Imbalance and fractures in the elderly Effects of decreased vibration sensation and vestibular asymmetry

Ella Kolbrun Kristinsdottir

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Control of the upright stance and locomotion is a complicated process of muscular activity. The muscular activity is dependant on afferent information from the different sensory organs and interpretation in the central nervous system. Age-related degenerative changes exist in all the domains concerned with control of posture.

The aims of the studies were to investigate if suspected age-related degenerative changes in sensation perception in lower limbs and vestibular asymmetry among the elderly could be associated with imbalance and fractures.

Vibration sensation in the lower limbs was tested with a tuning fork, function of the vestibular organs with a headshake test (video-nystagmoscopy) and postural control with measurements of vibration-induced postural sway (posturography).

Results suggested that the majority of elderly subjects had decreased vibration sensation, which did not correlate significantly with increased age. Elderly with intact sensation showed similar balance performance as individuals several decades younger. Elderly with diminished vibration sensation showed greatly reduced balance control compared with elderly with intact sensation and younger adults. The results also implied that elderly subjects had a diminished ability to use visual cues to improve balance control as vision could not fully compensate for proprioceptive impairment.

Decreased function of the vestibular apparatus in one ear compared to the other ear (asymmetric vestibular function) was quite common among healthy elderly individuals between 64 and 92 years of age (37%). The frequency of asymmetry was much higher among otherwise healthy elderly of the same age that had previously fallen and sustained a hip fracture (68%). Furthermore, individuals with asymmetric vestibular function demonstrated diminished postural control on posturography. The frequency of asymmetric vestibular function was higher (76%) among people at 50 years of age and older who had recently fallen and sustained a wrist fracture. Many of the hip and wrist fracture subjects had histories of previous falls and fractures mainly seen in the subjects with asymmetric vestibular function.

Results of the studies indicate that sensation in the lower limbs plays a major role in balance control. On the other hand, when an individual is confronted with an unexpected postural disturbance, the integrity of the vestibular organs is of significant importance. It is therefore essential to be aware of the sensory status in the lower limbs and the function of the vestibular organs when assessing balance among elderly people.

Exercises that combine facilitation to recognize body motion in the lower limbs and inner ear together with fall-reaction training might be beneficial for the aging population especially for individuals with fall-related fractures.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Otorhinolaryngology (Lund)
Supervisors/Advisors
  • Magnusson, Måns, Supervisor
Award date2006 Apr 27
Publisher
ISBN (Print)91-85481-71-8
Publication statusPublished - 2006

Bibliographical note

Defence details

Date: 2006-04-27
Time: 13:15
Place: Lundmarksalen, Astronomihuset, Lunds Universitet

External reviewer(s)

Name: Ödkvist, Lars
Title: Docent
Affiliation: Linköpings Universitet, Sverige.

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<div class="article_info">Ella Kolbrún Kristinsdóttir, Gun-Britt Jarnlo and Måns Magnusson. <span class="article_issue_date">1997</span>. <span class="article_title">Aberrations in postural control, vibration sensation and some vestibular findings in healthy 64-92-year-old subjects.</span> <span class="journal_series_title">Scand J Rehab Med</span>, <span class="journal_volume">vol 29</span> <span class="journal_pages">pp 257-265</span>.</div>
<div class="article_info">Ella Kolbrún Kristinsdóttir, Per-Anders Fransson and Måns Magnusson. <span class="article_issue_date">2001</span>. <span class="article_title">Changes in postural control in healthy elderly are related to vibration sensation, vision and vestibular asymmetry.</span> <span class="journal_series_title">Acta Otolaryngol</span>, <span class="journal_volume">vol 121</span> <span class="journal_pages">pp 700-706</span>.</div>
<div class="article_info">Ella Kolbrún Kristinsdóttir, Gun-Britt Jarnlo and Måns Magnusson. <span class="article_issue_date">2000</span>. <span class="article_title">Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures.</span> <span class="journal_series_title">Scand J Rehab Med</span>, <span class="journal_volume">vol 32</span> <span class="journal_pages">pp 56-60</span>.</div>
<div class="article_info">Ella Kolbrún Kristinsdóttir, Eva Nordell, Gun-Britt Jarnlo, Annika Tjäder, Karl-Göran Thorngren and Måns Magnusson. <span class="article_issue_date">2001</span>. <span class="article_title">Observation of vestibular asymmetry in a majority of patients over 50 years with fall-related wrist fractures.</span> <span class="journal_series_title">Acta Otolaryngol</span>, <span class="journal_volume">vol 121</span> <span class="journal_pages">pp 481-485</span>.</div>

Subject classification (UKÄ)

  • Otorhinolaryngology

Keywords

  • rehabilitation
  • Rehabilitering (medicinsk och social)
  • Postural Control
  • Elderly
  • Vibration sensation
  • Vestibular asymmetry
  • Falls
  • Fractures.
  • Surgery
  • orthopaedics
  • traumatology
  • Kirurgi
  • ortopedi
  • traumatologi
  • Otorhinolaryngology
  • audiology
  • auditive system and speech
  • revalidation
  • kinesitherapy
  • Physical medicine
  • hörsel- och talorganen
  • audiologi
  • Otorinolaryngologi

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