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Robinovitch SN, Dojnov A, Komisar V, Yang Y, Shishov N, Yu Y, Bercovitz I, Cusimano MD, Becker C, Mackey DC, Chong H. Protective responses of older adults for avoiding injury during falls: evidence from video capture of real-life falls in long-term care. Age Ageing 2022; 51:6881501. [PMID: 36477785 PMCID: PMC9729006 DOI: 10.1093/ageing/afac273] [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: 03/31/2022] [Revised: 08/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND falls are common in older adults, and any fall from standing height onto a rigid surface has the potential to cause a serious brain injury or bone fracture. Safe strategies for falling in humans have traditionally been difficult to study. OBJECTIVE to determine whether specific 'safe landing' strategies (body rotation during descent, and upper limb bracing) separate injurious and non-injurious falls in seniors. DESIGN observational cohort study. SETTING two long-term care homes in Vancouver BC. METHODS videos of 2,388 falls experienced by 658 participants (mean age 84.0 years; SD 8.1) were analysed with a structured questionnaire. General estimating equations were used to examine how safe landing strategies associated with documented injuries. RESULTS injuries occurred in 38% of falls, and 4% of falls caused injuries treated in hospitals. 32% of injuries were to the head. Rotation during descent was common and protective against injury. In 43% of falls initially directed forward, participants rotated to land sideways, which reduced their odds for head injury 2-fold. Upper limb bracing was used in 58% of falls, but rather than protective, bracing was associated with an increased odds for injury, possibly because it occurred more often in the demanding scenario of forward landings. CONCLUSIONS the risk for injury during falls in long-term care was reduced by rotation during descent, but not by upper limb bracing. Our results expand our understanding of human postural responses to falls, and point towards novel strategies to prevent fall-related injuries.
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Affiliation(s)
- Stephen N Robinovitch
- Address correspondence to: S. Robinovitch, Injury Prevention and Mobility Laboratory, Room K8508, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Aleksandra Dojnov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, 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
| | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Nataliya Shishov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Ying Yu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Ian Bercovitz
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, Li Ka Shing Knowledge Institute, Injury Prevention Research Office, St. Michael’s Hospital – Unity Health, Toronto, ON, Canada
| | - Clemens Becker
- Robert Bosch Hospital, Stuttgart, Germany,Unit of Digital Geriatric Medicine, University Hospital, Heidelberg, Germany
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
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Dejvajara D, Aungkasuraphan R, Palee P, Piankusol C, Sirikul W, Siviroj P. Effects of Home-Based Nine-Square Step Exercises for Fall Prevention in Thai Community-Dwelling Older Adults during a COVID-19 Lockdown: A Pilot Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10514. [PMID: 36078234 PMCID: PMC9517798 DOI: 10.3390/ijerph191710514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
The deterioration of muscle strength in aging has been associated with fall risks. During the COVID-19 pandemic, older adults were restricted from doing outdoor activities. This study aimed to investigate the effect of Nine-Square Step Exercises (NSSE) on improving physical performance and balance in older adults at risk of falling. We conducted an open-labelled, assessor-blinded, randomized controlled trial in 46 (aged 65-84 years) community-dwelling older adults. They were randomly assigned to an NSSE group (n = 24) instructed to perform the program for at least 45 days over 8 weeks or a control group (n = 22). The outcomes were measured by the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), the Five-Times-Sit-to-Stand test (FTSS), and hand grip strength during the baseline, 4th and 8th weeks in both groups. A mixed-effect linear regression model analysis was performed to estimate the independent effect of NSSE by the intention-to-treat over the 8-week period. The NSSE group showed significant weekly changes in BBS (β 0.57, 95% CI: 0.30, 0.84), TUG (β -0.44, 95% CI: -0.74, -0.14), and FTSS (β -0.52, 95% CI: -0.78, -0.25), demonstrating beneficial improvements in lower extremity and balance, whereas the control group did not demonstrate significant changes over time in any parameter.
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Affiliation(s)
| | | | - Piyathida Palee
- Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chanodom Piankusol
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Arnold CM, Lanovaz J, Farthing JP, Legg H, Weimer M, Kim S. Fall arrest strategy training improves upper body response time compared to standard fall prevention exercise in older women: A randomized trial. Clin Rehabil 2022; 36:940-951. [PMID: 35287479 PMCID: PMC9189718 DOI: 10.1177/02692155221087963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Exercise can decrease fall risk in older adults but less is known about training to reduce injury risk in the event a fall is unavoidable. The purpose of this study was to compare standard fall prevention exercises to novel Fall Arrest Strategy Training (FAST); exercises designed to improve upper body capacity to reduce fall-injury risk in older women. METHOD Forty women (mean age 74.5 years) participated in either Standard (n = 19) or FAST (n = 21) twice per week for 12 weeks. Both interventions included lower body strength, balance, walking practice, agility and education. FAST added exercises designed to enhance forward landing and descent control such as upper body strengthening, speed and practice of landing and descent on outstretched hands. RESULTS Both FAST and Standard significantly improved strength, mobility, balance, and fall risk factors from pre to post-intervention. There was a significant time by group interaction effect for upper body response time where FAST improved but Standard did not (p = 0.038). DISCUSSION FAST resulted in similar gains in factors that reduce fall risk as a standard fall prevention program; with the additional benefit of improving speed of arm protective responses; a factor that may help enhance landing position and reduce injury risks such as head impact during a forward fall.
