Physiological Profile Assessment of Posture in Children and Adolescents with Autism Spectrum Disorder and Typically Developing Peers

A sound postural system requires sensorimotor integration. Evidence suggests that individuals with Autism Spectrum Disorder (ASD) present sensorimotor integration impairments. The Physiological Profile Assessment (PPA) can be used to evaluate postural capacity assessing five physiological subsets (i.e., vision, reaction time, peripheral sensation, lower limb strength, balance); however, no studies applied the PPA in young individuals. Therefore, this study aimed to investigate the PPA in children and adolescents with ASD compared with age-matched typically developing (TD) individuals and examine the relationship between the PPA subset within the ASD and TD participants according to different age groups. Percentiles from the PPA were obtained from the TD children and adolescents (n = 135) for each test. Performances of the individuals with ASD (n = 18) were examined relative to the TD percentiles. ASD participants’ scores were above the 90th percentile (i.e., poor performance) in most sensory, motor and balance parameters. Performance in most of the PPA tests significantly improved with older age in the TD group but not in the ASD group. The study findings support the use of the PPA in TD children and adolescents while further research should investigate postural capacity in a larger ASD sample to enhance the understanding of sensorimotor systems contributing to compromised postural control.

Physiological risk of falls, physical and aerobic capacity in community-dwelling elderly

Introduction: Falls are multifactorial and are related to the aging process, reduced functional capacity, comorbidities, sensory deficits, muscle weakness, postural instability and decreased protective response. Objective: To verify the correlation between physiological risk of falls and physical and aerobic capacity of the community-dwelling elderly. Method: Participated elderly individuals from the community, aged ≥65 years, without distinction of sex, race, and/or social class. We excluded cognitive impairments, locomotion incapacity, neurological diseases or sequelae, and/or severe pain that prevented the performance of the tests. We evaluated risk of falls (Physiological Profile Assessment - PPA), physical capacity (Short Physical Performance Battery - SPPB) and aerobic capacity (Shuttle Walk Test - ISWT). Results: Participated 59 elderly (71.8±5.0 ys). The mean performance in PPA was 0.4±0.4; SPPB was 10.4±1.7 and ISWT was 281±111.7 meters. PPA presented a moderate and statistically significant correlation (P<0.001) for SPPB (r= -0.53) and ISWT (r= -0.46). Conclusion: There is a moderate correlation between the physiological risk of falls (PPA) and functional (SPPB) and aerobic capacity (ISWT). Preventive measures to reduce the risk of falls should include strategies to increase functional and aerobic capacity. It is suggested the systematic use of SPPB in clinical practice.

57 The Use of the Physiological Profile Assessment to Improve Prediction of Fragility Fractures in Community-Dwelling Older People

Introduction The Physiological Profile Assessment (PPA) is a validated composite measure of sensorimotor function, known to predict falls with 75% accuracy. This work aimed to investigate whether PPA is also associated with fragility fractures. Method Participants were 489 community-dwelling older people (age=70-90) enrolled in the longitudinal population-based Sydney Memory and Ageing Study. Participants underwent comprehensive assessments at enrolment, including the 5-item PPA (visual contrast sensitivity, lower limb proprioception, knee extension strength, simple reaction time and postural sway). Participant records were linked to emergency department, hospital and death records (2005-2014) to identify fragility fractures following baseline assessment, with median follow-up duration of 7.5 years. Negative binomial regression, with observation time as the offset, was used to assess factors associated with fractures. Results At baseline assessment, 281 (57.5%) participants were assessed as having low/mild fall risk [PPA&lt;1] and 208 (42.5%) as moderate/marked/very marked fall risk [PPA score &gt;1]. Over the study period, 72 (14.7%) individuals sustained 1 fracture, and a further 39 (8.0%) sustained 2 or more fractures. Univariate analysis showed that increasing age (Incidence Rate Ratio (IRR) 1.1, 95%CI 1.0-1.1, p=0.0026), being female (IRR 1.8, 95%CI 1.3-2.8, p=0.0033), having osteoporosis (IRR 1.7, 95%CI 1.1-2.6, p=0.0340) and moderate/marked/very marked PPA (IRR 1.8, 95%CI 1.2-2.7, p=0.0025) were associated with fractures. In the multivariate analysis, only moderate/marked/very marked PPA (IRR 1.6, 95%CI 1.1-2.5, p=0.0159) and being female (IRR 1.8, 95%CI 1.1-2.8, p=0.0121) remained independently associated with fractures. Conclusion These findings show that people at increased risk of falls based on the Physiological Profile Assessment are also at increased risk of future fragility fractures regardless of the presence of osteoporosis. Early identification of this high risk population provides the opportunity to intervene with evidence based strategies to minimize falls risk as well as considering pharmacological management of bone health.

