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Whitten J, Barrett R, Carty CP, Tarabochia D, MacDonald D, Graham D. Baseline Measures of Physical Activity and Function Do Not Predict Future Fall Incidence in Sedentary Older Adults: A Prospective Cohort Study. J Aging Phys Act 2024; 32:207-212. [PMID: 38016462 DOI: 10.1123/japa.2022-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023]
Abstract
Physical activity (PA) and physical function (PF) are modifiable risk factors for falls in older adults, but their ability to predict future fall incidence is unclear. The purpose of this study was to determine the predictive ability of baseline measures of PA, PF, and lower limb strength on future falls. A total of 104 participants underwent baseline assessments of PA, PF, and lower limb strength. Falls were monitored prospectively for 12 months. Eighteen participants fell at least once during the 12-month follow-up. Participants recorded almost exclusively sedentary levels of activity. PA, PF, and lower limb strength did not differ between fallers and nonfallers. Twelve participants, who reported a minor musculoskeletal injury in the past 6 months, experienced a fall. The results of this study suggest that in a cohort of highly functioning, sedentary older adults, PA does not distinguish fallers from nonfallers and that the presence of a recent musculoskeletal injury appears to be a possible risk factor for falling.
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Affiliation(s)
- Justin Whitten
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Rod Barrett
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Christopher P Carty
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Dawn Tarabochia
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - David MacDonald
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - David Graham
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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2
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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Sade S, Pickholz H, Melzer I, Shapiro A. Development of an Elliptical Perturbation System that provides unexpected perturbations during elliptical walking (the EPES system). J Neuroeng Rehabil 2023; 20:125. [PMID: 37749627 PMCID: PMC10521489 DOI: 10.1186/s12984-023-01251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND 'Perturbation-based balance training' (PBBT) is a training method that was developed to improve balance reactive responses to unexpected balance loss. This training method is more effective in reducing fall rates than traditional balance training methods. Many PBBTs are performed during standing or treadmill walking which targeted specifically step reactive responses, we however, aimed to develop and build a mechatronic system that can provide unexpected perturbation during elliptical walking the Elliptical Perturbation System (the EPES system), with the aim of improving specifically the trunk and upper limbs balance reactive control. METHODS This paper describes the development, and building of the EPES system, using a stationary Elliptical Exercise device, which allows training of trunk and upper limbs balance reactive responses in older adults. RESULTS The EPES system provides 3-dimensional small, controlled, and unpredictable sudden perturbations during stationary elliptical walking. We developed software that can identify a trainee's trunk and arms reactive balance responses using a stereo camera. After identifying an effective trunk and arms reactive balance response, the software controls the EPES system motors to return the system to its horizontal baseline position after the perturbation. The system thus provides closed-loop feedback for a person's counterbalancing trunk and arm responses, helping to implement implicit motor learning for the trainee. The pilot results show that the EPES software can successfully identify balance reactive responses among participants who are exposed to a sudden unexpected perturbation during elliptical walking on the EPES system. CONCLUSIONS EPES trigger reactive balance responses involving counter-rotation action of body segments and simultaneously evoke arms, and trunk reactive response, thus reactive training effects should be expected.
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Affiliation(s)
- Shoval Sade
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hodaya Pickholz
- Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel
| | - Itshak Melzer
- Schwartz Movement Analysis & Rehabilitation Laboratory, Physical Therapy Department, Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel.
| | - Amir Shapiro
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Te B, Komisar V, Aguiar OM, Shishov N, Robinovitch SN. Compensatory stepping responses during real-life falls in older adults. Gait Posture 2023; 100:276-283. [PMID: 36689855 DOI: 10.1016/j.gaitpost.2023.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND Laboratory studies of postural responses suggest that stepping is a common strategy for balance recovery. Yet little is known about the frequency and characteristics of stepping responses during real-life falls in older adults. RESEARCH QUESTIONS (1) Among falls experienced by older adults in long-term care (LTC), what is the prevalence of attempts to recover balance by stepping? (2) How often are steps aligned to the direction of the fall? (3) Do the prevalence and characteristics of steps associate with intrinsic and situational factors? METHODS We collected and analyzed video footage of 1516 falls experienced by 515 residents of LTC (of mean age 82.7 years). Using generalized estimating equations, we tested whether the prevalence, direction and size of steps associated with sex, age, fall direction, activity at the time of falling, cause of imbalance, and holding or grasping objects. RESULTS Stepping after imbalance was observed in 76% of falls, and 80% of these cases involved multiple steps. The direction of steps aligned with the initial fall direction in 81% of cases. The size of the first step was less than one-half foot length in 64% of cases. Secondary steps tended to be similar in size to the first step. Steps were more common for falls during walking than standing, and for sideways falls. Steps were less common in falls involving held objects, and steps were less likely to be aligned with the fall direction when reach-to-grasp responses were observed. SIGNIFICANCE Older adults in LTC tended to respond to falls with multiple compensatory steps. Steps were tailored to the direction of the fall, but small in size (less than one-half foot length in size). Exercise programs for fall prevention in older adults should focus on increasing step size to enhance the effectiveness of step recovery responses.
