In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.
Home care providers experience high occupational injury rates. Improving safety is becoming increasingly urgent as this sector expands to support the aging population. Caregivers identify assisting with toileting as a particularly frequent and difficult activity. This mixed-methods observational study identified and analyzed the toileting subactivities that place care providers at the greatest risk of musculoskeletal injury. Eight personal support workers (home care aides) assisted a frail older adult (actor) in a simulated home bathroom. Overall technique and body postures were analyzed. Exposure to musculoskeletal injury risk factors (low back loads and time in extreme trunk postures) was greatest when removing/replacing clothing and providing posterior perineal care; high loads were also possible during transfers. Exposures can be reduced by lowering the pants only to knee level or squatting to raise them. A bidet seat or attachment can perform perineal cleaning, which accounted for 32% of time in severe trunk flexion.
Situations that force the central nervous system to rely on either stored or online VSI tend to exacerbate age-related reductions in speed and accuracy of reach-to-grasp balance-recovery reactions. Further work is needed to determine if this increases risk of falling in daily life.
Bathroom assistive devices are used to improve safety during bathing transfers, but biomechanical evidence to support clinical recommendations is lacking. This study evaluated the effectiveness of common bathroom aids in promoting balance control during bathing transfers. Twenty-six healthy adults (12 young, 14 older) stepped into and out of a slippery bathtub while using a vertical grab bar on the side wall, a horizontal grab bar on the back wall, a bath mat, a side wall touch, or no assistance. Balance control was characterized using center of pressure measures and showed greater instability for older adults. The vertical grab bar and wall touch resulted in the safest (best controlled) transfers. The bath mat provided improved balance control in the axis parallel to the bathtub rim but was equivalent to no assistance perpendicular to the rim, in the direction of obstacle crossing. These results can support clinical recommendations for safe bathing transfers.
PURPOSE: Rapid reach-to-grasp balance-recovery reactions play a critical role in preventing falls. Recent young-adult studies suggest these reactions may be guided using stored visuo-spatial information from the central field, and that peripheral vision may also play an important role. This study used gaze recordings to examine the visual control of reach-to-grasp reactions in older adults. METHODS: A motion platform was configured to simulate a "reallife" environment that included a handrail. Subjects performed an activity that required walking to the end of the platform, which was triggered to move suddenly and unexpectedly as they approached the handrail. Twelve healthy older adults (64-79 years old) were tested and compared to 12 healthy young adults (22-30 years old) tested as part of another study. RESULTS: Older adults were more than twice as likely as young adults to react to the platform perturbation by grasping the handrail (10/12 versus 4/12), despite being much less likely to visually fixate the handrail after entering the new environment. Grasping errors were remarkably common (5/10 older, 2/4 young), but there was no consistent relationship to the preceding gaze behavior. CONCLUSION: Older adults were highly dependent on using a handrail to recover balance, but commonly failed to direct overt visual attention to the rail after entering the unfamiliar environment. The failure to fixate the rail required the reaching movement to be guided using peripheral vision. Further research is needed to determine whether grasping errors can be prevented via interventions that either attract overt attention to the handrail or improve processing of peripheral-field information. KEY WORDS: visual attention; eye movements; aging; postural balance; reaching and grasping; peripheral vision. RESUMEN OBJETIVO: Las reacciones rápidas de "alcanzar y agarrar" destinadas a recuperar el equilibrio juegan un papel fundamental a la hora de evitar caídas. Estudios recientes realizados en adultos jóvenes sugieren que estas reacciones podrían estar dirigidas por la información visuo-espacial previamente almacenada proveniente del campo visual central, y que la visión periférica podría desempeñar también un papel relevante. En este estudio se utilizaron grabaciones del recorrido de la mirada para analizar, en adultos de mayor edad, el control visual en el contexto de las reacciones de "alcanzar y agarrar". MÉTODOS: Una plataforma móvil se configuró de forma que simulara un entorno "de la vida real", en el que se incluyó un pasamanos. Se pidió a los sujetos que realizaran una actividad, para la cual tenían que andar hasta el extremo de la plataforma. Dicha plataforma estaba construida de modo que se moviese bruscamente y de forma inesperada cuando el sujeto llegaba cerca del pasamanos. Doce adultos de mayor edad (64-79 años) se sometieron a esta prueba y los resultados se compararon con los obtenidos anteriormente, en el marco de otro estudio, en 12 adultos jóvenes (22-30 años). Todos los participantes gozaban de buena sa...
For a reach-to-grasp reaction to prevent a fall, it must be executed very rapidly, but with sufficient accuracy to achieve a functional grip. Recent findings suggest that the CNS may avoid potential time delays associated with saccade-guided arm movements by instead relying on peripheral vision (PV). However, studies of volitional arm movements have shown that reaching is slower and/or less accurate when guided by PV, rather than central vision (CV). The present study investigated how the CNS resolves speed-accuracy trade-offs when forced to use PV to guide perturbation-evoked reach-to-grasp balance-recovery reactions. These reactions were evoked, in 12 healthy young adults, via sudden unpredictable anteroposterior platform translation (barriers deterred stepping reactions). In PV trials, subjects were required to look straight-ahead at a visual target while a small cylindrical handhold (length 25%> hand-width) moved intermittently and unpredictably along a transverse axis before stopping at a visual angle of 20°, 30°, or 40°. The perturbation was then delivered after a random delay. In CV trials, subjects fixated on the handhold throughout the trial. A concurrent visuo-cognitive task was performed in 50% of PV trials but had little impact on reach-to-grasp timing or accuracy. Forced reliance on PV did not significantly affect response initiation times, but did lead to longer movement times, longer timeafter-peak-velocity and less direct trajectories (compared to CV trials) at the larger visual angles. Despite these effects, forced reliance on PV did not compromise ability to achieve a functional grasp and recover equilibrium, for the moderately large perturbations and healthy young adults tested in this initial study.
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