ABILITY OF THE PHYSIOLOGICAL PROFILE ASSESSMENT TO CLASSIFY FALLER TYPE: A PROSPECTIVE COHORT STUDY

Accurately identifying older adults who will experience subsequent falls is important for the provision of secondary fall prevention. The purpose of this study was to determine the accuracy of the Physiological Profile Assessment (PPA) – a valid and reliable fall-risk assessment [1] – in predicting subsequent falls over a 12-month period in older adults who sought for medical attention after an index fall. Seven hundred thirty-seven community-dwelling adults, aged 70 years and older, who were seen at the Vancouver General Hospital Fall Prevention Clinic, completed the PPA at their initial visit. Falls over the subsequent 12 months were tracked prospectively via monthly falls calendars. All individuals received geriatric care at baseline. Binary logistic regressions were performed to determine the accuracy of classifying two prospective faller types: 1) no additional falls; 2) one or more additional fall(s). Baseline PPA, age, and sex were entered as independent variables. During the 12 month observation period, 345 participants had no additional falls (Age:81.3±6.6yrs;Female=251) and 392 fell one or more times (Age:82.3±6.5yrs;Female=230). The classification accuracy was 51.3% for those who had no additional falls and 64.8% for those with one or more additional fall(s) (Overall:58.5%;χ2=29.0;PPA:β=-0.21;Age:β=-0.01;Sex:β=-60). The PPA was not able to accurately differentiate between those who did and did not subsequently fall. Fall-risk assessment sensitivity and specificity should be improved in older adults seeking medical attention following an index fall to inform secondary fall prevention. [1] Lord SR, et al., 2003. Phys Ther.

Fatigue, Physical Activity, Quality of Life, and Fall Risk in People with Multiple Sclerosis

Background: Fatigue, inactivity, and falls are major health issues for people with multiple sclerosis (MS). We examined the extent to which fatigue and low walking activity are associated with quality of life and increased fall risk in people with MS. Methods: People with MS (N = 210, aged 21–74 years) were categorized as having either high or low reported fatigue and walking activity levels and were then followed up for falls using monthly fall diaries for 6 months. Results: A high level of fatigue was significantly associated with higher MS Disease Steps scores, worse balance, high composite physiological (Physiological Profile Assessment) fall risk scores, greater fear of falling, lower World Health Organization Disability Assessment Schedule (WHODAS) quality of life scores, and more prospectively recorded falls. Low walking activity was significantly associated with higher MS Disease Steps scores, reduced proprioception, worse standing and leaning balance, slow stepping, slow gait speed, worse fine motor control, high Physiological Profile Assessment fall risk scores, more fear of falling, and lower WHODAS quality of life scores. Conclusions: Increased fatigue and low walking activity levels were significantly associated with increased fall risk and lower quality of life in people with MS. Interventions aimed at addressing fatigue and inactivity may have multiple benefits for this group.

Fall risk in people with MS: A Physiological Profile Assessment study

Introduction The Physiological Profile Assessment (PPA) is used in research and clinical practice for assessing fall risk. We compared PPA test performance between people with multiple sclerosis (MS) and healthy controls, determined the fall-risk profile for people with MS and developed a reference database for people with MS. Methods For this study, 416 ambulant people with MS (51.5 ± 12.0 years) and 352 controls (52.8 ± 12.2 years) underwent the PPA (tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway) with composite fall-risk scores computed from these measures. MS participants were followed prospectively for falls for 3 months. Results The MS participants performed significantly worse than controls in each PPA test. The average composite fall-risk score was also significantly elevated, indicating a “marked” fall risk when compared with controls. In total, 155 MS participants (37.3%) reported 2 + falls in the follow-up period. Frequent fallers performed significantly worse than non-frequent fallers in the contrast sensitivity, reaction time and sway tests and had higher PPA composite scores. Conclusions In line with poor PPA test performances, falls incidence in people with MS was high. This study provides comprehensive reference data for the PPA measures for people with MS that could be used to inform future research and clinical practice.