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Affiliation(s)
- Bianca Te
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada; School of Engineering, The University of British Columbia, Kelowna, BC, Canada
| | - Olivia Mg Aguiar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Nataliya Shishov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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Are we missing parameters to early detect risk factors of falling in older adults? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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Pienciak-Siewert A, Ahmed AA. Whole body adaptation to novel dynamics does not transfer between effectors. J Neurophysiol 2021; 126:1345-1360. [PMID: 34433001 DOI: 10.1152/jn.00628.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
How does the brain coordinate concurrent adaptation of arm movements and standing posture? From previous studies, the postural control system can use information about previously adapted arm movement dynamics to plan appropriate postural control; however, it is unclear whether postural control can be adapted and controlled independently of arm control. The present study addresses that question. Subjects practiced planar reaching movements while standing and grasping the handle of a robotic arm, which generated a force field to create novel perturbations. Subjects were divided into two groups, for which perturbations were introduced in either an abrupt or a gradual manner. All subjects adapted to the perturbations while reaching with their dominant (right) arm and then switched to reaching with their nondominant (left) arm. Previous studies of seated reaching movements showed that abrupt perturbation introduction led to transfer of learning between arms, but gradual introduction did not. Interestingly, in this study neither group showed evidence of transferring adapted control of arm or posture between arms. These results suggest primarily that adapted postural control cannot be transferred independently of arm control in this task paradigm. In other words, whole body postural movement planning related to a concurrent arm task is dependent on information about arm dynamics. Finally, we found that subjects were able to adapt to the gradual perturbation while experiencing very small errors, suggesting that both error size and consistency play a role in driving motor adaptation.NEW & NOTEWORTHY This study examined adaptation of arm and postural control to novel dynamics while standing and reaching and subsequent transfer between reaching arms. Neither arm nor postural control was transferred between arms, suggesting that postural planning is highly dependent on the concurrent arm movement.
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Affiliation(s)
| | - Alaa A Ahmed
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado.,Department of Integrative Physiology, University of Colorado, Boulder, Colorado
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Tavakkoli Oskouei S, Malliaras P, Jansons P, Hill K, Soh SE, Jaberzadeh S, Perraton L. Is Ankle Plantar Flexor Strength Associated With Balance and Walking Speed in Healthy People? A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6106269. [PMID: 33481996 DOI: 10.1093/ptj/pzab018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between ankle plantar flexor muscle (PF) strength and balance and walking speed in healthy adults. METHODS Four databases (Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, and SPORTDiscus) were searched from inception to December 2019. Studies with any design were included if the association between PF strength and balance and walking speed was investigated among healthy adults. Articles were screened for eligibility independently by 2 reviewers. Study characteristics and Pearson r values derived from the association between PF strength and balance and walking speed were extracted. Thirty-four studies were eligible. The main group of interest in the studies was older adults. Pearson r values were transformed to rz values using Fisher z-transformation. Meta-analysis of rz values was conducted and then back-transformed to r. RESULTS In older adults, PF maximal isometric strength had a positive weak association with static balance (r = 0.20; 95% CI = 0.08-0.32), a positive moderate association with dynamic reactive balance (r = 0.42; 95% CI = 0.32-0.57) and proactive balance (r = 0.55; 95% CI = 0.18-1.06), and a positive weak association with preferred walking speed (r = 0.29; 95% CI = 0.19-0.41) and maximum walking speed (r = 0.34; 95% CI = 0.06-0.63). In younger adults, there was a moderate association between early-phase PF rate of torque development and reactive balance (0.42 < r < 0.52). CONCLUSIONS PF strength appears to be moderately associated with dynamic reactive and proactive balance and weakly associated with static balance and walking speed. This finding highlights the potential role of PF strength in dynamic reactive and proactive balance. IMPACT This meta-analysis showed that ankle PF strength might be important for challenging dynamic balance tasks.
