Egypt Rheumatol Rehab Vol. 36, No.

2, April, 2009

ASSESSMENT OF BALANCE IN OSTEOPOROTIC

POSTMENOPAUSAL WOMEN: EFFECT OF SPINAL
PROPRIOCEPTIVE EXTENSION PROGRAM
* NEVINE FOUDA, NITHREEN M. SAID*AND RASHA H. ELKABARITY
Rheumatology and Rehabilitation, Audiology Unit *(ENT
department), Faculty of Medicine, Ain Shams University
ABSTRACT
Objective: To assess the balance in osteoporotic patients with kyphosis and
the effect of intervention with a spinal proprioceptive extension exercise on the risk
of fall in these patients.
Methodology: This study included 20 postmenopausal osteoporotic women
with kyphosis and ten controls. Patients had to be physically active, and older than
60 years. Clinical assessment was performed by physical activity score fall efficacy
scale and pain scale. Balance assessment was done by computerized dynamic
posturography (CDP). Each patient underwent a program of back extension exercise
using one kg of weight suspended between T10 to L4 through fitted harness. Patients
were instructed to use this harness two hours twice daily for 4 weeks. Then they were
reassessed clinically and by CDP.
Results: There was a significant decreased balance score (63.7+9.72) in
osteoporotic kyphotic women compared to controls (79.4+14.2). There was a
significant inverse correlation between balance score and the fall efficacy scale (r=-
0.53) and positive correlation between balance score and the physical activity score
(r=0.55). In clinical reassessment, patients showed a significant increase in the
physical activity score (5.55+0.75) compared to pre-intervention values (4.4+0.68).
Also they had a significant decrease in the fall efficacy scale and pain
scale(28.05+4.90 and 3.3+0.86) respectively compared to their baseline data
(40.4+6.37 and 4.95+1.53 ) (p<0.001). In balance reassessment, patients showed a
significant increase in the balance score (75.5 +8.50) compared to their baseline
data (63.7+9.72) (p<0.001))
Conclusion: Osteoporotic postmenopausal women with kyphosis had
significantly greater balance abnormalities which plays an important role in
increasing their risk of falls. This study suggests that proprioceptive back extension
exercise could reduce the risk of fall and improve the pain and physical activity in
these patients.
Key words: Osteoporosis, balance, Computerized Dynamic Posturography

INTRODUCTION
Osteoporosis is a disease characterized by progressive loss of bone tissue which leads to an
increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone
microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is
altered (Kim and Vaccaro,2006). It is one of the most common complications of aging .
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

Osteoporosis is defined by the World Health Organization (WHO) in women as a bone

