Balance in the elderly population is a major concern given the often catastrophic and disabling consequences of fall-related injuries. Structural and functional declines of the somatosensory system occur with aging and potentially contribute to postural instability in older adults. The objectives of this article are: (1) to discuss the evidence regarding age-related anatomical and physiological changes that occur in the peripheral proprioceptive and cutaneous systems, (2) to relate the basic science research to the current evidence regarding clinical changes associated with normal aging, and (3) to review the evidence regarding age-related proprioceptive and cutaneous clinical changes and relate it to research examining balance performance in older adults. The article is organized by an examination of the receptors responsible for activating afferent pathways (muscle spindle, golgi tendon organ, and articular and cutaneous receptors) and the corresponding sensory afferent fibers and neurons. It integrates basic science laboratory findings with clinical evidence suggesting that advanced aging results in a decline in cutaneous sensation and proprioception. The potential relationship between postural instability and sensory impairments in older adults also is discussed. Current laboratory and clinical evidence suggests that aging results in: (1) diverse and nonuniform declines in the morphology and physiological function of the various sensory structures examined, (2) preferential loss of distal large myelinated sensory fibers and receptors, and (3) impaired distal lower-extremity proprioception, vibration and discriminative touch, and balance. These findings provide foundational knowledge that emphasizes the importance of using reliable and valid sensory testing protocols for older adults and the need for further research that clarifies the relationship between sensory impairment and balance.
The Y-balance test (YBT) is one of the few field expedient tests that have shown predictive validity for injury risk in an athletic population. However, analysis of the YBT in a heterogeneous population of active adults (e.g., military, specific occupations) involving multiple raters with limited experience in a mass screening setting is lacking. The primary purpose of this study was to determine interrater test-retest reliability of the YBT in a military setting using multiple raters. Sixty-four service members (53 males, 11 females) actively conducting military training volunteered to participate. Interrater test-retest reliability of the maximal reach had intraclass correlation coefficients (2,1) of 0.80 to 0.85 with a standard error of measurement ranging from 3.1 to 4.2 cm for the 3 reach directions (anterior, posteromedial, and posterolateral). Interrater test-retest reliability of the average reach of 3 trails had an intraclass correlation coefficients (2,3) range of 0.85 to 0.93 with an associated standard error of measurement ranging from 2.0 to 3.5cm. The YBT showed good interrater test-retest reliability with an acceptable level of measurement error among multiple raters screening active duty service members. In addition, 31.3% (n = 20 of 64) of participants exhibited an anterior reach asymmetry of >4cm, suggesting impaired balance symmetry and potentially increased risk for injury.
More than 10 000 Americans seek medical treatment for sports, recreational activity, and exercise-related injuries on a daily basis. 20 Researchers have estimated that 50% to 80% of these injuries are overuse in nature and involve the lower extremity. 1,11,25 In the military, physical training and exercise-related injuries account for 30% of hospitalizations and 40% to 60% of all outpatient visits, with 10 to 12 injuries per 100 soldier-months.12 Although the risk of musculoskeletal conditions and injuries is multifactorial, 7,9,10,15,[17][18][19] preliminary evidence suggests that neuromuscular and strength training programs may be beneficial for preventing the occurrence of these conditions. 7,9,10,15,[17][18][19] However, tools that assess movement to help predict those at highest risk for musculoskeletal conditions and injuries have been lacking for both athletic and military populations. The Functional Movement Screen (FMS) is a relatively new tool that attempts to address multiple movement factors, with the goal of predicting general risk of musculoskeletal T T STUDY DESIGN: Reliability study. T T OBJECTIVES:To determine intrarater testretest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. T T BACKGROUND:The FMS is used by various examiners to assess movement and predict timeloss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college-age participants. T T METHODS:Sixty-four active-duty service members (mean SD age, 25.2 3.8 years; body mass index, 25.1 3.1 kg/m 2 ) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to 72 hours later. Interrater reliability was based on the assessment from 2 raters, selected from a pool of 8 novice raters, who assessed the same movements on day 2 simultaneously. Descriptive statistics, weighted kappa (κ w ), and percent agreement were calculated on component scores. Intraclass correlation coefficients (ICCs), standard error of the measurement, minimal detectable change (MDC 95 ), and associated 95% confidence intervals (CIs) were calculated on composite scores. T T RESULTS:The average SD score on the FMS was 15.7 0.2 points, with 15.6% (n = 10) of the participants scoring less than or equal to 14 points, the recommended cutoff for predicting time-loss injuries. The intrarater test-retest and interrater reliability of the FMS composite score resulted in an ICC 3,1 of 0.76 (95% CI: 0.63, 0.85) and an ICC 2,1 of 0.74 (95% CI: 0.60, 0.83), respectively. The standard error of the measurement of the composite test was...
Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions.Questions/purposes The purposes of this study were (1) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk; and (2) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers. Methods Our study was a planned secondary analysis from a prospective cohort examining how baseline factors predict musculoskeletal injury. Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures. Army Physical Fitness Test (consisting of a 2-mile run and 2 minutes of sit-ups and push-ups). A total of 320 Rangers were invited to enroll and 211 participated (66%). Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys, medical record reviews, and a query of the Department of Defense healthcare utilization database. Injury surveillance data were available on 100% of the subjects. Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest. A logistic regression equation was then calculated to find the most pertinent set of predictors. Of the 188 Rangers (age, 23.3 ± 3.7 years; body mass index, 26.0 ± 2.4 kg/m 2 ) remaining in the cohort, 85 (45.2%) sustained a musculoskeletal injury of interest. Results Smoking, prior surgery, recurrent prior musculoskeletal injury, limited-duty days in the prior year for musculoskeletal injury, asymmetrical ankle dorsiflexion, pain with Functional Movement Screen clearing tests, and decreased performance on the 2-mile run and 2-minute situp test were associated with increased injury risk. Presenting with one or fewer predictors resulted in a sensitivity of 0.90 (95% confidence interval [CI], 0.83-0.95), and having three or more predictors resulted in a specificity of 0.98 (95% CI, 0.93-0.99). The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 (95% CI, 2.0-9.2), relative risk of 1.9 (95% CI, 1.4-2.6), and an area under the curve of 0.64. Conclusions Multiple factors (musculoskeletal injury history, smoking, pain provocation, movement tests, and lower scores on physical performance measures) were associated with individuals at risk for musculoskeletal injury. The summation of the number of risk factors produced a highly sensitive (one or less factor) and specific (three o...
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