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Affiliation(s)
- Sanam Tavakkoli Oskouei
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Paul Jansons
- Bone and Muscle Health Research Group, School of Clinical Sciences at Monash Health, Monash Medical Centre, Victoria, Australia
| | - Keith Hill
- Ageing and Independent Living (RAIL) Research Centre, Monash University, Victoria, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Luke Perraton
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Muggenthaler H, Hubig M, Meierhofer A, Mall G. Slip and tilt: modeling falls over railings. Int J Legal Med 2020; 135:245-251. [PMID: 33034680 PMCID: PMC7782458 DOI: 10.1007/s00414-020-02432-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/30/2020] [Indexed: 10/26/2022]
Abstract
Falls over railings are frequent case scenarios forensic experts are confronted with. An important issue is the differentiation of accidental and non-accidental falling scenarios. From a biomechanical point of view, this is a challenging task and should be addressed in a multifactorial approach. This work presents a simplified mechanical model in terms of a cranked rod that can be used in cases without relevant dynamic components in terms of pushing or jumping. If the anti-slip and the anti-tilt condition are violated, the possibility for a person to get over a railing should be assumed and investigated in more detail. Because our approach also involves uncertainties, the formulae should be understood to be part of a multifactorial approach. Numerical simulation, experimental reconstruction, injury pattern, and trace analysis can yield additional substantial connecting facts.
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Affiliation(s)
- H Muggenthaler
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
| | - M Hubig
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - A Meierhofer
- Institute of Legal Medicine, Medical University of Graz, Graz, Austria
| | - G Mall
- Institute of Legal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Acute Effects of Single- Versus Double-Leg Postactivation Potentiation on Postural Balance of Older Women: An Age-Matched Controlled Study. J Aging Phys Act 2020; 29:200-206. [PMID: 32820137 DOI: 10.1123/japa.2019-0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/24/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
AIMS To compare the postactivation potentiation effects of isometric contraction until failure in double- and single-leg tasks on older women's balance. METHODS The one-legged balance test was performed before and immediately after a rise-to-toes task until the task failure. Older women were divided into two groups: a group performed the task with double leg (n = 43) and the other group with single-leg support (n = 55). RESULTS The single-leg group showed slower velocity of sway post rise-to-toes task (pre = 4.02 ± 1; post = 3.78 ± 1.15 m/s; p = .04) without differences for the center of pressure path length (pre = 79 ± 21; post = 75 ± 23 cm; p = .08). In the double-leg group, faster velocity of sway (pre = 4 ± 1.22; post = 4.25 ± 1.13; p = .03) and increased center of pressure path length (pre = 80 ± 24; post = 85 ± 23 cm; p = .03) were observed after the task. CONCLUSIONS The single-leg group showed improved balance outcomes due to postactivation potentiation, while the double-leg group showed worsened balance consistent with muscle fatigue.
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Bohm S, Mandla-Liebsch M, Mersmann F, Arampatzis A. Exercise of Dynamic Stability in the Presence of Perturbations Elicit Fast Improvements of Simulated Fall Recovery and Strength in Older Adults: A Randomized Controlled Trial. Front Sports Act Living 2020; 2:52. [PMID: 33345043 PMCID: PMC7739602 DOI: 10.3389/fspor.2020.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022] Open
Abstract
Age-related impairments of reactive motor responses to postural threats and reduced muscular capacities of the legs are key factors for the higher risk of falling in older people. It has been evidenced that a training of dynamic stability in the presence of perturbations has the potential to improve these deficits. However, the time course of training effects during such interventions is poorly understood. The purpose of this parallel-group study was to investigate the temporal adaptation dynamics of the balance recovery performance and leg strength during a dynamic stability training. Forty-two healthy older adults (65–85 years) were randomly assigned to a training (n = 27, analyzed n = 18) or control group (n = 15, n = 14). The training was conducted in a group setting for 6 weeks (3×/week, 45 min). The exercises focused on the mechanism of stability control (i.e., modulation of the base of support and segment counter-rotations around the center of mass) during standing, stepping, and jumping on unstable surfaces with a high balance intensity. Before, after 3 and after 6 weeks, the maximum plantar flexion moment and the knee extension moment were assessed. The recovery performance was evaluated by a simulated forward fall (lean-and-release test) and the margin of stability concept. The margin of stability at release decreased significantly after 3 weeks of training (34%, effect size g = 0.79), which indicates fast improvements of balance recovery performance. The margin of stability further decreased after week 6 (53%, g = 1.21), yet the difference between weeks 3 and 6 was not significant. Furthermore, the training led to significant increases in the plantar flexion moment after weeks 3 (12%, g = 0.72) and 6 (13%, g = 0.75) with no significant difference between weeks. For the knee extension moment, a significant increase was found only after week 6 (11%, g = 1.07). The control group did not show any significant changes. This study provides evidence that a challenging training of dynamic stability in the presence of perturbations can improve balance recovery performance and leg strength of older adults already after a few weeks. Therefore, short-term training interventions using this paradigm may be an effective strategy for fall prevention in the elderly population, particularly when intervention time is limited.