mineral density 2.5 standard deviations below peak bone mass (20 years old healthy female
average) as measured by Dual energy X-ray absorptiometry (DEXA). The term "established
osteoporosis" includes the presence of a fragility fracture. Osteoporosis is most common in
women after menopause, when it is called postmenopausal osteoporosis. After menopause, BMD
can continue to decline at a rate as high as 3% per year in some women, resulting in 70% of
women over the age of 80 having BMD measurements more than 2.5 SDs below young normal
values (Raisz ,2005).
Falls present a serious risk of injury in osteoporotic population (Tencer,2005). Falls can
lead to permanent changes in lifestyle, such as hospitalization, long-term rehabilitation, and the
inability to function independently, which can cause further decline in postural stability and
quality of life (Fletcher and Hirdes,2004). Falls are most often associated with gait and balance
disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, postural
hypotension(Rubenstein et al.,1996) and use of sedating and psychoactive medications(Krauss
et al.,2005. and Ganz et al.,2007). Consequently, researchers and clinicians have an intense
interest in identifying the components that contribute to postural instability and falls in
osteoporotic patients (Tencer,2005).
The term ‘balance’ refers to a multisystem function that strives to keep the body upright
while sitting or standing and while changing posture. Body balance can be understood as the
human ability of being standing straight up and performing movements with no oscillations of
falls(Novalo et al.,2008).Horak and his colleagues in 1996 proposed that balance (postural
stability) requires three distinct processes: (i) sensory organization, in which one or more of the
orientational senses (somatosensory, visual and vestibular) are involved and integrated within the
CNS; (ii) a motor adjustment process involved with executing coordinated and properly scaled
neuromuscular responses; and (iii) the background tone of the muscles, through which changes
in balance are effected.
Faulty balance mechanisms may contribute to fall-related injuries, restriction of gait patterns
and decreased mobility. These disabilities lead to loss of functional independence and social
isolation. Structural and functional declines of the somatosensory system occur with aging and
potentially contribute to postural instability in older adults(Peterka,2002). Kyphotic posture,
associated with osteoporosis, places the body’s center of gravity closer to the limit of stability
and thus increasing the risk of fall in this population. Balance in the osteoporosis population is a
major concern given the often catastrophic and disabling consequences of fall-related injuries
(Shkuratova et al 2004).
The evaluation of the body balance consists of tests that either determine diagnostic values
or inform the ability of the individual in remaining in a static posture. One of these tests is the
Computerized Dynamic Posturography (CDP) (Black and Pesznecker,2003) . It evaluates the
body oscillation by recording patient's foot pressure on a platform (force-plate) and it also allows
us to analyze the secondary posture reaction towards the central displacement of the body mass
(Nashner,2001). The use of CDP has been identified in many studies in the assessment of post-
surgical acoustic neuroma patients (Cohen et al.,2002), for the assessment of fall risk (Carter et
al.,2002, Reid et al.,2002,Sinaki and Lynn 2002) to assess the effects of vestibular
rehabilitation(Cohen and Kimball,2004) and to assess balance and high-intensity resistance
training in idiopathic Parkinson's disease patients(Hirsch et al.,2003).
The traditional management of osteoporosis has focused on the pharmacologic aspects of
treatment. Nonpharmacologic approaches, such as the use of orthoses, exercise programs and fall
prevention have largely been overlooked. Evidence for an essential contribution of

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Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

nonpharmacologic treatments in the management of osteoporotic patients is increasing,

particularly for patients who cannot, or will not comply with medication regimens)Lin and Lane
,2008).
Exercise and exercise programs have a key role in the management of the osteoporotic
patient and can result in a myriad of positive benefits. Exercise can provide overall increases in
strength and flexibility. It has also been shown to increase bone mineral density (BMD), with
larger changes noted in patients undergoing exercise and pharmacologic treatment than in those
undergoing pharmacologic treatment alone (Villareal,2003). Additional positive effects of the
exercise program as regards improved balance and so reducing fall risks is also recently
investigated (Ganz et al.,2007).
Aim of the work:
Is to assess the balance in osteoporotic patients with kyphosis, and to assess the effect of
intervention with a proprioceptive back extension exercise on the risk of fall in these patients.
PATIENTS AND METHODS
The present study is a cross sectional one that included twenty postmenopausal osteoporotic
patients with kyphosis [who had thoracic kyphosis of 50° to 65° (Cobb angle)] and ten age and
sex matched controls. The subjects had a confirmed diagnosis of osteoporosis verified through
radiographic changes of the spine and low bone mineral density by DEXA (T score > –2.5 SD
below peak bone mass of a young, healthy adult).
They were selected from those attending the Rheumatology and Rehabilitation outpatient
clinic in Ain Shams University Hospitals. Patients had to be physically active, older than 60
years. Patients who had history of dizziness or any neurogenic or myopathic disorder that known
to impair motor function were excluded from this study. Also, patients on drugs known to affect
CNS or equilibrium or other medical disorders that could affect gait or balance were excluded.
All patients were subjected to the following:
1- Full history taking laying stress on history of diseases affecting gait or balance and
medications as anti hypertensive, sedating or psychoactive drugs. .
2- Clinical assessment of the patients which include the following:
*Weight (Kg) and height (m).
* Physical Activity Score for assessed levels of 3 types of activity (house-work, job and
sports) (Sinaki and Offord, 1988) (Table 1). This score reflects the total level of daily physical
activity including housework (0-6), job (0-6) and sports (0-6). This was designed to assess of the
daily physical activity by converting the amount of weight lifting and walking involved in
housework, job and sports into METs (1 MET is the metabolic oxygen requirement under basal
condition which is equal to the basal metabolic rate).
*Fall efficacy scale to determine propensity to falling(Tinetti. Et al.,1990). On this scale, a
score of 10 is normal and the higher the score, the greater the propensity to fall (Tab 2).
*Pain scale to determine level of pain. A standard pain scale from 0 to 10 (0 = no pain, 10 =
severe pain) was used to assess back pain by face to face interview.
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

Table (1): Categories of physical activities and scoring system used to evaluate level of activity.

