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Objective:To determine the effectiveness of 8-week group functional balance training classes on balance outcomes in community-dwelling veterans at risk for falls.Design:Pre-test, post-test using retrospective data.Setting:VISN 8 Patient Safety Center at James A. Haley Veterans Hospital in Tampa, FL, USA.Participants:Fifty one community living veterans with mean age of 78 at risk for falls.Intervention:Participants received a weekly 1-hour functional balance training class for 8 weeks in a small group setting (4–5 participants).Measurements:Pre and post intervention measures included Berg Balance Scale, Limits of Stability (LOS) and modified Clinical Test of Sensory Interaction on Balance (mCTSIB).Results:Eighty four percent of the participants completed 5 or more weekly classes. Peripheral neuropathy was the most common risk factor among the participants. There was a significant improvement in the Berg (p < 0.0001) and Composite Reaction Time (p < 0.0004) after the intervention.Conclusion:An eight week group functional balance training class was safe and effective in improving balance outcomes in a cohort of elderly veterans at risk for falls.

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The most commonly used functional status (FS) instruments were examined to determine the validity, reliability, sensitivity, and specificity to change and feasibility in residents in an assisted living facility (ALF). Twenty-six ALF residents were assessed weekly for up to 8 months using six instruments. Group and single-subject analyses were used to examine associations between instruments and acute events. Two were problematic initially (Katz Index of Independence in Activities of Daily Living and hand grip) and were excluded early in the study. Of the remaining instruments, only the Barthel Index and Resident Assessment Instrument had acceptable psychometric profiles. However, these instruments were either not feasible in this environment or did not capture the full range of FS in this population. The current study's findings suggest that instruments commonly used to measure FS may be inadequate for this population and environment. These findings may be used to develop assessment methods for ALF residents that capture both the full range of FS in ALF settings as well as acute and long-term changes in functioning.

Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.

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Rehabilitation nurses are in a critical position to lead interdisciplinary team fall prevention management, including injury risk reduction. This article provides an update for rehabilitation nurses on evidence-based strategies to reduce patients'risk of fall-related injuries. This content builds on existing literature by focusing on knowledge to promote patient responses that reduce the risk of falls and ultimately fall-related injuries. Although rehabilitation nurses understand the complex nature of falls, addressing the intrinsic and extrinsic risk factors that increase the risk of fall-related injuries requires both individually based treatment programs and a system-wide commitment. A plethora of literature discusses fall risks and falls, but this article profiles the at-risk patient and describes current and emerging evidence-based interventions to protect patients from fall-related injuries by reducing risk factors. This discussion is limited to exercise, environmental redesign, osteoporosis prevention, and hip protectors.

Background-Maximum step length is a brief clinical test involving stepping out and back as far as possible with the arms folded across the chest. This test has been shown to predict fall risk, but the biomechanics of this test are not fully understood. Knee and hip kinetics (moments and powers) are greater for longer steps and for younger subjects, but younger subjects also step farther.Methods-To separate effects of step length, age, and fall history on joint kinetics; 14 healthy younger, 14 older non-fallers, and 11 older fallers (27(5), 72(5), 75(6) years respectively) all stepped to the same relative target distances of 20-80% of their height. Knee and hip kinetics and knee co-contraction were calculated.Findings-Hip and knee kinetics and knee co-contraction all increased with step length, but older non-fallers and fallers utilized greater stepping hip and less stepping knee extensor kinetics. Fallers had greater stepping knee co-contraction than non-fallers. Stance knee co-contraction of non-fallers was similar to young for shorter steps and similar to fallers for longer steps.Interpretation-Age had minimal effects and fall history had no effects on joint kinetics of steps to similar distances. Effects of age and fall history on knee co-contraction may contribute to agerelated kinetic differences and shorter maximal step lengths of older non-fallers and fallers, but step length correlated with every variable tested. Thus, declines in maximum step length could indicate declines in hip and knee extensor kinetics and impaired performance on similar tasks like recovering from a trip.