2024, Volume 20
Cognitive-behavioral effects of reducing the susceptibility to the body injuries during the fall by nursing home care patients under the influence of innovative interventions
Jarosław Klimczak1, Dawid Dobosz2, Katarzyna Balewska-Juras1, Artur Kalina3, Izabela Orłowska-Bojarska4, Monika Staniszewska4, Monika Subkowska4, Bartłomiej Gąsienica-Walczak5
1School of Public Health, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
2EPIONE Sp. z o.o., Katowice, Poland
3Plus-Rehabilitation Services Ltd., Cristal Lake, United States
4Nersing Home Care in Barczewo, Barczewo, Poland
5Health Institute, University of Applied Sciences in Nowy Targ, Nowy Targ, Poland
Author for correspondence: Bartłomiej Gąsienica-Walczak; Health Institute, University of Applied Sciences in Nowy Targ, Nowy Targ, Poland; email: bartlomiej.gasienica@ppuz.edu.pl
Abstract
Background and Study Aim: The phenomenon of the susceptibility to the body injuries during the fall (SFI) is neither a disease nor a pandemic, but affects every person – without exception – throughout ontogeny. Therefore, the three most important tasks of prevention are: permanent monitoring of the SFI phenomenon; reducing errors during unintentional falls through professional interventions; achieving the ability to protect the distal parts of the body that are most exposed to damage during a fall (head, upper limbs, trunk, lower limbs). The aim of this pilot study is the cognitive and motor effects of the intervention program among nursing home care residents (volunteers).
Material and Methods: Among the seven volunteers, the most homogeneous group consisted of 4 men: from 62 to 81 years old, between 167 and 174 cm and 62 and 114 kg; 2 primary education and 2 secondary education; all were eligible patients with a history of neurological events; everyone participated in both general workout (GWS) and dedicated safe fall (SFS) sessions. Woman, 75 years old (149 cm, 71 kg; primary education; chronic obstructive pulmonary disease; arterial hypertension) participated only in SFS. Male 75 years old (165 cm, 70 kg; primary education; type 2 diabetes; arterial hypertension; condition after stroke) was the only person whose final SFI result worsened, but observation coincided with his radical deterioration of health condition and soon the patient died. Man, 75 years old (168 cm, 66 kg; primary education; bladder cancer).
The SFI phenomenon was measured by the susceptibility test to the body injuries during the fall (STBIDF-M), elevated version, because none of the subjects performed a deep squat during the pre-test. The Timed Test Up and Go (TTUG), 30 seconds Chair Stand Test (30CST) and 6 Minute Walk Test (6MWT) were used to measure basic functional movement capabilities, balance, lower limb muscle strength and physical performance. The number of days during which patients undertook exercise, the number and duration of GWS and/or SFS sessions were recorded.
Results: The collective profile of four patients reports that they reduced SFI by 30% to 17% during 51 days of exercise (leader), 50 days and 37 days for two residents. They preferred SFS (33 to 43 sessions with 10 to 49 GWS). Three improved the 30CST result by 11% to 37% and only one TTUG by 14%. The participants of the experiment reduced the risk of bodily injury resulting from an unintentional fall from the following levels: very high, one person on low, one on high; average three people on low and a woman who voluntarily participated in 44 SFS, staying within this risk level, reduced it by 7%. The SFI reduction result correlates statistically significantly with the SFI time (r = 0.992, p<0.01) and the number of SFI (r = 0.978, p<0.05). Only a man who had not suffered any neurological injuries in the past achieved both positive motor and cognitive effects. When performing STBIDF-M after the end of the experiment, he did not make any ground impact errors with his hands and head during each of the six test tasks.
Conclusions: The method of combining GWS with exercises during SFS (regardless of whether the sessions were combined or separated by a break), as well as explaining the causes of body damage caused by collision with the ground using simple examples, turned out to be an effective prevention, mainly in the behavioral dimension. We expect to increase cognitive (and, of course, also behavioral) effects in more accurate recording of appropriate measures (repetitions of exercises, cyclical arrangement over longer periods, etc.), as well as in monitoring immediate physiological effects (especially HR at rest and during exercise, explaining to people simple criteria for independent interpretation), motivation to exercise and the degree of satisfaction with the achieved motor results. This is basic information to individualize prevention and therapy measures based on the complementary approach.
Key words: injury prevention, motor safety of seniors, ‘Polish School of Safe Falling’, unintentional fall