Score Housework Job Sports

0 (very light) Has help

Sedentary, drives to work Non
1.5-2 METs

1 (light) Light, no heavy lifting,1 to Sedantary, walks(up to 1 Very rarely participates in

2-3 METs 2 persons in household mile) to work sports
More than light housework Homemaker with housework
2 (light to
including shopping and activity score of 2 or an office Walks about 1 mile 3 times
moderate)
cooking,3 persons in worker frequently doing light per week
4-5 METs
household manual labor
Average housework with Performs daily calisthenics
3 (moderate) Light manual labor but no
heavy lifting,4-6 persons in with relatively low energy
5-6 METs regular heavy lifting
household consumption
Homemaker with activity Participates in outdoor
4 (moderate to Moderately active, does
score of 4, moderate manual sports golfing-horse back
heavy) 6-7 gardening, infrequent
labor on job, infrequent riding 2 to 3 times per
METs heavy lifting
heavy lifting week, swims twice a week
Participates in light sports
Heavy lifting regularly, eg bicycles slowly for 30
Moderate heavy manual
5 (heavy) 7-8 household has one or min 3 times per week,
work, regular heavy lifting on
METs more young (<4 yr) swims 30 min 2 times a
job
children week or jogs 15 min 3
times a week
Regularly does yard work, Actively participate as farm
Weekly jogs 5-10 miles,
6 (very heavy) maintenance work and homemaker with housework
plays tennis 3 times, skis 3
8-10 METs heavy lifting (eg washing activity score of 6 most of the
times or swims 3 times
windows and floors day

One MET is the metabolic oxygen requirement under basal condition which is equal to the metabolic rate.

Table (2): Fall efficacy scale.

Score
Activity 1=very confident
10=not confident at all

-Take a bath or shower.

-Reach into cabinets or closets.
-Walk around the house.
-Prepare meals not requiring carrying
Heavy or hot object.
-Get in and out bed.
-Answer the door or telephone.
-Get in and out the chair.
-Getting dressed and un dressed.
-Personal grooming (i.e washing your face).
-Getting on and off the toilet.

A total score of greater than 70 indicates that the

person has a fear of falling

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Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

3- Radiological assessment:
*Lateral standard radiography of the spine to diagnose increased thoracic kyphosis (between
50° and 65°) in the osteoporotic kyphotic patients ( Itoi,1991)
*Bone densitometry (dual-energy x-ray absorptiometry) of the spine and/or hip for
diagnosis of osteoporosis.
4- Balance assessment: by computerized dynamic posturography (CDP)
All individuals were evaluated with Equitest System® - Version 4.0 introduced by Neuro
Com International® - USA. During the assessment, patients remained in standing position on a
platform fastened by a safety belt in order to prevent any falls. They were instructed to keep their
arms loose beside the body, their feet slightly apart and motionless and gazing forward (fig.1)
All patients were assisted by the same doctor and the test commands were standardized for
all patients. For each task, three series of repetitions were performed during 20 minutes each.
During each trial, the patient is instructed to ignore any surface or visual surround motion and
remain upright and as steady as possible.

The sensory organization test (SOT):

A protocol of six test conditions that evaluates a person's ability to organize dynamic visual,
vestibular, and proprioceptive sensory input for maintaining balance(Nashner,1993) (fig.2).
However, condition 5 and 6 are the only accurate conditions for assessing vestibular imput.
Improvement in conditions 5 and 6 reflects more reliance on vestibular cues with central
compensation process going on.
- Condition 1: Standing position, fixed platform and open eyes.
- Condition 2: Standing position, fixed platform and closed eyes.
-Condition 3: Standing position, fixed platform open eyes and sight followed by
movement.
- Condition 4: Standing position, unstable platform and open eyes;
- Condition 5: Standing position, unstable platform and close eyes;
- Condition 6: Standing position, unstable platform and unstable vision with open eyes.
- The composite score: characterizes stability as a non – dimensional percentage comparing
the individual’s peak amplitude of antero–posterior (AP) sway with the theoretical limit of
stability in AP direction. Scores near 100 % indicate minimal sway, where as scores approaching
0% indicate maximal sway.