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Affiliation(s)
- Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Mandla-Liebsch
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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11
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The Relationship Between Trunk Muscle Thickness and Static Postural Balance in Older Adults. J Aging Phys Act 2020; 28:269-275. [PMID: 31722293 DOI: 10.1123/japa.2019-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/23/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
Trunk muscles are required for safety of movement in aging. The authors aimed to investigate the relationship between trunk muscle thickness and the static postural balance in older adults. A total of 31 females and 23 males with a mean age of 73.39 ± 6.09 completed the study. The thickness of the trunk muscles was determined with ultrasound imaging. Postural balance was assessed with force plate. There was a positive weak correlation between right and left upper rectus abdominis muscle thickness and anterior stability area (p < .05, r > .3). The negative and moderate correlation was determined between the left lower rectus abdominis and the perturbated stability sway value (p < .01, r > .5). The increase in trunk muscle thickness in older adults increases the postural stability area and decreases the postural sway especially in the mediolateral direction.
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12
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Pienciak-Siewert A, Horan DP, Ahmed AA. Role of muscle coactivation in adaptation of standing posture during arm reaching. J Neurophysiol 2020; 123:529-547. [PMID: 31851559 DOI: 10.1152/jn.00939.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ability to maintain stable, upright standing in the face of perturbations is a critical component of daily life. A common strategy for resisting perturbations and maintaining stability is muscle coactivation. Although arm muscle coactivation is often used during adaptation of seated reaching movements, little is known about postural muscle activation during concurrent adaptation of arm and standing posture to novel perturbations. In this study we investigate whether coactivation strategies are employed during adaptation of standing postural control, and how these strategies are prioritized for adaptation of standing posture and arm reaching, in two different postural stability conditions. Healthy adults practiced planar reaching movements while grasping the handle of a robotic arm and standing on a force plate; the robotic arm generated a velocity-dependent force field that created novel perturbations in the forward (more stable) or backward (less stable) direction. Surprisingly, the degree of arm and postural adaptation was not influenced by stability, with similar adaptation observed between conditions in the control of both arm movement and standing posture. We found that an early coactivation strategy can be used in postural adaptation, similar to what is observed in adaptation of arm reaching movements. However, the emergence of a coactivation strategy was dependent on perturbation direction. Despite similar adaptation in both directions, postural coactivation was largely specific to forward perturbations. Backward perturbations led to less coactivation and less modulation of postural muscle activity. These findings provide insight into how postural stability can affect prioritization of postural control objectives and movement adaptation strategies.NEW & NOTEWORTHY Muscle coactivation is a key strategy for modulating movement stability; this is centrally important in the control of standing posture. Our study investigates the little-known role of coactivation in adaptation of whole body standing postural control. We demonstrate that an early coactivation strategy can be used in postural adaptation, but muscle activation strategies may differ depending on postural stability conditions.
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Affiliation(s)
| | - Dylan P Horan
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Alaa A Ahmed
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado
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13
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Pretty SP, Armstrong DP, Weaver TB, Laing AC. The influence of increased passive stiffness of the trunk and hips on balance control during reactive stepping. Gait Posture 2019; 72:51-56. [PMID: 31146190 DOI: 10.1016/j.gaitpost.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Age-related changes, which include increased trunk and hip stiffness, negatively influence postural balance. While previous studies suggest no net-effect of trunk and hip stiffness on initial trip-recovery responses, no study to date has examined potential effects during the dynamic restabilisation phase following foot contact. RESEARCH QUESTION Does increased trunk and hip stiffness, in isolation from other ageing effects, negatively influence balance during the restabilisation phase of reactive stepping. METHODS Balance perturbations were applied using a tether-release paradigm, which required participants to react with a single-forward step. Sixteen young adults completed two blocks of testing: a baseline and an increased stiffness (corset) condition. Whole-body kinematics were utilized to estimate spatial step parameters, center of mass (COM), COM incongruity (peak - final position) and time to restabilisation, in anteroposterior (AP) and mediolateral (ML) directions. RESULTS In the corset condition, peak COM displacement was increased in both directions (p < 0.024), which drove reductions in minimum margins of stability (p < 0.032) as step width and length were unchanged (p > 0.233). Increased passive stiffness also increased the magnitude and variability of peak shear ground reaction force, COM incongruity, and time to restabilisation in the ML (but not AP) direction (p < 0.027). SIGNIFICANCE In contrast to previous literature, increased stiffness resulted in greater peak COM displacement in both directions. Our results suggest increased trunk and hip stiffness have detrimental effects on dynamic stability following a reactive step, particularly in the ML direction. Observed increases in magnitude and variability of COM incongruity suggest the likelihood of a sufficiently large loss of ML stability - requiring additional steps - was increased by stiffening of the hips and trunk. The current findings suggest interventions aiming to mobilize the trunk and hips, in conjunction with strengthening, could improve balance and reduce the risk of falls.