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Affiliation(s)
- Catherine M Arnold
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hayley Legg
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- St Mary’s University, Twickenham, London, UK
| | - Melanie Weimer
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Soo Kim
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Arnold C, Lanovaz J, Banman D. Is it a Macho Thing? Older Adults' Perceptions of Gender Differences inFall Prevention Class Participation. J Appl Gerontol 2022; 41:1952-1959. [PMID: 35543184 PMCID: PMC9364234 DOI: 10.1177/07334648221095623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Perceptions that women are in greater need of fall prevention might impact their
participation in programs. This study aimed to understand gender differences in motivating
factors and experiences in a fall prevention program. Thirty-four adults (18 men and 16
women) aged 60 years or older participated in focus groups after 12 weeks of fall
prevention exercises and education. Six main themes emerged. It might be a macho
thing represented an overarching theme of why men might not participate in fall
prevention as readily as women. Personal experience as a motivator,
Get my balance back, and Challenges/Successes were
common themes for men and women. Both genders realized the benefits of the program;
however, men emphasized the importance of personal outcomes (Being part of
something bigger), whereas women highlighted group outcomes
(Socialization). These findings can guide the future messaging and
marketing of fall prevention programs for older adults.
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Affiliation(s)
- Catherine Arnold
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joel Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Danelle Banman
- Saskatchewan and College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Yang Y, van Schooten KS, Komisar V, McKay HA, Sims-Gould J, Cheong D, Robinovitch SN. Effects of the Mobility-Fit Physical Activity Program on Strength and Mobility in Older Adults in Assisted Living: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095453. [PMID: 35564848 PMCID: PMC9102970 DOI: 10.3390/ijerph19095453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Physical activity programs focusing on fall prevention often overlook upper-limb strength, which is important for transferring, balance recovery, and arresting a fall. We developed and evaluated a physical activity program, Mobility-Fit for older adults in Assisted Living (AL) that includes upper-limb strengthening, agility, coordination, and balance exercises. Thirty participants (85 ± 6 years) were recruited from two AL facilities; 15 were assigned to Mobility-Fit (three times/week, 45 min/session for 12 weeks) and 15 maintained usual care. Twenty-two participants (11 in each group) completed the study. We compared outcome changes between groups and interviewed participants and staff to explore the effectiveness and feasibility of the program. Among participants who attended Mobility-Fit, knee extension strength increased by 6%, reaction time decreased by 16%, and five-time sit-to-stand duration decreased by 15%. Conversely, participants in the usual care group had a 6% decrease in handgrip strength. Changes of these outcomes were significantly different between two groups (p < 0.05). Participants enjoyed the program and staff suggested some changes to improve attendance. Our results indicate that Mobility-Fit is feasible to deliver and beneficial for older adults in AL and may guide future clinical trials to evaluate the effectiveness of upper limb strengthening on safe mobility of older adults in care facilities.
