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Query: UMLS:C0241981 (loss of balance)
 452 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Respiratory muscles are essential to alveolar ventilation. These muscles work against increased mechanical loads due to airflow limitation and geometrical changes of the thorax derived from pulmonary hyperinflation. Respiratory muscle fibres show several degrees of impairment in cellular and subcellular structures which, in many cases, are proportional to the severity of the disease and accompanying conditions (ageing, deconditioning, starvation, comorbidity). This structural impairment translates, from the functional point of view, to a loss of strength (capacity to generate tension) and an increased susceptibility to failure in the face of a particular load (early onset of fatigue). On the other hand, there is accumulating evidence that the diaphragm and other respiratory muscles are also able to express adaptive changes in response to the chronic mechanical load imposed by the disease. In most cases, impairment and adaptation of the respiratory muscles reaches a balance that permits enough ventilation for patients' survival. However, this balance can be altered for additional increments of the mechanical or metabolic load on the muscles (e.g. abdominal or thoracic surgeries, pneumonia, pulmonary embolism, etc.). Moreover, loss of balance is not always associated with extreme situations. Many patients develop ventilatory failure and require hospital admission even if the cause of the exacerbation is less dramatic (bronchial infections, pain of any nature, electrolyte disturbances, etc.). Although the physiopathology of chronic obstructive pulmonary disease exacerbations is multifactorial, the above-mentioned fragility suggests the existence of a "fragile balance" between respiratory muscle overload and respiratory muscle adaptations. Assessment of respiratory muscle function through specific tests evaluating the strength and endurance could offer valuable information about this particular susceptibility to muscle imbalance. Identification of patients possessing a fragile respiratory muscle balance could have important implications for the application of specific strategies such as respiratory muscle training, nutrition, or anabolic treatment.
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PMID:Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation? 1462 Nov 6

Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.
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PMID:Vestibular rehabilitation in a patient with whiplash-associated disorders. 1718 55

This is an exploratory descriptive study with a quantitative approach, in which variables associated to the occurrence of falls observed in elderly assisted in an outpatient clinic are delineated from the nursing diagnoses. Data from the files of 490 elderly with age between 60 and 98 years old were investigated. Univariate and bivariate statistical analyses were performed (p <0,05). The dependent variable, occurrence of falls, was prevalent in 30% of the cases and occurred with more frequency among females. A positive and independent association with the following diagnoses of Nursing was found: loss of balance (p <0,001), high blood pressure (p <0,001), weakness (p <0,025) and urinary incontinence (p <0,025). No association was observed for: altered vision, altered audition, joints pain, altered march and postural hypotension. The study shows the importance of working issues related to the variables that presented positive association with the occurrence of falls in the nursing practice.
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PMID:The association between nursing diagnoses and the occurrence of falls observed among elderly individuals assisted in an outpatient facility. 1754 65

A retrospective analysis of adults treated with long instrumented fusion for scoliosis from the thoracic spine proximally to L4 or L5. To evaluate the long-term clinical outcomes as well as radiological changes in distal unfused mobile segments and to evaluate factors that may predispose to distal disc degeneration and/or poor outcome. A total of 151 mobile segments in 85 patients (65 female), mean age 43.2 (range 21-68), were studied. Curve type, number of fused levels and pelvic incidence were recorded. Clinical outcome was measured using the Whitecloud function scale and disc degeneration using the UCLA disc degeneration score. Spinal balance, local segmental angulations and lumbar lordosis were measured pre- and post-operatively as well as at the most recent follow up--mean 9.3 years (range 7-19). A total of 62% of patients had a good or excellent outcome. Eleven had a poor outcome of which ten underwent extension of fusion--five for pain alone, three for pain with stenosis and two for pseudarthroses. Pre-operative disc degeneration was often asymmetric and was slightly greater in older patients. Overall, there was a significant deterioration in disc degeneration (P < 0.0001) that did not correlate with clinical outcome. Disc degeneration correlated with the recent sagittal balance (Anova F = 14.285, P < 0.001) and the most recent lordosis (Anova F = 4.057, P = 0.048). The post-operative sagittal balance and local L5-S1 sagittal angulation correlated to L4 and L5 degeneration, respectively. There was no correlation between degeneration and age, pre-operative degenerative score, pelvic incidence, sacral slope, number of fused levels or distal level of fusion. Disc degeneration does occur below an arthrodesis for scoliosis in adults which does not correlate with clinical outcome. The correlation of loss of sagittal balance with disc degeneration may be as a result of degeneration causing the loss of balance or vice versa, i.e. sagittal imbalance causing degeneration. Immediate post-operative imbalance correlates with degeneration of the L4/5 disc, which may imply the latter.
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PMID:Lumbar disc degeneration below a long arthrodesis (performed for scoliosis in adults) to L4 or L5. 1799 8