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Affiliation(s)
- Steven P Pretty
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Daniel P Armstrong
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Tyler B Weaver
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Andrew C Laing
- Injury Biomechanics and Aging Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada.
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14
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Ochi A, Ohko H, Hayashi T, Osawa T, Sugiyama Y, Nakamura S, Ibuki S, Ichihashi N. Relationship Between Balance Recovery From a Forward Fall and Lower-Limb Rate of Torque Development. J Mot Behav 2019; 52:71-78. [PMID: 30915901 DOI: 10.1080/00222895.2019.1585743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors examined the relationship between the maximum recoverable lean angle via the tether-release method with early- or late-phase rate of torque development (RTD) and maximum torque of lower-limb muscle groups in 56 young healthy adults. Maximal isometric torque and RTD at the hip, knee, and ankle were recorded. The RTD at 50-ms intervals up to 250 ms from force onset was calculated. The results of a stepwise multiple regression analysis, early RTD for hip flexion, and knee flexion were chosen as predictive variables for the maximum recoverable lean angle. The present study suggests that some of the early RTD in the lower limb muscles, but not the maximum isometric torque, can predict the maximum recoverable lean angle.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Hiroshi Ohko
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Tatsuya Osawa
- Faculty of Rehabilitation, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Yuto Sugiyama
- Faculty of Rehabilitation, Kakamigahara Rehabilitation Hospital, Kakamigahara, Japan
| | | | - Satoko Ibuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Tanel MR, Weaver TB, Laing AC. Standing Versus Stepping-Exploring the Relationships Between Postural Steadiness and Dynamic Reactive Balance Control. J Appl Biomech 2018; 34:488-495. [PMID: 29989471 DOI: 10.1123/jab.2017-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
While the literature has characterized balance control during quasi-static and/or dynamic tasks, comparatively few studies have examined relationships across paradigms. This study investigated whether quiet-stance postural steadiness metrics were associated with reactive control parameters (during both stepping and restabilization phases) following a lean-and-release perturbation. A total of 40 older adults participated. Postural steadiness (center of the pressure range, root mean square, velocity, and frequency) was evaluated in "feet together" and "tandem stance" positions. During the reactive control trials, the step length, step width, movement time, and reaction time were measured, in addition to the postural steadiness variables measured during the restabilization phase following the stepping response. Out of 64 comparisons, only 10 moderate correlations were observed between postural steadiness and reactive spatio-temporal stepping parameters (P ≤ .05, r = -.312 to -.534). However, postural steadiness metrics were associated with the center of pressure velocity and frequency during the restabilization phase of the reactive control trials (P ≤ .02, r = .383 to .775 for velocity and P ≤ .01, r = .386 to .550 for frequency). Although some elements of quasi-static center of pressure control demonstrated moderate associations with dynamic stepping responses, relationships were stronger for restabilization phase dynamics after foot-contact. Future work should examine the potential association between restabilization phase control and older adult fall-risk.
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16
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Azarpaikan A, Taheri Torbati H. Effect of somatosensory and neurofeedback training on balance in older healthy adults: a preliminary investigation. Aging Clin Exp Res 2018; 30:745-753. [PMID: 29063490 DOI: 10.1007/s40520-017-0835-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to assess the effectiveness of balance training with somatosensory and neurofeedback training on dynamic and static balance in healthy, elderly adults. The sample group consisted of 45 healthy adults randomly assigned to one of the three test groups: somatosensory, neurofeedback, and a control. Individualization of the balance program started with pre-tests for static and dynamic balances. Each group had 15- and 30-min training sessions. All groups were tested for static (postural stability) and dynamic balances (Berg Balance Scale) in acquisition and transfer tests (fall risk of stability and timed up and go). Improvements in static and dynamic balances were assessed by somatosensory and neurofeedback groups and then compared with the control group. Results indicated significant improvements in static and dynamic balances in both test groups in the acquisition test. Results revealed a significant improvement in the transfer test in the neurofeedback and somatosensory groups, in static and dynamic conditions, respectively. The findings suggest that these methods of balance training had a significant influence on balance. Both the methods are appropriate to prevent falling in adults. Neurofeedback training helped the participants to learn static balance, while somatosensory training was effective on dynamic balance learning. Further research is needed to assess the effects of longer and discontinuous stimulation with somatosensory and neurofeedback training on balance in elderly adults.
