Yaşlı Bireylerde Plantar Duyu ve Basınç Dağılımı Değişikliklerinin Denge ve Düşmeye Etkisi
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Ünver, B, Effects of Plantar Sensitivity and Pressure Distribution Changes to Balance and Falling in Elderly Subjects. Hacettepe University, Institute of Health Sciences, PhD. Thesis in Prostetics-Orthotics and Biomechanics, Ankara, 2017. The aim of this study was to compare the parameters of plantar sensitivity and plantar pressure in different regions of the foot, static postural sway, temporal and spatial characteristics of gait between young and elderly subjects; investigate the possible differences of these parameters and fear of falling in elders with and without falling story. Fourty older subjects consisting of 21 women and 19 men, aged between 65-88 years and 44 young subject consisting of 30 women and 14 men aged between 18-45 years were included in the study. Subjects were divided into two groups as with (n=14) and without falling story (n=26) according to the falling stories of the past one year. Plantar light touch-tactile sensitivity was evaluated by Semmes-Weinstein® monofilament and static two point discrimination was evaluated by aesthesiometer. Static and dynamic plantar pressures, static postural sway, temporal and spatial characteristics of gait were evaluated with the WinTrack® Pedobarograph. Fear of falling was assessed by Falls Efficacy Scale. The plantar light touch-tactile sensitivity and two-point discrimination of the elderly were significantly lower than those of the young on dominant and non-dominant side, in all 9 regions of the foot (p<0.001 p=0.001, p=0.002). Plantar light touch-tactile sensitivity of older and young subjects were lower in rear foot compared to fore and midfoot; plantar two point discrimination of elders were lower in rear foot compared to fore and midfoot on dominant side, in rear foot compared to midfoot on non-dominant side (p<0.001 p=0.003, p=0.002, p=0.017). The contact areas of the fore and rear foot, weight transferred to each leg and maximum pressures of the midfoot were higher (p<0.001, p=0.001, p=0.020, p=0.001), maximum pressures of the both feet and dominant rear foot were lower (p=0.016, p=0.040) in elders compared to young according to static pedobarographic measurement. Static maximum pressures were respectively in rear, fore and midfoot from the highest to the lowest in young and elderly (p<0.017). Maximum pressures of both feet, fore and rear foot, mean pressures of dominant foot were lower (p<0.001, p=0.001, p=0.002, p=0.044), contact area and contact time of non-dominant midfoot and contact time of dominant fore foot were higher (p=0.047, p=0.038) in elders compared to young according to dynamic pedobarographic measurement. Contact area and contact time were respectively in fore, rear and midfoot from the highest to the lowest in young and elderly (p<0.001); maximum pressures were respectively in fore, rear and midfoot from the highest to the lowest in young on both side and in elders on non-dominant side (p<0.017). Maximum pressures were lower in midfoot compared to fore and rear foot in elderly on dominant side (p<0.001). Average Q speed and latero-lateral speed were higher in eyes-open condition (p=0.008, p=0.017), COM area, average Q speed, latero-lateral, antero-posterior speed, and antero-posterior deviation were higher in eyes-closed condition (p=0.003, p<0.001, p=0.007) in elderly compared to young. COM area, average Q speed, latero-lateral, antero-posterior speed, and antero-posterior deviation were higher in eyes-closed compared to eyes-open condition in elderly (p=0.001 p<0.001, p=0.021). Cadence, step length and gait cycle length were lower (p=0.019, p<0.001); step duration, gait cycle duration and double stance duration of dominant foot, swing duration of both feet, and foot angle of dominant foot were higher (p=0,032, 0,045, p<0,001, p=0,024) in elderly compared to young. There were no significant differences between elders with and without falling story in terms of plantar sensitivity, plantar pressures, static postural sway and gait parameters (p>0.05); fear of falling was higher in elders with falling story compared to those without falling story (p=0.007). The results of our study revealed that plantar sensitivity was lower in all regions of the foot, alterations in static and dynamic plantar pressures and gait occur , static postural sway was higher in elderly compared to young, however, those parameters were similar between elders with and without falling story and fear of falling was higher in elders with falling story compared to those without falling story.