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Affiliation(s)
- Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-4001
| | - Kimberley S. van Schooten
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2033, Australia;
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - Vicki Komisar
- School of Engineering, The University of British Columbia—Okanagan Campus, Kelowna, BC V1V 1V7, Canada;
| | - Heather A. McKay
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
| | - Debbie Cheong
- British Columbia Women’s Health Centre, Vancouver, BC V6H 3N1, Canada;
| | - Stephen N. Robinovitch
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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Komisar V, Dojnov A, Yang Y, Shishov N, Chong H, Yu Y, Bercovitz I, Cusimano MD, Becker C, Mackey DC, Robinovitch SN. Injuries from falls by older adults in long-term care captured on video: Prevalence of impacts and injuries to body parts. BMC Geriatr 2022; 22:343. [PMID: 35439948 PMCID: PMC9019961 DOI: 10.1186/s12877-022-03041-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Falls are the leading cause of injuries in older adults. However, most falls in older adults do not cause serious injury, suggesting that older adults may fall in a manner that reduces the likelihood of impact to body sites that are most vulnerable to injury. In this observational study of falls in long-term care (LTC), we tested whether body parts differed in their probability of impact and injury. Methods We recorded and analyzed videos of 2388 falls by 658 LTC residents (mean age 84.0 (SD = 8.1); 56.4% female). We used Linear Mixed Models to test for differences between body parts in the probability of impact and injury, and injury when impacts occurred. Results Injuries were reported in 38.2% of falls, and 85.9% of injuries involved direct impact to the injured body part. Impact occurred most often to the hip/pelvis (probability (standard error) = 0.95 (0.01); p < .001 relative to other body parts), and least often to the head (0.35 (0.01)). Conversely, injury occurred most often to the head (p < .001 relative to other body parts). The probability of injury when impacts occurred was 0.40 (0.01) for the head, and 0.11 or less for all other body parts. Conclusion Our results help to explain why most falls by older adults in LTC do not cause serious injury: residents land on body parts that are the most resilient to injury. The high susceptibility of the head to injury reinforces the need to enhance upper limb protective responses for fall arrest. The dominant role of direct impact as the mechanism of injury supports approaches to attenuate impact forces through strategies like protective clothing and compliant flooring.
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Affiliation(s)
- Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,School of Engineering, The University of British Columbia, 1137 Alumni Ave, Kelowna, BC, V1V 1V7, Canada.
| | - Aleksandra Dojnov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, SAR, Shenzhen, China
| | - Nataliya Shishov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ying Yu
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ian Bercovitz
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Unity Health, LiKaShing Knowledge Institute, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Clemens Becker
- Robert Bosch Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany.,Unit of Digital Geriatric Medicine, University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Borrelli J, Creath R, Westlake K, Rogers MW. Test-retest reliability of the FALL FIT system for assessing and training protective arm reactions in response to a forward fall. MethodsX 2022; 9:101702. [PMID: 35518921 PMCID: PMC9062354 DOI: 10.1016/j.mex.2022.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
The use of the hands and arms is an important protective mechanism in avoiding fall-related injury. The aim of this study was to evaluate the test-retest reliability of fall dynamics and evokd protective arm response kinematics and kinetics in forward falls simulated using the FALL simulator For Injury prevention Training and assessment system (FALL FIT). Fall FIT allows experimental control of the fall height and acceleration of the body during a forward fall. Two falls were simulated starting from 4 initial lean angles in Experiment 1 and with 4 different fall accelerations in Experiment 2. Fourteen younger adults (25.1±3.5 years) and 13 older adults (71.3±3.7 years) participated in Experiment 1 and 13 younger adults (31.8±5.7 years) participated in Experiment 2. Intraclass correlation coefficients (ICC) were used to the evaluate absolute agreement of single measures at each condition and averages across conditions. Average measures of fall dynamics and evoked kinematics and kinetics exhibited excellent reliability (ICC(A,4)>0.86). The reliability of single measures (ICC(A,1) > 0.59) was good to excellent, although 18% of single measures had a reliability (ICC(A,1)) between 0.00 and 0.57. The FALL FIT was shown to have good to excellent reliability for most measures. FALL FIT can produce a wide range of fall dynamics through modulation of initial lean angle and body acceleration. Additionally, the range of fall velocities and evoked kinematics and kinetics are consistent with previous fall research.The FALL FIT can be used to gain further insight into the control of protective arm reactions and may provide a therapeutic tool to assess and train protective arm reactions.
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Borrelli J, Creath R, Westlake K, Rogers MW. Age-related changes in protective arm reaction kinematics, kinetics, and neuromuscular activation during evoked forward falls. Hum Mov Sci 2022; 81:102914. [PMID: 34923206 PMCID: PMC8895474 DOI: 10.1016/j.humov.2021.102914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Fall related injuries in older adults are a major healthcare concern. During a fall, the hands and arms play an important role in minimizing trauma from ground impact. Although older adults are able to orient the hands and arms into a protective orientation after falling and prior to ground impact, an inability to avoid increased body impact occurs with age. Previous investigations have generally studied rapid arm movements in the pre-impact phase or absorbing energy in the post-impact phase. There are no known studies that have directly examined both the pre-impact and post-impact phase in sequence in a forward fall. The aim of this study was to identify age-related biomechanical and neuromuscular changes in evoked arm reactions in response to forward falls that may increase fall injury risk. Fourteen younger and 15 older adults participated. Falls were simulated while standing with torso and legs restrained via a moving pendulum system from 4 different initial lean angles. While there was not a significant age-related difference in the amount of energy absorbed post-impact (p = 0.68), older adults exhibited an 11% smaller maximum vertical ground reaction force when normalized to body weight (p = 0.031), and 8 degrees less elbow extension at impact (p = 0.045). A significant interaction between age and initial lean angle (p = 0.024), indicated that older adults required 54%, 54%, 41%, and 57% greater elbow angular displacement after impact at the low, medium, medium-high, and high initial lean angles compared to younger adults. These results suggested older adults may be at greater risk of increased body impact due to increased elbow flexion angular displacement after impact when the hands and arms are able to contact the ground first. Both groups exhibited robust modulation to the initial lean angle with no observed age-related differences in the initial onset timing or amplitude of muscle activation levels. There were no significant age-related differences in the EMG timing, amplitude or co-activation of muscle activation preceding impact or following impact indicating comparable neuromotor response patterns between older and younger adults. These results suggest that aging changes in muscular elements may be more implicated in the observed differences than changes in neuromuscular capacity. Future work is needed to test the efficacy of different modalities (e.g. instruction, strength, power, perturbation training, fall landing techniques) aimed at reducing fall injury risk.