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17
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Oludare SO, Pater ML, Rosenblatt NJ, Grabiner MD. Trip-specific training enhances recovery after large postural disturbances for which there is NO expectation. Gait Posture 2018; 61:382-386. [PMID: 29448221 DOI: 10.1016/j.gaitpost.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Informed consent usually provides foreknowledge of experimental methods that can potentially increase expectation of stimuli and, therefore, influence the response. We determined the effects of increased expectation and trip-specific training on the recovery response following a treadmill-delivered, trip-specific disturbance. To deliver unexpected disturbances, subjects were deceived during the informed consent process. The primary hypothesis was that the recovery response following an expected postural disturbance would be characterized by trunk kinematics that have been shown to decrease the likelihood of a fall, compared to following an unexpected postural disturbance. We further hypothesized that following an unexpected postural disturbance, the recovery response of the subjects who had completed a trip-specific training protocol would be more biomechanically favorable to recovery compared to those of subjects who had not received the training. METHODS Young adults were randomized into Untrained or Trained groups. During the informed consent process, the purpose of the study was explained to subjects in both groups as being to determine the effect of trip-specific training on postural sway while performing an attention-demanding task. Untrained subjects completed two trials during which they minimized their postural sway. During the second trial, an unexpected disturbance was delivered while they performed the attention-demanding task. Trained subjects performed a pre-training postural sway trial, followed by the delivery of a series of expected, training disturbances. Finally, an unexpected disturbance was delivered while they minimized postural sway and performed the attention-demanding task. RESULTS Expectation significantly improved trunk kinematics (p < .05). In addition, participation in the trip-specific training protocol following the unexpected disturbance the trunk kinematics of the Trained subjects were more biomechanically favorable to recovery than those of the Untrained subjects (p < .01). CONCLUSION Improved trunk kinematics following trip-specific training may be independent of the extent to which the disturbance is expected.
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Affiliation(s)
- Simisola O Oludare
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Room 654, Chicago, IL 60612, United States.
| | - Mackenzie L Pater
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Room 654, Chicago, IL 60612, United States.
| | - Noah J Rosenblatt
- Rosalind Franklin University of Medicine and Science, Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine, 3333 Green Bay Road, North Chicago, IL 60064, United States.
| | - Mark D Grabiner
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Room 654, Chicago, IL 60612, United States.
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18
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Hamed A, Bohm S, Mersmann F, Arampatzis A. Exercises of dynamic stability under unstable conditions increase muscle strength and balance ability in the elderly. Scand J Med Sci Sports 2018; 28:961-971. [DOI: 10.1111/sms.13019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
Affiliation(s)
- A. Hamed
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
- Department of Biomechanics; Faculty of Physical Therapy; Cairo University; Cairo Egypt
| | - S. Bohm
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - F. Mersmann
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - A. Arampatzis
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
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19
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Graham DF, Carty CP, Lloyd DG, Barrett RS. Muscle contributions to the acceleration of the whole body centre of mass during recovery from forward loss of balance by stepping in young and older adults. PLoS One 2017; 12:e0185564. [PMID: 29069097 PMCID: PMC5656315 DOI: 10.1371/journal.pone.0185564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/14/2017] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to determine the muscular contributions to the acceleration of the whole body centre of mass (COM) of older compared to younger adults that were able to recover from forward loss of balance with a single step. Forward loss of balance was achieved by releasing participants (14 older adults and 6 younger adults) from a static whole-body forward lean angle of approximately 18 degrees. 10 older adults and 6 younger adults were able to recover with a single step and included in subsequent analysis. A scalable anatomical model consisting of 36 degrees-of-freedom was used to compute kinematics and joint moments from motion capture and force plate data. Forces for 92 muscle actuators were computed using Static Optimisation and Induced Acceleration Analysis was used to compute individual muscle contributions to the three-dimensional acceleration of the whole body COM. There were no significant differences between older and younger adults in step length, step time, 3D COM accelerations or muscle contributions to 3D COM accelerations. The stance and stepping leg Gastrocnemius and Soleus muscles were primarily responsible for the vertical acceleration experienced by the COM. The Gastrocnemius and Soleus from the stance side leg together with bilateral Hamstrings accelerated the COM forwards throughout balance recovery while the Vasti and Soleus of the stepping side leg provided the majority of braking accelerations following foot contact. The Hip Abductor muscles provided the greatest contribution to medial-lateral accelerations of the COM. Deficits in the neuromuscular control of the Gastrocnemius, Soleus, Vasti and Hip Abductors in particular could adversely influence balance recovery and may be important targets in interventions to improve balance recovery performance.
