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Pitts J, Komisar V, Elmblad K, Smith A, Verbrigghe D, Siko C, Nussbaum MA, Duncan CA. Influences of backpack loading on recovery from anterior and posterior losses of balance: An exploratory investigation. APPLIED ERGONOMICS 2024; 117:104236. [PMID: 38237306 DOI: 10.1016/j.apergo.2024.104236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 12/01/2023] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Abstract
Backpacks are common devices for carrying external posterior loads. However, relatively little is known about how these external loads affect the ability to recover from balance loss. In this exploratory investigation, 16 young adults (8 female, 8 male) performed forward and backward lean-and-release balance recovery trials, while wearing a backpack that was unloaded or loaded (at 15% of individual body weight). We quantified the effects of backpack loading on balance recovery in terms of maximum recoverable lean angles, center-of-mass kinematics, and temporal-spatial stepping characteristics. Mean values of maximum lean angles were 20° and 9° in response to forward and backward perturbations, respectively. These angles significantly decreased when wearing the additional load for only backward losses of balance. During backward losses of balance, the additional load decreased peak center-of-mass velocity and increased acceleration by ∼10 and 18% respectively, which was accompanied by ∼5% faster stepping responses and steps that were ∼9% longer, 11% higher, and had an ∼10% earlier onset. Thus, wearing a backpack decreases backward balance recovery ability and changes backward recovery stepping characteristics.
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Affiliation(s)
- Jessica Pitts
- Department of Kinesiology and Integrative Physiology, Student Development Complex, 1400 Townsend Drive, Michigan Technological University, Houghton, MI, 49922, USA.
| | - Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kayley Elmblad
- Department of Mechanical Engineering and Engineering Mechanics, R. L. Smith ME-EM Building, 8th Floor, 1400 Townsend Drive, Houghton, MI, 49931, USA
| | - Alyssa Smith
- Department of Kinesiology and Integrative Physiology, Student Development Complex, 1400 Townsend Drive, Michigan Technological University, Houghton, MI, 49922, USA
| | - Derek Verbrigghe
- Department of Physical Therapy, Central Michigan University, 1200S Franklin St, Mount Pleasant, MI, 48859, USA
| | - Carly Siko
- Department of Physical Therapy, Central Michigan University, 1200S Franklin St, Mount Pleasant, MI, 48859, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, 521 Whittemore Hall, 1185 Perry Street (0118), Blacksburg, VA, 24061, USA
| | - Carolyn A Duncan
- Department of Kinesiology and Integrative Physiology, Student Development Complex, 1400 Townsend Drive, Michigan Technological University, Houghton, MI, 49922, USA.
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Menz HB, Bergin SM, McClelland JA, Munteanu SE. Footwear and Falls in Long-Term Residential Aged Care Facilities: An Analysis of Video Capture Data. Gerontology 2024; 70:611-619. [PMID: 38626742 DOI: 10.1159/000538731] [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: 12/18/2023] [Accepted: 03/31/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Several footwear characteristics have been shown to affect balance and gait patterns and may therefore influence the risk of falling in older adults. However, attributing a link between footwear and falls is inherently difficult as it often relies on self-report which may be inaccurate. METHODS Archival video recordings of falls that occurred in two long-term residential aged care facilities were initially screened to determine whether the footwear worn at the time (barefoot, socks, slippers/sandals, or shoes) could be documented. These falls were then independently evaluated by three additional assessors and a meeting was held to obtain consensus in relation to whether the footwear could have potentially contributed to the fall, and what mechanism may have been responsible. Cross-tabulations were performed in relation to footwear type and fall characteristics (proposed mechanism and fall direction). RESULTS There were 300 falls experienced by 118 older adults aged 58 years-98 years (mean age 82.8 years, SD 7.6). Of these falls, footwear could be ascertained in 224 (75%). After the consensus meeting, the proportion of falls considered to be potentially related to footwear was 40 (18%). The likelihood of footwear contributing to the fall was highest when participants were wearing socks (14/19 falls; 74% of all footwear-related falls), followed by being barefoot (2/6 falls; 33%), wearing slippers/sandals (17/100 falls; 17%), and wearing shoes (7/99 falls, 7%). CONCLUSION Footwear could be a potential contributor to a substantial number of falls in residential aged care. Wearing socks would appear to place an older person at risk of future falls and should therefore be avoided in this population.
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Affiliation(s)
- Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shan M Bergin
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jodie A McClelland
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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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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Arkkukangas M. Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention. Clin Interv Aging 2023; 18:2165-2170. [PMID: 38149083 PMCID: PMC10751217 DOI: 10.2147/cia.s430309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a "train-The-trainer" approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.
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Affiliation(s)
- Marina Arkkukangas
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Medicine, Sport and Fitness Science, Dalarna University, Falun, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
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Bolton DAE, Baggett CC, Mitton CA, Harper SA, Richardson JK. Suppressing a Blocked Balance Recovery Step: A Novel Method to Assess an Inhibitory Postural Response. Brain Sci 2023; 13:1488. [PMID: 37891855 PMCID: PMC10605013 DOI: 10.3390/brainsci13101488] [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: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Stepping to recover balance is an important way we avoid falling. However, when faced with obstacles in the step path, we must adapt such reactions. Physical obstructions are typically detected through vision, which then cues step modification. The present study describes a novel method to assess visually prompted step inhibition in a reactive balance context. In our task, participants recovered balance by quickly stepping after being released from a supported forward lean. On rare trials, however, an obstacle blocked the stepping path. The timing of vision relative to postural perturbation was controlled using occlusion goggles to regulate task difficulty. Furthermore, we explored step suppression in our balance task related to inhibitory capacity measured at the hand using a clinically feasible handheld device (ReacStick). Our results showed that ReacStick and step outcomes were significantly correlated in terms of successful inhibition (r = 0.57) and overall reaction accuracy (r = 0.76). This study presents a novel method for assessing rapid inhibition in a dynamic postural context, a capacity that appears to be a necessary prerequisite to a subsequent adaptive strategy. Moreover, this capacity is significantly related to ReacStick performance, suggesting a potential clinical translation.
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Affiliation(s)
- David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (C.C.B.IV); (C.A.M.); (S.A.H.)
- Sorenson Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Charlie C. Baggett
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (C.C.B.IV); (C.A.M.); (S.A.H.)
| | - Chase A. Mitton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (C.C.B.IV); (C.A.M.); (S.A.H.)
| | - Sara A. Harper
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (C.C.B.IV); (C.A.M.); (S.A.H.)
- Sorenson Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
- Kinesiology Department, The University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - James K. Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA;
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