How Can Providers Better Address Recovery Needs for Geriatric TBI Survivors?

Older adults are at increased risk for poorer recovery from traumatic brain injury (TBI), incidence of pre-injury frailty, and comorbidity compared to younger adults. In this study, a longitudinal multiple case study approach was taken to describe gaps in health service delivery identified by older adults following mild-moderate TBI. Participants were interviewed at 1 week, and 1, 3, 6, and 12 months post injury (5 times). In total, 57 interviews were conducted with 13 participants and transcribed verbatim. Codes were identified inductively to develop a codebook for guiding thematic analysis in NVIVO. Two independent investigators double coded 16 transcripts (28%) and reached consensus; remaining transcripts were allocated to the two investigators for independent coding and verified and reconciled with the other coder until consensus was reached. Many participants were happy with the care they received. However, ongoing health issues and TBI symptoms sometimes remained unaddressed. Follow-up and care planning would have been helpful for most patients as well as ways to address common balance and dizziness issues. Among some, the unwillingness to go to a provider for follow-up or adhere to medication and physical therapy exercises were issues. In some cases, providers were unable to help or understand the reason for patients’ symptoms (e.g., smell/taste changes, ear issues, etc.). Sometimes, providers did not address the issues that were of most concern to patients, or they would prescribe treatments that were not acceptable to patients. Empathetic, tailored, and patient-centered approaches are needed to improve care delivery and outcomes.

Balance disorders among walk-in patients in the International Islamic University Malaysia (IIUM) Ear, Nose And Throat (ENT) clinic: An exploratory study

Introduction: The epidemiological studies of balance disorder symptoms in Malaysia are still understudied, therefore this research sought to explore this issue among the walk-in patients at the International Islamic University Malaysia (IIUM) Ear, Nose and Throat (ENT) clinic in Kuantan, Pahang. Methods: The study aimed to 1) observe the association of common balance disorder symptoms with factors like gender, ethnicity and age groups; 2) reveal the patterns of cases with each of the balance disorder symptom according to factors in 1); and 3) determine the pattern of balance disorders in this clinic. This study took place between February and April of 2016. The medical records of these patients were examined after services by ENT doctors. To extract the data, these documents were reviewed using a medical record review checklist. Results: A total of 92 medical records were reviewed. They consisted of 45.6% male and 54.4% female; Malay (60.8%), Chinese (27.2%), Indian (10.9%) and others (1.1%); these patients were from 3 months to 69 years old. Only 13 (14.1%) out of these cases presented with balance disorders. The findings indicated no association (p > 0.05) between each of the balance symptom and the demographic factors. Out of the 13 cases; the most frequent symptoms observed were headache (76.9%), imbalance (53.8%) and vertigo (46.2%). The peripheral vestibular disorder was found as the most common diagnosis of balance disorder; benign paroxysmal positional vertigo (BPPV) (4) and Meniere’s disease (1). Both of the disorders showed vertigo, vomiting, headache and blur vision. Conclusions: It is crucial to understand the symptoms of balance disorders, particularly for a Malaysian population as it can enhance the clinical services and its quality of treatment or rehabilitation.

QUANTITATIVE ANALYSIS OF THE RESULTS OBTAINED BY THE FUNCTIONAL TESTING WITH THE SWAYTM BALANCE APPLICATION IN RELATION TO NORMS FOR APPROPRIATE GENDER AND AGE