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Affiliation(s)
- David F. Graham
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Christopher P. Carty
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - David G. Lloyd
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- * E-mail:
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20
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McCrum C, Gerards MHG, Karamanidis K, Zijlstra W, Meijer K. A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. Eur Rev Aging Phys Act 2017; 14:3. [PMID: 28270866 PMCID: PMC5335723 DOI: 10.1186/s11556-017-0173-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/27/2017] [Indexed: 11/22/2022] Open
Abstract
Background Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults. Methods A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined. Results In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies. Conclusions To date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults. Electronic supplementary material The online version of this article (doi:10.1186/s11556-017-0173-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher McCrum
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Human Movement Science, Maastricht, The Netherlands.,Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Marissa H G Gerards
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Human Movement Science, Maastricht, The Netherlands.,azM Herstelzorg Centre for Geriatric Rehabilitation and Care, Maastricht, The Netherlands
| | - Kiros Karamanidis
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany.,Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Human Movement Science, Maastricht, The Netherlands
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21
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Hip joint contact loads in older adults during recovery from forward loss of balance by stepping. J Biomech 2016; 49:2619-2624. [DOI: 10.1016/j.jbiomech.2016.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
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22
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Examination of Inertial Sensor-Based Estimation Methods of Lower Limb Joint Moments and Ground Reaction Force: Results for Squat and Sit-to-Stand Movements in the Sagittal Plane. SENSORS 2016; 16:s16081209. [PMID: 27490544 PMCID: PMC5017375 DOI: 10.3390/s16081209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 11/23/2022]
Abstract
Joint moment estimation by a camera-based motion measurement system and a force plate has a limitation of measurement environment and is costly. The purpose of this paper is to evaluate quantitatively inertial sensor-based joint moment estimation methods with five-link, four-link and three-link rigid body models using different trunk segmented models. Joint moments, ground reaction forces (GRF) and center of pressure (CoP) were estimated for squat and sit-to-stand movements in the sagittal plane measured with six healthy subjects. The five-link model and the four-link model that the trunk was divided at the highest point of the iliac crest (four-link-IC model) were appropriate for joint moment estimation with inertial sensors, which showed average RMS values of about 0.1 Nm/kg for all lower limb joints and average correlation coefficients of about 0.98 for hip and knee joints and about 0.80 for ankle joint. Average root mean square (RMS) errors of horizontal and vertical GRFs and CoP were about 10 N, 15 N and 2 cm, respectively. Inertial sensor-based method was suggested to be an option for estimating joint moments of the trunk segments. Inertial sensors were also shown to be useful for the bottom-up estimation method using measured GRFs, in which average RMS values and average correlation coefficients were about 0.06 Nm/kg and larger than about 0.98 for all joints.
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23
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Benichou O, Lord SR. Rationale for Strengthening Muscle to Prevent Falls and Fractures: A Review of the Evidence. Calcif Tissue Int 2016; 98:531-45. [PMID: 26847435 DOI: 10.1007/s00223-016-0107-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/04/2016] [Indexed: 12/11/2022]
Abstract
Falls represent a major public health problem in older people, predominantly due to the resulting injuries which lead to progressive disability, immobilization and resulting comorbidities, dependency, institutionalization, and death. Reduced muscle strength and power have been consistently identified as risk factors for falls and related injuries, and it is likely these associations result from the central role played by reduced muscle strength and power in poor balance recovery. In addition, muscle strength and power are involved with protective responses that reduce the risk of an injury if a fall occurs. Progressive resistance training (PRT) is the standard way to increase muscle strength and power, and this training forms one of the main components of fall prevention exercise interventions. However, PRT has rarely been implemented in routine practice due to multiple challenges inherent to frail older people. The ongoing development of drugs expected to increase muscle power offers a new opportunity to reduce the risk of falls and fall-related injuries. The intent here is not to replace exercise training with drugs but rather to offer a pharmacologic alternative when exercise is not possible or contraindicated. The target population would be those most likely to benefit from this mechanism of action, i.e., weak older people without major causes for falls independent of muscle weakness. Provided such a tailored strategy was followed, a muscle anabolic may address this major unmet need.
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Affiliation(s)
- Olivier Benichou
- Eli Lilly and Company, 24, Boulevard Vital-Bouhot, 92200, Neuilly, France.
