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Question:

Discuss about the the impact of use of balance Orthotic that helps in elevating the measures of balance and movement in case of older adults. 
 
 

Answer:

Introduction

The improvement of quality of life of the older adults should be recognized as one of the prime priorities of the health care services. Studies have shown that in the recent years the nature of the medical services that is provided to the older adults have changed, increasing their life expectancy to about 80 years . Most of the clinicians tend to focus on the ways of diagnosing the disease as well as treatment of the disease, however it has been that the older people are mostly concerned about the quality of their lives. Although they may be troubled by the concept of ageing, as a result of which they are not eager to seek treatment for the serious health conditions, in spite of suffering from disability or distress. This paper therefore aims to highlight two different ways to promote quality of health with respect to that of the older adults. The paper discusses the techniques of Tai chi which is a form of martial art that helps to elevate the health conditions of the older people in terms of strength, improving balance that will prevent falls and promote functional mobility. Additionally the paper illustrates the impact of use of balance Orthotic that helps in elevating the measures of balance and movement in case of older adults. A critical analysis is carried out in order to better understand how these techniques help to enhance the betterment of lives of the older adults.

Description of topic of interest

The topic of interest here focuses on the promotion of health care in the older adults populations. Individuals of this population generally fails to understand the importance of quality of care and simple concentrate on the result of the treatment procedures. Hence promotion of good quality of health care maintenance is required. Examples of such health care strategies can be implemented of Tai Chi along with use of balance orthotic in such groups of people (Wayne et al., 2014). Using these strategies the health of the patients can be increases to a great extend thus promoting quality care of and health service.

 

Review of article 1

The research article used a deductive approach of research strategy since a quasiexperimental study was conducted using 1-group pre-/posttest method. This helped to understand the impact of daily wear during a term of 4 months. The study aimed primarily the effect it had on the mobility. Additionally it investigated the balance and the rate of falls in case of older adults.

The study reflected balance orthotic and its functionality as being the independent variables whereas the older adults on whom the effect is being studied as the dependent variables. In order to recruit participants, methods were adapted such as distribution of flyers along with a letter addressed by a retirement center. In order to screen participants a study was conducted along with obtaining of written consent from the participants. Criteria of inclusion involved age of 65 and above, study assessment completion ability, and the capacity of the walk a distance of 30 ft with or without an assistive device. The confirmation of mobility limitation which was indicated by a score between 4 and 9 out of 12 points on the Short Physical Performance Battery (SPPB). The exclusion criteria were impairment of the cognitive features that was indicated by a score of less than 24 out of 30 points in the Mini-Mental State Examination. Other factors were uncontrolled diabetes, uncontrolled cardiovascular issues or pain, and a progressive neurological disorder (Parkinson’s disease or MS) accompanied by severe visual impairment (Paiehdar et al., 2014).

For assessments of the patients the method of balance-based torso weighting (BBTW) was conducted by the clinicians which provided the quantitative data.  For the treatment a combination of small, light weights (0.5, 0.25, and 0.125 lb) was placed on each participant’s BO to decrease the direction, magnitude, and velocity of balance loss. Participants were given instruction in donning, doffing, and laundering the BO. The clinician repeated the BBTW assessment and adjusted weights according to the protocol once each month.

This study demonstrates that wearing the BO for 2 hours, twice per day for 4 months, results in quality enhancement in measures of gait, balance, chair stands, fall risk, and mobility disability in a group of older, mobility-impaired adults. Minimal clinically important differences and minimal detectable changes have been characterized in the literature for the GS, SPPB, and FTSST (Noah, Gibson-Horn & Vincenzo, 2018).