The Motor Control Test (MCT):

It consists of forward and backward translations of medium and large movement. The
latency (the time between translation onset and initiation of the patient's active response) was
measured and compared to the controls (fig.3).
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

Fig. (1): Computerized Dynamic Posturography.

Fig. (2): The six sensory organizing test conditions.

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Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

Fig. (3): motor control test.

Spinal proprioceptive extension program:

Each patient underwent 3 times training sessions per week in the outpatient clinic and
instructed for performing the same program daily at home for 4 weeks. The daily home-based
program consisted of performing back extension exercises for 15 minutes twice daily using one
kg of weight suspended between T10 to L4 of the spine through fitted harness. Patients were
instructed to use this (backpack) for one hour in the morning and one hour in the evening during
ambulatory activities. Application of this weight increases the patient’s perception of spinal joint
position. All the patients were given a diary and asked to complete the diary each day to show
their compliance.
After the 4 weeks, all the patients were reassessed clinically by the weight, height, physical
activity score, fall efficacy scale and pain scale. They were also assessed by CDP for the sensory
organization and motor control tests.
Statistical analysis:
Standard computer program SPSS for Windows, release 13.0 (SPSS Inc, USA) was used for
data entry and analysis. All numeric variables were expressed as mean ± standard deviation
(SD). Comparison of different variables in various groups was done using student t test and
Mann Whitney test for normal and nonparametric variables respectively. Spearman’s correlation
test was used for correlating non-parametric variables (Daniel,1995). For all tests a probability
(p) less than 0.05 was considered significant. Graphic presentation of the results was also done.

RESULTS
(Results of this study are shown in the tables 3-8 and figures 4-7)
This study included 20 osteoporotic patients with kyphosis. All were postmenopausal
women, their ages ranged from 60 to 68 years (mean 62.1± 2.29 years). The physical activity
scale ranged from 3 to 6 (mean 4.4 ± 0.68), the fall efficacy scale ranged from 30 to 52 (mean
40.4 +60.37) and pain scale ranged from 3 to 7 (mean 4.95+1.53) (Tab 3).
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

Table (3): demographic and clinical assessment of the patients.

Minimum Maximum Mean SD

Age (y) 60 68 62.1 2.29

Weight(kg) 57 73 67.55 4.50

Height(m) 156 162 158.8 2.09

Physical activity scale 3 6 4.4 0.68

Fall efficacy scale 30 52 40.4 6.37

Pain scale 3 7 4.95 1.53

Table (4): Comparison between patients and controls as regards sensory organization test (SOT).
Patients Control
t P
(n=20) (n=10)
Mean SD Mean SD
C1 92.25 4.24 93.67 2.31 0.98 NS
C2 89.85 3.11 91.02 2.98 0.98 NS
C3 88 5.42 88.89 5.15 0.43 NS
C4 84.45 6.15 85.18 4.94 0.33 NS
C5 52.15 11.85 65.22 21.6 -2.15 S
C6 53 11.01 64.7 17.3 -2.26 S
Cs 63.7 9.72 79.4 14.2 1.95 S
Cs=composite score.

100
90
80
70
60
50 p
40 patients and control as regards sensory organization test.
Fig. (4): Comparison between C
30
20
10
0
C1 C2 C3 C4 C5 C6 Cs

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Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

Table (5): Comparison between patients and controls as regards motor control test.

Patients Control
Latency t p
(n=20) (n=10)
Mean SD Mean SD
Backward Medium 160.75 14.26 155.2 10.32 1.10 NS
Backward Large 162.25 13.90 151.7 11.6 2.07 S
Forward Medium 159 13.91 155 10.7 0.80 NS
Forward Large 152.75 33.65 132 24.6 1.73 S

There was a significant inverse correlation between composite score and the fall efficacy scale (r =-0.53)
and positive correlation between composite score and the physical activity scale (r =0.55) fig (5, 6).

55

50

45
Fall Scale
40

35

30

25
45 55 65 75 85
CS

Fig. (5): Linear regression analysis showing the correlation between CS and fall scale among all studied
patients.

