| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 99 === Dementia affects more than 24.3 million individuals, approximately 5~8% of the aged population in the year of 2005. With aging of the world population, this number is expected to continue to increase. Older adults with dementia have become a major category of residents in long-term care facilities in Taiwan. The impaired balance and gait in older adults with dementia is a main concern for health care team members as it affects their activities of daily living and increasing their risk of falls.
Previous studies have revealed that exercise training is feasible for dementia patients. Older adults with dementia can still learn motor and functional skill. However, they have difficulty generalizing the skill to other conditions. Balance problem may be affected by their poor ability of sensory integration and use of sensory strategies. As a result, tasks of the exercise program targeting balance performance should relate closely to the basic activities of daily living, and should combine with sensory manipulations.
Few studies have reported the effectiveness of exercise training in patients with dementia, and their programs are longer than 3 month in duration. Considering the principle of short-term or intermittent intervention, effects of short term intervention must be established for dementia residents in institutions. Balance training based on a task-oriented approach with sensory manipulation has been shown to be effective in patients with neurological disorders and older people.
Based on previous reviews, researches with better designed exercise program are needed. The purpose of this study was to investigate whether older adults with dementia who have balance and gait problems can improve their balance and gait after an individualized 4-week tasks-oriented balance training with sensory manipulation.
This study was a single-blind randomized controlled trial. This project was approved by National Taiwan University Hospital Research Ethics Committee. Participants were recruited from 3 long-term care facilities in Taipei, Taiwan, and screened for eligibility. Older adults with dementia were recruited and randomly assigned to the training group or control group. Training group received 4 weeks balance training, twice a week and 1 hour each session. Control group received 4 weeks upper extremities exercise in sitting position. Both groups were evaluated before training, after training and at one month follow-up. Outcome evaluation included Timed Up and Go Test, Berg Balance Scale, gait speed, 30-s chair-stand test, chair sit-and-reach test, Saint Louis University mental status examination and Barthel index. Two-way ANOVA was used to compare differences between two groups, and significant level was set at 0.05. Intention-to-treat analysis was used for missing data.
Training group showed significant improvement on Berg Balance Scale after 4 weeks task-oriented balance training (P = 0.001), but there was no long-term effect at follow-up evaluation. There were trends of increased walking speed and improvement on Timed Up and Go Test in Training group at post-test. Both groups had significant improvement on Saint Louis University mental status examination (P = 0.034), chair sit-and-reach test (P = 0.038) and Barthel index (P = 0.012) at post-test compared to baseline. After 4 weeks of detraining, both groups had significant decline in walking speed (P = 0.001), chair sit-and-reach test (P = 0.034), and Barthel index (P = 0.012).
A 4 weeks task-oriented balance training program had positive effect on balance in older adults with dementia. Exercises also led to significant improvement on flexibility, cognition and activities of daily living, but long-term effects were not observed. Further studies are needed to optimize the most effective dose of task-oriented balance training on balance and walking ability. Researches with larger sample size and exercise program for dementia patients with different severities are also needed.
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