the elderly and hospitalized elderly form physical ability and depression(p<.05). But Fall efficacy was no significant difference(p>.05). 10m walking with TUG, heel with fall efficacy showed quantitative correlation and 10m walking with fall efficacy, depression with fall efficacy, heel with TUG, 10m walking showed amulet correlation. There was a statistically significant difference. Conclusion: Elderly showed better results in physical ability and depression than hospitalized patients.

Purpose: This study was conducted in order to investigate the effects of an aerobic exercise program on mobility,fall efficacy, balance, and stress in the elderly at senior centers. Methods: This research was conducted as a quasi-experimental pretest and posttest control and experimental comparison study. The subjects were 41 senior residents (Exp.=18, Cont.=23) who aged above 65 at senior centers in S City. The period of time for data collection and intervention was from August 25 to December 5, 2008. Results: Mobility (t=-3.10, p<.01) in the experimental group were significantly higher than those in the control group without an aerobic exercise program. However,fall efficacy (t=1.28, p=.207), balance (t=-.53, p=.602; t=.36, p=.723), stress (t=-1.32, p=.199) in the experimental group was not significantly higher than that in the control group. Conclusion: These findings confirmed that aerobic exercise programs make a contribution to improving mobility in the elderly at senior centers.