Power lifting injuries most often involve shoulder injuries with an injury rate of 0.57 to 0.71/1000 hours of power lifting. Wrist injuries are less common in power lifters with 0.05/1000 hours exposure vs. 0.23/1000 h in elite weight lifting men. Often, two contributing factors causing wrist injuries are encountered: a) loss of balance causing the barbell to drift back behind the head of the power lifter, which hyperextends the wrist and b) the maximal weight. We report on an elite power lifting athlete preparing for the World Masters Bench press championships suffering two months of persisting pain during bench press exercise and rest in the snuff-box area following a loss of balance of the bar-bell during bench press with 280 kg load. Following prolonged presentation 2 months after the initial injury with training in the meantime, CT-scan was performed revealing a C-type scaphoid fracture. Surgery was performed as Herbert screw fixation and bone grafting according to the technique of Matti-Russe, followed by an immobilisation of twelve weeks with a plaster. We recommended ending the athletes' power lifting career, however he further exercised with the plaster with consecutive re-operation 3months later and 2nd Matti-Russe and Herbert screw re-do. One year later he became national champion with 240 kg bench pressing. Given the limited scaphoid blood supply and the high complication rate especially among C-type scaphoid fractures, a surgical procedure with bone grafting, Herbert screw fixation and sufficient plaster immobilisation is advocated in scaphoid fractures in elite athletes.
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PMID:[C-type scaphoid fracture in a elite power lifting]. 1854 66

Our study examined the posture of 15 patients who had sustained a simple unilateral or bilateral fracture of the condylar head of the mandible as a result of sports or traffic accidents. Following preliminary testing of vestibular function, the patients underwent balance testing: Romberg test with eyes closed (EC), Romberg EC and bite test (ECBT), EC and head retroflexed (ECR). The study parameters were: surface (S) of the statokinesigram, stomatognathic influence index related to S (SSI), and postural oscillations on the frontal plane (X). In keeping with the literature, we felt that the following pattern in static balance suggested a posture destabilised by the stomatognathic system: SSI values of less than 60, reduction of S in the transition from EC to ECR, pathological increase of postural oscillations on the X plane. The study was completed by obtaining a list of new symptoms reported by the patients (altered bite, fullness, tinnitus, pain, loss of balance). The most significant patterns were observed in patients with vestibular dysfunctions and neck pain. It seems that a fracture of the condylar head can affect postural behaviour, although proprioceptive changes alone are not enough to cause true loss of balance and there must be concomitant vestibular dysfunction. The stabilometric pattern is not conditioned by the extent of the trauma or the related treatment. In terms of proprioceptive elements, the presence of muscle pain seems to point to cervical muscle tension as the main culprit in the onset of posttraumatic instability.
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PMID:Correlations between posturographic findings and symptoms in subjects with fractures of the condylar head of the mandible. 1881 Apr 77