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24
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McCrum C, Epro G, Meijer K, Zijlstra W, Brüggemann GP, Karamanidis K. Locomotor stability and adaptation during perturbed walking across the adult female lifespan. J Biomech 2016; 49:1244-1247. [PMID: 26970886 DOI: 10.1016/j.jbiomech.2016.02.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/18/2022]
Abstract
The aim of this work was to examine locomotor stability and adaptation across the adult female lifespan during perturbed walking on the treadmill. 11 young, 11 middle and 14 older-aged female adults (mean and SD: 25.5(2.1), 50.6(6.4) and 69.0(4.7) years old respectively) walked on a treadmill. We applied a sustained perturbation to the swing phase of the right leg for 18 consecutive gait cycles, followed by a step with the resistance unexpectedly removed, via an ankle strap connected to a break-and-release system. The margin of stability (MoS) at foot touchdown was calculated as the difference between the anterior boundary of the base of support (BoS) and extrapolated center of mass. Older participants showed lower MoS adaptation magnitude in the early adaptation phase (steps 1-3) compared to the young and middle-aged groups. However, in the late adaptation phase (steps 16-18) there were no significant differences in adaptation magnitude between the three age groups. After removing the resistance, all three age groups showed similar aftereffects (i.e. increased BoS). The current results suggest that in old age, the ability to recalibrate locomotion to control stability is preserved, but the rate of adaptive improvement in locomotor stability is diminished.
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Affiliation(s)
- Christopher McCrum
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Human Movement Science, Maastricht, The Netherlands; Institute of Movement and Sport Gerontology, German Sport University Cologne, Germany
| | - Gaspar Epro
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Germany
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Human Movement Science, Maastricht, The Netherlands
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Germany
| | - Kiros Karamanidis
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Germany.
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25
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Erickson B, Hosseini MA, Mudhar PS, Soleimani M, Aboonabi A, Arzanpour S, Sparrey CJ. The dynamics of electric powered wheelchair sideways tips and falls: experimental and computational analysis of impact forces and injury. J Neuroeng Rehabil 2016; 13:20. [PMID: 26935331 PMCID: PMC4776350 DOI: 10.1186/s12984-016-0128-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background To reduce the occurrence of wheelchair falls and to develop effective protection systems, we aimed to quantify sideways tip and fall dynamics of electric power wheelchairs (EPWs). We hypothesized that driving speed, curb height and angle of approach would affect impact forces and head injury risk for wheelchair riders. We further expected that fall dynamics and head injury risk would be greater for unrestrained riders compared to restrained riders. Methods Sideways wheelchair tip and fall dynamics were reconstructed using a remotely operated rear wheel drive EPW and a Hybrid III test dummy driving at different approach angles (5 to 63°) over an adjustable height curb (0.30 to 0.41 m) at speeds of 0.6–1.5 m/s. Rigid body dynamics models (Madymo, TASS International, Livonia, MI) were developed in parallel with the experiments to systematically study and quantify the impact forces and the sideways tip or fall of an EPW user in different driving conditions. Results Shallower approach angles (25°) (p < 0.05) and higher curbs (0.4 m) (p < 0.05) were the most significant predictors of tipping for restrained passengers. Unrestrained passengers were most affected by higher curbs (0.4 m) (p < 0.005) and fell forward from the upright wheelchair when the approach angle was 60°. Head impact forces were greater in unrestrained users (6181 ± 2372 N) than restrained users (1336 ± 827 N) (p = 0.00053). Unrestrained users had significantly greater head impact severities than restrained users (HIC = 610 ± 634 vs HIC = 29 ± 38, p = 0.00013) and several tip events resulted in HICs > 1000 (severe head injury) in unrestrained users. Conclusions Sideways tips and forward falls from wheelchairs were most sensitive to curb height and approach angle but were not affected by driving speed. Sideways tips and falls resulted in impact forces that could result in concussions or traumatic brain injury and require injury prevention strategies. Seat belts eliminated the risk of falling from an upright chair and reduced head impact forces in sideways wheelchair tips in this study; however, their use must be considered within the ethical and legal definitions of restraints.
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Affiliation(s)
- Brett Erickson
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Ave., Surrey, BC, V3T 0A3, Canada.
| | - Masih A Hosseini
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Ave., Surrey, BC, V3T 0A3, Canada.
| | - Parry Singh Mudhar
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Ave., Surrey, BC, V3T 0A3, Canada.
| | - Maryam Soleimani
- MobiSafe Systems Inc., Room 5330 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada.
| | - Arina Aboonabi
- MobiSafe Systems Inc., Room 5330 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada.
| | - Siamak Arzanpour
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Ave., Surrey, BC, V3T 0A3, Canada.
| | - Carolyn J Sparrey
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Ave., Surrey, BC, V3T 0A3, Canada. .,International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute and The University of British Columbia, Vancouver, BC, Canada.
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