Ohara Akihiro, Yasuhiro Miyamoto, Mochizuki Fumihiro, Shinohe Tatsuya, Sasano Yoshiyuki, Suzuki Kaori, Mikami Koshi, Koizuka Izumi
Department of Otolaryngology, St. Marianna University School of Medicine, Japan.
Department of Otolaryngology, St. Marianna University School of Medicine, Japan.
Auris Nasus Larynx. 2021 Aug;48(4):571-576. doi: 10.1016/j.anl.2020.10.010. Epub 2020 Nov 19.
Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder.
Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane.
A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4-53.7 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6-53.2 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7-98.4 cm/s) to 96.1 cm/s (95% CI, 88.3-103.9 cm/s) (p = 0.005).
Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.
65岁以上患有平衡障碍的成年人跌倒风险约为无平衡障碍者的两倍。跌倒导致老年人常见的股骨近端骨折约74%。由于平衡障碍在老年人中比在年轻人中更普遍，因此应对老年人的平衡障碍以预防跌倒及其导致的日常生活活动（ADL）能力下降非常重要。在本研究中，我们调查了前庭康复（VR）和使用手杖对改善65岁以上患有平衡障碍患者的步态和平衡的影响。
纳入2018年7月1日至11月1日期间到圣玛丽安娜大学医学院耳鼻喉科就诊、头晕症状持续≥3个月且日语版头晕残障量表评分≥26分的65岁以上患者。我们定量分析了他们在VR前后以及使用和不使用手杖情况下的步态。
共有21名患者参与研究（14名女性；平均年龄73.9±6.9岁）。在VR之前，使用手杖对步长或步行速度没有影响。VR后，使用手杖使步长从50.5厘米（95%置信区间[CI]，47.4 - 53.7厘米）增加到52.0厘米（95%CI，48.9 - 55.1厘米）（p = 0.039）。步行速度没有变化。比较VR前后使用手杖时的步行评估结果，步长从49.9厘米（95%CI，46.6 - 53.2厘米）增加到52.0厘米（95%CI，48.9 - 55.1厘米）（p = 0.005），步行速度从90.5厘米/秒（95%CI，82.7 - 98.4厘米/秒）增加到96.1厘米/秒（95%CI，88.3 - 103.9厘米/秒）（p = 0.005）。
VR后使用手杖时的步行速度和步长显著改善。VR和使用手杖可能协同作用以改善步行。