About 60 to 70 percent of people with diabetes have some neuropathy. Diabetic neuropathy can be classified as peripheral, autonomic, proximal, focal and multifocal or mixed. Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain and/or loss of feeling in the toes, feet, legs, hands, and arms; extreme sensitivity to touch, loss of balance and coordination; muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. The aim of this study is to underline the importance of drug and rehabilitative approach in the therapy of peripheral neuropathy, that frequently influences both diabetes mellitus type 1 and diabetes mellitus type 2.
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PMID:[Diabetic peripheral neuropathy: reflections and drug-rehabilitative treatment]. 1972 72

The multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings. The ligaments that stabilize the upper cervical spine can be injured. Dynamic kine magnetic resonance imaging (dMRI) may reveal the pathological motion patterns caused by injury to these ligaments. To compare the findings and motion patterns in the upper cervical spine, 25 whiplash trauma patients with longstanding pain, limb symptoms and loss of balance indicating a problem at the level of C0-C2, as well as matched healthy controls were imaged using dMRI. Imaging was performed with an Intera 1.5 T (Philips Healthcare, USA) magnet. A physiotherapist performed the bending and rotation of the upper cervical spine for the subjects to ensure that the movements were limited to the C0-C2 level. An oblique coronal T2- and proton density-weighted sequence and a balanced fast field echo axial sequence were used. The movements between C0-C2 and the signal from the alar ligaments were analyzed. Contact of the transverse ligament and the medulla in rotation was seen in two patients. The signal from the alar ligaments was abnormal in 92% of the patients and in 24% of the control subjects (P<0.0001). Abnormal movements at the level of C1-C2 were more common in patients than in controls (56% versus 20%, P=0.028). Whiplash patients with longstanding symptoms had both more abnormal signals from the alar ligaments and more abnormal movements on dMRI at the C0-C2 level than controls.
Pain Res Manag
PMID:Dynamic kine magnetic resonance imaging in whiplash patients and in age- and sex-matched controls. 2001 12

Peripheral neuropathies are a common side effect of certain types of chemotherapy drugs, including taxanes, platinum-based drugs, vinca alkaloids, and thalidomide. Neuropathies may last for months or years following treatment and can impact functional performance and quality of life. The purpose of this study was to explore the effects of chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain on the lives of patients with cancer. Participants were recruited from an urban outpatient medical oncology clinic in West Central Florida. Semistructured, private interviews with 14 participants were conducted and transcripts were reviewed for symptoms and effects. Participants often had difficulty describing neuropathic symptoms but reported simultaneous pain or discomfort and loss of sensation in the upper and lower extremities. Injuries secondary to numbness, muscle weakness, and loss of balance were reported. Neuropathic symptoms interfered with many aspects of daily life and participants voiced feelings of frustration, depression, and loss of purpose as a result of having to give up enjoyable activities. The results of this study emphasize the importance of ongoing assessment and communication with patients about their experiences with peripheral neuropathies. Knowledge of what patients with CIPN experience will guide nurses in suggesting interventions to promote safety and help alleviate symptoms.
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PMID:Patient perceptions associated with chemotherapy-induced peripheral neuropathy. 2052 85

Disturbances in static balance have been demonstrated in subjects with persistent whiplash. Some also report loss of balance and falls. These disturbances may contribute to difficulties in dynamic tasks. The aim of this study was to determine whether subjects with whiplash had deficits in dynamic and functional balance tasks when compared to a healthy control group. Twenty subjects with persistent pain following a whiplash injury and twenty healthy controls were assessed in single leg stance with eyes open and closed, the step test, Fukuda stepping test, tandem walk on a firm and soft surface, Singleton test with eyes open and closed, a stair walking test and the timed 10 m walk with and without head movement. Subjects with whiplash demonstrated significant deficits (p < 0.01) in single leg stance with eyes closed, the step test, tandem walk on a firm and soft surface, stair walking and the timed 10 m walk with and without head movement when compared to the control subjects. Specific assessment and rehabilitation directed towards improving these deficits may need to be considered in the management of patients with persistent whiplash if these results are confirmed in a larger cohort.
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PMID:Dynamic and functional balance tasks in subjects with persistent whiplash: a pilot trial. 2136 48


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