6.5
Phy. Activity
6
5.5
5
4.5
4
3.5
3
2.5
2
45 55 65 75 85
CS

Fig. (6): Linear regression analysis showing the correlation between

CS and Physical activity among all studied patients.
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

After 4 weeks of the proprioceptive back extension exercise, osteoporotic kyphotic

patients showed a significant increase in the physical activity score (5.55+0.75) compared to pre-
intervention values (4.4 +0.68) (p <0.001). Also they had a significant decreased fall efficacy
scale and pain scale (28.05+4.90 and 3.3+0.86) respectively compared to their baseline data
(40.4+6.37 and 4.95+1.53 ) (p<0.001). Patient's weight and height did not show significant
change from baseline data (p>0.05). Tab (6).
As regards balance assessment by CDP, after 4 weeks of the exercise program, the patients
showed a significant increase in the balance score (75.5 +8.50) compared to their baseline data
(63.7+9.72) (p<0.001) (tab 7, fig 7). As regards motor control test there was a statistical decrease
in the latencies of large backward and forward in patients compared to controls (p<0.05) (tab 8)

Table (6): Comparison of clinical data of patients at baseline and after 4 weeks of the exercise program.

4 weeks
Baseline data t p
follow up
Weight(kg) 67.55+4.50 67.45+4.47 1.45 NS
Height(cm) 158.8+2.09 159.95+1.98 -0.27 NS
Physical activity score 4.4 +0.68 5.55+0.75 -8.75 HS
Fall efficacy scale 40.4 +6.37 28.05+4.90 7.39 HS
Pain scale 4.95+1.53 3.3+0.86 6.77 HS

Table (7): Comparison of Sensory organization test data of patients at baseline and after 4 weeks of the
exercise program.

Pre Post t P
Mean SD Mean SD
C1 92.25 4.24 93.35 4.25 -2.01 NS
C2 89.85 3.11 91.3 2.88 -1.23 NS
C3 88 5.42 90.65 3.67 -1.39 NS
C4 84.45 6.15 87.55 5.41 -1.35 NS
C5 52.15 11.85 61.55 9.33 -4.93 HS
C6 53 11.01 56.3 9.65 -3.44 HS
Cs 63.7 9.72 75.5 8.50 -7.19 HS

100

80

60

40
Fig. (7): Comparison of Sensory organization test data of patients at baseline and after 4 weeks of the
exercise program.

20 10

0
C1 C2 C3 C4 C5 C6 Cs
Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

Table (8): Comparison of motor control test data in patients at baseline and after 4 weeks of the exercise
program.

Pre Post t p
Mean SD Mean SD
Backward Medium 160.75 14.26 155 10.32 1.42 NS
Backward
162.25 13.90 150.75 11.6 3.25 HS
Large
Foreward
159 13.91 154.75 10.7 1.64 NS
Medium
Foreward
152.75 33.65 148.25 24.6 2.21 S
Large

DISCUSSION
People affected by osteoporosis are at a particular risk for bone fractures. Falls present a
serious risk of injury in these population. Several studies have shown the life threatening
complications associated with falls(Tencer,2005). An area that has received less attention in the
field of osteoporosis research is the prevention of falls. Although multiple factors often
contribute to a fall, impaired balance is an important element and so improvement of balance
may reduce that risk(Peterka,2002).
CDP is a quantitative method for assessing upright balance function under a variety of
conditions that simulate conditions encountered in daily life (Nashner,2001). CDP testing has
been proposed as a complement to clinical tests that localize and categorize the pathology of
balance disorders. It is most applicable in situations where balance needs to be followed
quantitatively, to determine whether a disorder is getting better or worse and to judge the
response to treatment(Cohen and Kimball ,2004).
The aim of this study was to assess the balance in osteoporotic kyphotic postmenopausal
women and the effect of intervention with a specific back extension exercise on the risk of fall in
these patients.
In this study, the osteoporotic kyphotic patients had significantly decreased scores in
sensory organizing test (SOT) in conditions C5, C6 and composite scores compared to the
control group. Also there was prolongation in latencies of large backward and forward
translations in motor control test (MCT). This is in agreement with other studies(Lynn et
al.,1997 and Sinaki et al.,2005a&b). These investigators studied balance characteristics of
postmenopausal women with osteoporosis and recorded that osteoporotic patients had greater use
of hip strategies for maintaining balance than did the normal group. They recorded that
osteoporotic patients with kyphosis had greater postural sway than patients with osteoporosis
without kyphosis. Their Data show that thoracic kyphosis on osteoporotic patients plays an
important role in increasing risk of falls in these patients.
Kyphotic posture that often develops in osteoporotic patients places their center of gravity
closer to their limit of stability and the spine become at a disadvantage for proper recruitment of
back extensors(Tencer,2005). A fall is a biomechanical event, in that an external force or gravity
destabilize the body’s alignment of the torso over the legs. If the center of gravity moves outside
(anterior, posterior, or lateral) the base of support, a fall will result(Ganz et al.,2007and Tinetti
et al.,2006). This explain why the osteoporotic kyphotic patients in this study had increase in the
fall efficacy scale.
All the patients instructed for a 4-week program of back exercise and a weighted
Assessment of balance in osteoporotic postmenopausal women Nevine Fouda et al.