The Balance Error Scoring System (BESS) is a common balance test relying on assessment tools such as the SwayTM Balance application for IOS mobile, encompassing the tri-axial accelerometers and movement sensors to measure bodily sway. Given that age and gender are important factors when using this methodology, suitable normative score sets were determined. The main aim of this study was a quantitative analysis of the ability of healthy, 21-year-old participants of both genders to maintain postural balance using the aforementioned normative values. The postural balance scoring was done by the co-application of the modified BESS test and SwayTM Balance software during a protocol organized in three-week double-scoring sessions. In order to assess the participants’ age- and gender-dependent abilities, the average balance score medians were contextualized with the appropriate normative values. All of the participants showed average results, with scores ameliorating during the procedure, and the female participants showed generally better results than the males. Focusing solely on the first-session scores revealed, however, that men had scored at the low average cut-off point, while women scored below average age- and sex-dependent cut-off points. However, in the last session both genders scored deeply within the average. This study showed average abilities of the studied participants according to the normative values, as well as a generally better performance of the women compared to the men, but it has also pointed out that, due to subject adaptation, the chosen combination of protocol and technology is of limited usefulness for balance assessment in the general population, indicating the need for protocol adjustments in future studies.

The Dix-Hallpike and Modified Epley Manoeuvres in the diagnosis and management of Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common balance disorders and one of the easiest to diagnose and treat. It is characterised by short lived episodes of vertigo and geotropic rotatory nystagmus, which occur a few seconds after rapid changes in head position. The vertigo usually lasts no more than a minute and the symptoms reduce in severity with repetitions of the evoking movement.

Balances of Power and European Great Power War, 1815–1939: A Suggestion and Some Evidence

Three contrary theories of great power war are examined. The first is the common balance of power argument that parity preserves peace. The second is Organski's oft-cited alternative, “the power transition.” The third is a conflation of the first and second. Like the first, the inherent inability to measure power precisely is the basis of the conflated balance of power theory. Like the second, the conclusion is that parity encourages war. Unlike either the first or second theory, the third provides an explanation of the incidence and extent of warfare between great powers. The basic proposition tested is that nonseparated great powers fight as they approach parity in power capabilities. The evidence is from the relations between the European great powers during 1815–1939.

Interrelationships among Balance Tests Prior to and after Practice

To determine the effects of practice on the interrelationships of six balance tasks 10 Ss were tested on 6 common balance tests prior to and following 4 days of practice. Inspection of the two matrices indicated higher relationships following practice. It was concluded that more research investigating the factor of balance is warranted.

II. On a determination of the mean density of the earth and the gravitation constant by means of the common balance

In a paper printed in the ‘Proceedings of the Royal Society,’ No. 190, 1878, an account was given of some experiments undertaken in order to test the possibility of using the common balance in place of the torsion balance in the Cavendish experiment. The success obtained seemed to justify the continuation of the work, and this paper contains an account of an experiment carried out with a large bullion balance, in place of the chemical balance used in the preliminary trials. The work has been carried out at the Mason College, Birmingham.

XIV. On a determination of the mean density of the Earth and the gravitation constant by means of the common balance

In a paper printed in the Proceedings of the Royal Society,' No. 190, 1878 (vol. 28, pp. 2-35), I gave an account of some experiments undertaken in order to test the possibility of using the Common Balance in place of the Torsion Balance in the Cavendish Experiment. The success obtained seemed to justify the intention expressed in that paper to continue the work, using a large bullion balance, instead of the chemical balance with which the preliminary experiments were made. As I have had the honour to obtain grants from the Royal Society for the construction of the necessary apparatus, I have been able to carry out the experiment on the larger scale which appeared likely to render the method more satisfactory, and this paper contains an account of the results obtained.

On the elasticity of threads of glass, with some of the most useful applications of this property to torsion balances

The author proposes the employment of threads of glass in the construction of torsion-balances, in place of the silver wire, used by Coulomb for the measurement of minute electric or magnetic forces. He describes a galvanometer of his invention, acting upon this principle, the intensity of the galvanic current being measured by the torsion of a slender filament of glass, to the lower end of which a magnetized needle is fixed at right angles. He also applies the same power to the improvement of the sensibility of the common balance for weighing minute bodies, by affixing to the beam a long glass thread horizontally in the axis of suspension, by the torsion of which, when the balance has been brought nearly to a level, the more accurate adjustments are to be effected. On the whole he considers that glass, from its perfect elasticity, possesses decided advantages over metallic wires, for the construction of instruments acting on the principle of torsion.