Welcome back for another installment of Research Bites! For all of you who missed my research posts on my Instagram (@science_of_falling), you came to the right place. Every few weeks I will be posting a new set of five quick and dirty research reviews with the main findings, how it was performed, and my quick take on it.

The trick is, I only have the space of an Instagram caption (2200 characters) to dive in and extract main points. It makes for a fun challenge! If you want to see these posts sooner, head on over to Instagram and hit that follow button.

Enjoy that tasty research!

Study Details

🔸48 adults with type 1 diabetes (38 men/10 women; mean age 50.0 +/- 8.5 years) and 28 healthy adult controls (17 men/11 women; mena age 49.9 +/- 11.9 years)
-Diabetic subjects confirmed to have distal symmetric peripheral neuropathy (DSPN) which is neuropathy in both feet symmetrically
-DSPN confirmation performed via vibration perception threshold testing
-Demographic data also taken down for each subject for final analysis
🔸Participants underwent MRI scan of their brain to determine structural composition
-gray matter volume (GMV) and cortical thickness estimated from this data
🔸Parietal N-acetylaspartate/creatine (NAA/cre) assessed via magnetic resonance spectroscopy sequencing (MRS)
-NAA/cre has been associated with periphera nerve dysfunction and brain atrophy in other regions of the brain

Study Findings

🔹GMV significantly ⬇️in the diabetes group compared to the control group (627.4 +/- 4.1 mL VS. 642.5+/- 5.2mL)
-Painful DSPN significantly ⬇️ GMV than those with non-painful DSPN (619.1 +/- 8.9 mL VS 629.7 +/- 4.6mL)
🔹In diabetic subjects with proliferative retinopathy GMV were further ⬇️ (609.9 +/- 6.8 mL)
🔹Total GMV showed associations with: severity of polyneuropathy, diabetes duration, age, and parietal NAA/cre
-Did not show association with HbA1c
🔹No brain regions of diabetic subjects showed ⬆️ GMV when compared to controls
-Diabetic subjects showed ⬇️ GMV in left superior frontal gyrus/caudal middle frontal, right superior frontal gyrus, left pars opercularis, right caudal middle frontal gyrus

My Take 🤔

It's clear from this study that type 1 diabetes, and specifically the presence of DSPN and retinopathy, lead to significant neurological changes. This is most likely a combination of decreased brain "usage" due to dulled sensory input, and general circulatory issues typically associated with diabetes which may lead to malnourishment of some brain regions. Overall this study tells a compelling story in regards to how type 1 diabetes not only can affect the body but also the brain itself.

Study Details

🔶Two groups:
-CIPN group: 35 older patients with CIPN 65+ years old
-Control group: 16 older adults matched with CIPN group for age, sex, and BMI
🔶All participants assessed with the following tests and measures:
-FoF assessed with using the Falls Self-Efficacy Scale (FES-1)
-Peripheral neuropathy severity assessed via vibration perception threshold (VPT)
-Gait performance measured via wearable sensors and walking a 40ft distance at their habitual speed; gait speed, stride length, cadence, and stride time calculated
-Postural sway evaluated by wearable sensors on low back and shin of dominant leg while participant stood quietly with arms crossed for 30s with eyes opened and eyes closed conditions
🔶CIPN group subdivided into those with high FoF (CIPN FoF+) and those with low FoF (CIPN FoF-)

Study Findings

🔷CIPN FoF+ showed 16.1% slower gait speed than CIPN FoF- and 33.3% slower than control
🔷CIPN FoF+ 12.4% shorter stride length vs CIPN FoF- and 21.4% than controls
🔷CIPN FoF+ had 15.9% slower cadence and CIPN FoF- had 11.7% slower vs controls
🔷CIPN FoF+ had 21.3% greater stride time and CIPN FoF- had 14.8% greater vs controls
🔷Postural sway in both CIPN groups significantly more than controls during balance tasks, but no significant difference within the CIPN group as a whole

My Take 🤔

This study shows that CIPN is not the only variable that may affect a cancer survivors balance. In fact, the mere FoF affected these participants' gait speed, stride length, cadence, and stride time to a significant degree as compared to their low fear and control counterparts. In turn this study demonstrates that a FoF in those with CIPN may significantly worsen gait performance and increase overall caution when ambulating. When we pair this study with findings from other publications that say slower gait speeds may lead to higher fall risks, we can see how FoF with CIPN may spiral out of control quickly.