“backpack”. We specifically selected a 4-week trial to avoid affecting the result with a muscle-
strengthening exercise program. At least 6 weeks of exercise training is necessary for exercise to
increase muscle strength( Sinaki et al.,2002).
It was of interest that all patients had a reduced level of pain after the program and also
increased physical activity. These results are in accordance with (Sinaki and Lynn ,2002,
Sinaki et al.,2005b). Perhaps these two factors are related in that with less pain, patients were
inclinated to be more active.
There was also significant decrease in the fall efficacy scale after the program. This agrees
with the study of Sinaki in 2005. This can be explained by decreased kyphotic posturing through
recruitment of back extensors and improved mobility. Thus, decreased body sway as a risk factor
for falls and fall-related fractures and the patients are in a better position to look ahead and avoid
obstacles while walking (Pfeifer et al.,2004).
There was no significant increase in the height of patients after intervention. This disagreed
with the study of Sinaki and his colleagues. However the follow up for this study was not long
enough to show the postural changes radiologically.
Balance score improved significantly after a 4-week trial of the program of back exercise
and the proprioceptive dynamic posture. This is in agreement with other studies(Sinaki and
Lynn ,2002, Sinaki et al.,2005b). Improvement in conditions 5 and 6 reflects more reliance on
vestibular cues with central compensation process going on. These results have implications for
reducing the incidence of falls in these patients.
An intervention strategy in this study consisted of using a weighted “backpack” along with
participating in a back extension exercise program. The backpack has 2 beneficial effects. It
displaces the center of gravity posterior to the edge of support along the joints of the toes,
increasing stability against incidents that would cause the person to pitch forward and fall. Also,
it allows the person to stand more erect because of its addition to the extension moment
generated by the back muscles. By performing the exercise program, the patients would
theoretically receive the compounded benefits of altered biomechanics (from the weighted
backpack) and the known, independent benefits of the exercise program, plus any added
interaction between the 2 treatment modalities (Sinaki and Lynn ,2002 ).
However the additive changes of the 4-week exercise program were not separately
examined in this study. In a previous study conducted by Sinaki in 2002, they divided their
patients into2 groups, exercise group only and the other group received the same exercise plus a
weighted “backpack”. They found a significant improved balance only in the group with both
exercise and a weighted “backpack”. So further study is recommended to clarify and confirm
these differences and to optimize rehabilitative management of these patients
The proprioception had to play a role because the weight was placed between T10 and L4.
This may act through local effect of proprioception of related intervertebral joints and maintain
the gravity line to help balance sensory organization and to serve as a proprioceptive reminder to
the patient to extend their thoracic spine (Sinaki and Lynn ,2002 ).

