3.2.2.3 Timed up and go

The Timed up and go (TUG) test was developed in 1991 [49]. The test consists of finding the time the patient takes to get up from a chair (height about 46 cm), walk the distance of 3 m at a comfortable and safe step, turn around and go back to the chair, and sit down again. The subject wears his regular footwear and uses his customary walking aid (cane or walker) if necessary [49]. A faster time indicates a better functional performance [50].

#### Key points


Figure 5. Recommendations to guide the use of exercise for falls prevention.

### 4. Improvement of the postural balance

Falls are a public health problem. The risk of falling increases with age for many reasons, for example overall weakness and frailty, balance problems, cognitive problems, vision problems, some medications and polypharmacy, acute illness, and other environmental hazards. Because of this, multifactorial interventions should include an initial assessment of modifiable risk factors for falls and subsequent customized interventions for each patient based on issues identified in the initial assessment.

One type of treatment to improve balance is physical exercise. Figure 5 presents a summary of best practice recommendations to use for improving postural balance and, consequently, fall prevention.

#### 4.1 Types of exercises

inability to walk independently and safely in activities of daily living and, conse-

The short physical performance battery (SPPB) is designed to measure functional status and physical performance, assessing walking speed, standing balance, and sitto-stand performance [47]. The scores range from 0 (worst performance) to 12 (best performance). In a study, Veronese et al. demonstrated that SPPB scores ≤6

The Timed up and go (TUG) test was developed in 1991 [49]. The test consists of finding the time the patient takes to get up from a chair (height about 46 cm), walk the distance of 3 m at a comfortable and safe step, turn around and go back to the chair, and sit down again. The subject wears his regular footwear and uses his customary walking aid (cane or walker) if necessary [49]. A faster time indicates a

• A good clinical evaluation, a detailed history, and a thorough physical examination are essential to

• Assessment of balance is important for both diagnostic and therapeutic reasons in clinical practice.

• The tests can be divided between single-task and multiple-task measures.

quently, increased risk of falls [46].

Geriatric Medicine and Gerontology

better functional performance [50].

evaluate postural balance.

3.2.2.3 Timed up and go

Key points

Figure 5.

182

Recommendations to guide the use of exercise for falls prevention.

3.2.2.2 Short physical performance battery

are associated with a higher fall rate in old people [48].

Any physical exercise that overloads the balance systems without putting the patient at risk is recommended. It is possible, for example, to make a training circuit, with different stimuli for the elderly [51]. In the circuit, exercises such as one-legged support (both sides), gait on unstable surface, tandem gait, among others can be done, always increasing the level of difficulty.

Another possibility is to join two modalities of exercises: video games and muscle strengthening, for example. In a study, Prata and Scheicher found improvement in fear of falling and in mobility after 12 weeks of video game and muscle strength training in older women with a history of falls [52].

#### 4.1.1 Video games

Postural balance training involving new technologies can promote more challenging situations for the elderly, increasing patient motivation and adherence to the program [53]. The use of video games provides immediate visual feedback, allowing users to make changes in motion according to the situations of the games and thus to develop strategies to restore and/or maintain postural balance, and may therefore be effective for the prevention of falls [54].

Carvalho et al. showed an increase in gait speed and a decrease in the TUG time in elderly female fallers after 12 weeks of training (two sessions per week) with commercialized games of Wii Fit by Nintendo® in sync with the Wii Balance Board® [55]. Three different games were used for postural balance training: Penguin Slide, where the participants had to catch fish while balanced on a piece of ice by shifting their weight from side to side; Table Tilt, where participants move their bodies in various directions to put balls into holes; and Tightrope, where participants walk on a tightrope with several vertical jumps to avoid obstacles.

#### 4.1.2 Treadmill exercise

In the last decade, the use of the treadmill in the rehabilitation of gait in Parkinson's disease patients, stroke patients, and cerebral palsy (CP) patients has been studied. Some studies explain the reasons for improving postural balance patterns with treadmill training. One of them explains that treadmill training has the capacity to promote motor re-learning and, consequently, improve locomotor capacity during walking [56]. It has also been suggested that training, through repetitive movements generated by the treadmill, activates locomotor patterns of functional movements, sensory inputs, and circuits of the central nervous system [57]. In addition, it has been hypothesized that repetitive movements associated

with cutaneous and proprioceptive impulses may induce activation of central movement patterns and, in the long term, potentiate the motor cortex, facilitating motor learning [58].

Conflict of interest

Author details

São Paulo, Brazil

185

Natália Moya Rodrigues Pereira<sup>1</sup> and Marcos Eduardo Scheicher<sup>2</sup>

2 Physiotherapy and Occupational Therapy Department, UNESP, Marília,

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Biosciences Institute, UNESP, Rio Claro, São Paulo, Brazil

\*Address all correspondence to: marcos.scheicher@unesp.br

provided the original work is properly cited.

\*

The authors declare no conflicts of interest.

Postural Imbalance in the Elderly: Main Aspects DOI: http://dx.doi.org/10.5772/intechopen.79830

Toole et al. and Frenkel-Toledo et al. showed an improvement in the gait and balance in Parkinson's patients that participated in a six-week treadmill walking program [59, 60]. Herman et al. showed an enhancement in the gait rhythmicity and several improvements in motor signs, the latter remaining significantly better 4 weeks after the training was stopped [61].

Training on a treadmill to fight the stroke-related disabilities resulted in valuable results: fatigue resistance [62], endurance performance improvement [63], and the development of motor function [64]. A study in chronic non-ambulatory hemiparetic subjects revealed that partial body weight–supported treadmill training was superior to conventional physiotherapy with regard to restoration of gait and improvement of ground walking velocity [65]. In this study, during one 30-min session of treadmill training, patients could practice up to 1000 gait cycles as compared with a median of less than 50 gait cycles during one regular physiotherapy session.

Bjornson et al. studied the effect of short-burst interval locomotor treadmill training on walking capacity and performance in cerebral palsy and concluded that this training may improve short-term walking capacity and performance [66]. In another study, Mattern-Baxter et al. concluded that home-based treadmill training accelerates the attainment of walking skills and decreases the amount of support used for walking in young children with CP [67].

In healthy elderly with falls history, there are few studies that evaluated the responses of the postural balance with the treadmill training. Dorfman et al. found that after 6 weeks of treadmill plus dual-task training program, elderly fallers demonstrated improved scores on tests of mobility, functional performance tasks, and cognition [68]. In another study, van Ooijen et al., using a treadmill training with visual context, found improvement in walking ability and reduced risk of falls and fear of falling in older adults with a recent fall-related hip fracture [69].

#### Key points


#### 5. Conclusion

It is necessary to consider the various facets of the postural balance system when a patient presents a problem related to this. Evaluating these facets is important in prescribing the correct treatment for each situation. There are many types of training that can improve postural balance. Physical exercises, when performed with a moderate or high challenge to the balance system, are a type of treatment that can help reduce the risk of falls in the elderly.

Postural Imbalance in the Elderly: Main Aspects DOI: http://dx.doi.org/10.5772/intechopen.79830