Study Details

🔸71 participants with history of CLBP split into two groups
-Each participants CLBP associated with lumbar pathology as documented via medical imaging
-Experiemental group (EG): 33 subjects, 58.6 +/- 13 years old
-Control group (CG): 38 subjects, 57.1 +/- 12.4 years old
*Subjects were split into groups of 4-6 subjects with their fellow group members
🔸Each group underwent interventions for 2 sessions/week, 60 mins/session, 10 total sessions over 5 weeks
-Each session consisted of 15 min walk and 30 min of flexibility exercises for each group
-Control group did an additional 15 min of strengthening exercises for limbs and trunk
-Experimental group did an additional 15 min of trunk balance exercises
🔸Strengthening exercises performed with 50% of maximal voluntary contraction with focus on abdominals, quads, hamstrings, and latissimus dorsi
🔸Balance exercises performed in sitting, kneeling, quadruped, and supine for 30s-2min
🔸Outcome measured used included VAS (for pain levels), Roland and Morris Questionnaire (RMQ) [for disability level], 12-Item Short-Form Health Survey (SF-12) [for quality of life]

Study Findings

🔹RMQ scores significantly lower in EG meaning reduced disability
🔹Significant improvements in the SF-12 for physical quality life in EG, but no difference in mental component
🔹No significant differences between groups beyond these factors
-Both groups saw a general reduction in pain med use
-Both groups saw a reduction in VAS score
-Both groups saw an improvement in painful positions

My Take 🤔

The improved RMQ and SF-12 (physical component) scores demonstrate that the EG balance exercises may be beneficial for overall functional capacity improvements vs the strength exercises. Pain, medication use, and painful positions improved in both groups. Thus while balance work helps function, both balance and strength are valid ways to rehab low back pain and should be used in tandem. This tandem approach is the best in my experience!

Study Details

🔸40 elderly subjects with increased fall risk (OFR) [80.6 yo +/- 5.4 yrs], 41 elderly controls (OC) [79.1 +/- 4.9 yrs], and 40 young controls (YC) [21.6 +/- 1.4yrs]
🔸All groups assessed for spinal posture and mobility using the SpinalMouse, gait analysis over two 18 meter trials, and general functional performance (grip strength, grip work [time until grip strength diminished by 50%], TUG, POMA)
🔸Fall risk defined as at least one (+) finding in 3 areas: a fall in the last 6 months, TUG of 15s+, or a POMA score of </= to 24/28

Study Findings

🔹OFR showed significantly ⬇ overall mobility and balance compared to OC and YC
🔹OFR showed largest trunk inclination angle (stooped posture) vs YC having smallest inclination angle (erect posture)
🔹No significant differences in thoracic kyphosis angles (TKA) between the three groups and vertebral compression fractures equally distributed in OFR and OC
🔹Lumbar and sacral inclination angles ⬇ in OFR and OC vs YC
🔹OFR and OC showed ⬇ flexion mobility in the thoracic and lumbar spine, and ⬇ extension in the sacral region
🔹OFR showed smallest amount of sacral extension mobility
🔹OFR showed the slowest walking speed and lower medio-lateral step and stride regularity
🔹OC showed largest sacral flexion mobility paired with ⬆ step and stride regularity
🔹More pronounced stooped posture (sacral inclination angle/trunk inlcination angle) significantly related to worse scores on gait testing
🔹Better thoracic mobility significantly related to faster walking speed and better scores on physical outcomes
🔹Increased fall risk related to larger trunk inclination and smaller extension mobility

My Take 🤔

This study shines light on how trunk mobility and posture influence fall risk, especially of older individuals. These findings were significant yet only small-to-moderately so. Thus, trunk mobility and posture should be included in a comprehensive rehab plan after fall risk is assessed to ensure a complete holistic approach.

Study Details

🔸Retrospective cross-sectional study using EDIIS database in South Korea with patients 65+ who visited one of 23 emergency rooms between 2011 and 2018
-Only injuries that included a slipping or falling with accidental head injury/TBI included in study
-9,747 patients included: 5,557 female/4,190 male, 3,922 aged 65-74, 4319 aged 75-85, 1506 aged 85+
🔸Study mining data for in-hospital mortality which included deaths during hospitalization after accident and age of patient
-Divided into the three age groups defined above
-Area where accident occured recorded
-Mechanism of fall recorded: slip, falling from height, falling down stairs

Study Findings

🔹Most common injury mechanism was a slip and fall (71.9%)
🔹Proportion of falls from heights/stairs decreased with age
🔹Injury location prevalence: Room/bedroom (29.1%), living room/kitchen (23%), bathroom (20.2%), stairs (15.8%), and outdoor spaces of the house (11.9%)
🔹Falls that occured either on the stairs or outdoor spaces resulted in highest mortality for all age groups
🔹In-hospital mortality ratios (higher meaning increased likely hood of death) based on fall type: slip (1), fall from a height (1.36), fall on stairs (1.6)
🔹Overall in-hospital mortality due falling related to TBI within the home increased with age across all locations

My Take 🤓

This study may seem to have an obvious conclusion that increased age = increased mortality from TBI caused by a fall. Although obvious, it gives insight into where prehabilitative and preventative measures should focus to reduce these unnecessary deaths. Focus should be placed on increasing safety on the stairs (due to highest mortality), and in the bedroom (highest number of falls) as a starting point for prevention. This may be done through environment mod. or targeted training.

Additionally, it's important to note that non-fatal secondary complications were not investigated in this study but may be another reason for preventative measures to be undergone.

Thanks for reading the eleventh volume of Research Bites! I hope you learned a tidbit or two. Be sure to follow my Instagram account to see these research bites right away, and comment below on what you think about the findings above.

Happy Falling!