Two of the measure that were conducted like tandem stance time (TST) and Falls Efficacy Scale (FES) reported that there was no significant improvement. The results lagged behind the expectation on case of the FES test. The repeated exposure of the BBTW assessments to the brisk perturbations were performed in order to study the improvement in the risk of the falls that was able to offer an alternative for the 4-month trial period. However the study failed to investigate the changes in balance employing repeated upper and lower trunk perturbations. It was evident form the study that improvements of significant nature was seen in case of SPPB, FTSST, GS, TUG, and FGA, in contrast with the results of the preceding 5-day RCT, which only led to significant SPPB improvements. This was perceived as a success of BO in facilitating the FTSST, GS, Timed Up and Go (TUG) and Functional Gait Assessment (FGA) improvements, which could lead to long term treatment procedures. Future research scopes lies in the fact that a relationship can be established between the period of treatment duration and that of the improvements in the measures of mobility (Samitier et al., 2016). Recommendations have been made for implementation of more intervention strategies in order to increase the quality of the care using the balance orthotic.

 

Review of article 2

This paper also applied a deductive approach of research strategy like the previous one, implementing a quasi-experimental pre- and posttest design that allowed comparison of an experimental group with a control group. The test group consisted of 16 participants (8 males, 8 females); of those, 85.7% had previous Tai Chi experience in the recent past. The experimental group had an average (SD) age of 80.4 (6.8) years. The study reflected the community based Tai-chi interventions as being the independent variables and the older adults dwelling in the community as the dependent variables. In order to be included in the study, subjects confined in either of the groups required to be community dwelling and English-speaking, falling in the age group of 55 years or more, who could ambulate in an independent manner. No specifications were observed with respect to gender, income, or educational level. Individuals who suffered from recent cardiac or neurological changes in medical status or surgical procedures within the last 6 months were not included in the study. In both groups, subjects reported various longstanding cardiac, hypertension, and arthritic issues (Lee et al., 2013).

The study was quantitative in nature as it quantified the functional strength of the individuals using Fifty Foot Walk Test (FFWT) that helped in demonstrating the improvements in performance that occurred in the individuals who participated in Tai Chi group. However when ABC scale scores were evaluated, no significant change was seen after a tenure of 16 weeks in either the test group or the control group. The individuals who participated in the Tai Chi training, however, reported that there was a significant increase in self-reported confidence in terms several aspects on the ABC scale, with varied from moderate to high effect sizes. Certain questions were asked for proper evaluation that included: “Are you confident that you will not lose balance or become unstable during bending over to pick up something off the floor?”  “How confident that when you stand on a chair to reach for something you will be steady?’ and “How do you feel while walking outside on icy sidewalks?”.

 


When mixed ANOVA analysis was carried out for the two groups, it was seen that there was a comparison in terms of age and initial knee strength which were accounted for as co-variants that successfully indicated differences in question that were of significance. After a tenure of 16 weeks it was observed that Tai Chi was able to improve the strength and the confidence of the individuals to a significant amount. There is a scope of future research in terms of increasing the sample size which could possibly give a better evaluation of the performance measurements (Wang et al.,  2014).

Critical analysis

The study conducted helped to gain information regarding the measures that to be undertaken in order to provide a successful amount of healthcare especially to the older adults. The merits of the study belong to the fact that careful observations have been conducted in order to understand the amount of care that is required by such group of populations. The strengths of the study includes the use of quasiexperimental methods using the deductive approach of research strategy which considers the individuals and helps to discuss the causal impact of the intervention on the particular population. The limit of the studies include the consideration of a small sample which in turn decreases the credibility of the study. Alternatively a big sample can be considered with individuals from a wide variety of backgrounds which will hep to understand the variability in the data obtained thus making it more credibility.

Summary of knowledge gained

The study that was conducted successfully showed that on wearing the balance orthotic for a period of two hours, twice per day for 4 months helped in improving the results of gait measurements, balance, and risk for fall in a group of older people who are suffering from impairment of mobility. The study showed that there has been improvements in terms of gait speed (GS), and the FTSST improvement that was evidently detectable. Other functional measurements of the individuals were seen to be improving due to the impact of the BO. The methods of analysis that were employed for the study successfully declared that wearing a BO for a period of 4 hours per day for 4 months can result in elevation in the assessments of functions that are linked with the fall risk (SPPB, GS, FGA, TUG, and FTSST) in a group of participants who are older adult suffering from limited mobility (Bubela et al., 2017).