So the osteoporotic patients should participate not only in regular weight-bearing exercise
(to stimulate osteoblasts to form bone) (Lin and Lane,2008) but also in thoracic-stabilization
exercises particularly exercises that strengthen the back extensor.Further research is now needed
to determine the feasibility of using this intervention in larger populations of patients, so that
issues of patient compliance plus treatment effects can be better elucidated.
In conclusion, osteoporotic postmenopausal women with kyphosis had significantly greater

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Egypt Rheumatol Rehab Vol. 36, No. 2, April, 2009

balance abnormalities which plays an important role in increasing their risk of falls. This study
suggests that proprioceptive back extension exercise could reduce the risk of fall and improve
the pain and physical activity in these patients. This in turn will prevent the downstream,
potentially life-threatening consequences of falling.
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‫تقييم التزان في السيدات المصابات بهشاشة العظام في‬

‫فترة توقف الطمث مع دراسة تأثير برنامج تأهيلي للعمود‬
‫الفقري‬
‫ نثرين محمد سعيد عبد السلم – رشا حمدى‬-‫نيفين فوده‬
‫الكباريتى‬

‫ تقييم التزان في السيدات المصابات بهشاشة العظام مع وجود إنحننناء‬:‫الهدف من البحث‬

.‫أمامي بالعمود الفقري في فترة توقف الطمث مع دراسة تأثيربرنامج تأهيلي للعمودالفقري‬
‫ سننيدة فنني فننترة توقننف الطمننث يعننانون مننن هشاشننة‬20 ‫ تناول البحننث‬:‫طريقة البحث‬
‫العظام مع إنحناء أمامي بالعمود الفقري ولقد تم إختيارهم من عيادة الطب الطبيعي والروماتيزم‬
‫ أشننخاص كمجموعننة ضنابطة وقنند تننم إسننتثناء المرضنني‬10 ‫ جامعة عين شننمس بالضننافة إلنني‬-
‫المصننابون بننأمراض او يسننتخدمون عل ج دوائي يننؤثر علنني التننزان وقنند خضننع المرضنني جميعننا‬
‫لمعرفة التاريخ المرضي والكشف الكلينيكي لتقييم النشاط الحركنني للمرضنني و قابليننة التعننرض‬
‫للسقوط ودرجننة اللننم و قنند تننم عمننل الختبننارات التشخيصننية لجهنناز التننزان الحسننى الحركننى‬

14
‫‪Egypt Rheumatol Rehab‬‬ ‫‪Vol. 36, No. 2, April, 2009‬‬

‫للمرضي والمجموعة الضابطة بواسطة جهاز التزان الحركى بالكمبيوتر وقد خضع جميع المرضنني‬
‫لبرنامج تأهيلي يتكون من تمارين فرد للظهرمع إستخدام ثقل مثبت علنني الفقننرات )مننن الفقننرة‬
‫الظهرية العاشرة الي القطنية الرابعة( بواسطة حوامل ظهريننة مننع إرتننداء الثقننل لمنندة سنناعتين‬
‫مرتين يوميا لمدة ‪ 4‬أسابيع وتم إعادة تقييم المرضنني إكلينيكينا وبواسننطة جهنناز التنزان الحركننى‬
‫بالكمبيوتر‪.‬‬
‫نتائج البحث‪ :‬أظهننر البحننث وجننود تننأثرفي مقينناس التننزان للمرضنني مقارنننة بالمجموعننة‬
‫الضابطة بواسطة جهاز التزان الحركى بالكمبيوتر كما أظهرت وجود علقة عكسننية بيننن مقينناس‬
‫التزان و قابلية السقوط وعلقة إيجابية بين التنزان والنشناط الحركني للمرضني وقند تنم إعنادة‬
‫تقييم المرضي بعد البرنامج التأهيلي لمدة ‪ 4‬أسابيع فأسفرت النتائج عن زيننادة النشنناط الحركنني‬
‫للمرضي وتقليل قابلية السقوط واللم لديهم وأيضا تحسن في مقينناس التننزان لجميننع المرضنني‬
‫مقارنة بما قبل البرنامج التأهيلي‪.‬‬
‫من هذه الدراسة نستنتج أن السيدات المصابات بهشاشة العظام مع إنحننناء العمننود الفقننري‬
‫يعانون من تأثر في مقياس التزان وهو ما يننؤدي إلنني زيننادة مخنناطر الوقننوع لننديهم‪ .‬كمننا اثبتننت‬
‫الدراسة ان البرنامج التأهيلي أدي إلي تحسننن فنني التننزان والنشنناط الحركنني للمرضنني وتقليننل‬
‫إحتمالية الوقوع وتوابعة الجسيمة في هؤلء المرضي‪.‬‬