 


The other paper which deals with the studies of Tai Chi succeeded in showing that training in Tai Chi involves the improvement of information that acts as indications in the balance change that required consideration of the performance of the older adults in terms of fall risk, functional mobility, strength, and fear of falling. Participation of these older adults in a Tai Chi program that is mainly community based, might provide ways for the improvement in strength, mobility, and acquirement of confidence in functional tasks performance. Certain elements of Tai Chi are needed to be implemented into the therapy programs for older adults related to the risk for fall. Another significant option might be referral to community-based Tai Chi programs in the continuum of health related care in case of the older adults (Noah, Gibson-Horn & Vincenzo, 2018).

Summary of paper

The paper showed that used of the methods of quasiexperimental process was appropriate for conduction of such experiments as it mainly focuses on the understanding the causal effects of the health care measures on the affected groups of individuals. The method was quite reliable because good quality analysis tools were implemented in the study methods. The study also undertook implementation of intervention approaches which made the data of the study more reliable and increased its credibility. A community based approach was undertaken which helped to include a variety of individuals into the study process making the conditions of the study applicable to many situations and not just only one circumstance. The study also suggests recommendations for further improvement in the study methods so that other interventions can be undertaken by the researchers in order to promote better quality of care for the older adults.

 

References

Bubela, D., Sacharko, L., Chan, J., & Brady, M. (2017). Balance and Functional Outcomes for Older Community-Dwelling Adults Who Practice Tai Chi and Those Who Do Not: A Comparative Study. Journal of geriatric physical therapy (2001). Retrieved from: https://europepmc.org/abstract/med/29135600

Lee, H. J., Lim, K. B., Jung, T. H., Kim, D. Y., & Park, K. R. (2013). Changes in balancing ability of athletes with chronic ankle instability after foot orthotics application and rehabilitation exercises. Annals of rehabilitation medicine, 37(4), 523-533. Retrieved from: https://www.synapse.koreamed.org/search.php?where=aview&id=463566&code=1041ARM&vmode=FULL

Noah, S., Gibson-Horn, C., & Vincenzo, J. L. (2018). Four Months of Wearing a Balance Orthotic Improves Measures of Balance and Mobility Among a Cohort of Community-Living Older Adults. Journal of geriatric physical therapy (2001). Retrieved from: https://europepmc.org/abstract/med/29351127

Paiehdar, S., Saeedi, H., Ahmadi, A., Kamali, M., & Mohammadi, M. (2014). The comparison of the immediate effect of 3 functional, UCBL and modified UCBL foot orthotics impact on dynamic balance in subjects with flexible flatfoot. Journal of Rehabilitation, 14(4), 66-73. Retrieved from: https://www.ingentaconnect.com/content/doaj/16072960/2014/00000014/00000004/art00008

Samitier, C. B., Guirao, L., Costea, M., Camós, J. M., & Pleguezuelos, E. (2016). The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthetics and orthotics international, 40(1), 83-88. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0309364614546927

Wang, F., Lee, E. K. O., Wu, T., Benson, H., Fricchione, G., Wang, W., & Yeung, A. S. (2014). The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. International journal of behavioral medicine, 21(4), 605-617. Retrieved from: https://link.springer.com/article/10.1007/s12529-013-9351-9

Wayne, P. M., Walsh, J. N., Taylor?Piliae, R. E., Wells, R. E., Papp, K. V., Donovan, N. J., & Yeh, G. Y. (2014). Effect of Tai Chi on cognitive performance in older adults: Systematic review and meta?Analysis. Journal of the American Geriatrics Society, 62(1), 25-39. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12611

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