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Affiliation(s)
- James Borrelli
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA.
| | - Robert Creath
- Lebanon Valley College, Exercise Science Department, Annville, PA, USA
| | - Kelly Westlake
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
| | - Mark W Rogers
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
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9
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Legg HS, Arnold CM, Trask C, Lanovaz JL. Does functional performance and upper body strength predict upper extremity reaction and movement time in older women? Hum Mov Sci 2021; 77:102796. [PMID: 33862278 DOI: 10.1016/j.humov.2021.102796] [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: 11/13/2020] [Revised: 03/08/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reaction time to initiate upper limb movement and movement time to place hands on the landing surface may be important factors in forward fall landing and impact, contributing to injury reduction. The aim was to investigate the relationship of physical function and upper body strength to upper limb reaction and movement time in older female participants. METHODS 75 female participants (72 ± 8 yrs) performed 5 arm response trials. Reaction time (signal to initiation of movement), and movement time (initial movement to contact), were collected using 3D motion capture. Additional variables were: handgrip; sit-to-stand; shoulder flexion and elbow extension strength measured by hand-held dynamometry; one-legged balance; fall risk; and physical activity scores. Prediction variables for reaction and movement time were determined in separate backward selection multiple regression analyses. Significance was set at P < 0.05. FINDINGS Significant regression equations for RT (r2 = 0.08, P = 0.013) found a relationship between stronger handgrip (Beta = -0.002) and faster reaction time, accounting for 8% variance. For movement time (r2 = 0.06, P = 0.036) greater shoulder flexion strength (Beta = -0.04) was related to faster movement time, explaining 6% variance. Stronger SF strength was related to a decrease in MT by 4%. DISCUSSION A relationship between arm strength measures and faster upper body reaction and movement time was shown, with 10-20% higher strength associated with a 5% faster response time. Even though this was a relatively weak relationship, given that strength is a modifiable component this provides a potential avenue for future intervention efforts. This in turn could have an impact on forward fall landing and potential reduction of injury risk.
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Affiliation(s)
- Hayley S Legg
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; St Mary's University, London, UK.
| | - Cathy M Arnold
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; School of Rehabilitation Science, University of Saskatchewan, Canada
| | - Catherine Trask
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada; Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Canada; Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Joel L Lanovaz
- Biomechanics of Balance and Movement Laboratory, College of Kinesiology, University of Saskatchewan, Canada
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Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation. CURRENT GERIATRICS REPORTS 2020; 9:134-141. [PMID: 34790518 DOI: 10.1007/s13670-020-00328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose of Review People living with lower limb amputation are at an increased risk of falling compared with the healthy geriatric population. Factors of increased age and increased number of comorbidities could compound the already increased risk. The purpose of this article is to highlight recent research associated with fall risk in amputees and provide the reader with evidence to help guide clinical interventions. Recent Findings Though research on the topic of falls in people with amputation is becoming more common, there is still a dearth of evidence regarding what contributes to increased fall risk and how to address it in this population. There are recent studies that have examined therapy and prosthetic interventions that could mitigate fall risk in people with amputation, yet there is not enough evidence to develop a consensus on the topic. More research is required to determine what contributes to increased fall rates in people with amputation, and what detriments to an amputee's function or psyche may result after incurring a fall. Summary Borrowing from what is known about geriatric fall risk and combining the information with novel and existing approaches to fall mitigation in amputees can offer clinicians the opportunity to develop evidence-based programs to address fall risk in their patients with lower limb amputation.
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Martínez-Carbonell Guillamón E, Burgess L, Immins T, Martínez-Almagro Andreo A, Wainwright TW. Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review. BMC Geriatr 2019; 19:52. [PMID: 30795740 PMCID: PMC6387499 DOI: 10.1186/s12877-019-1065-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors. METHODS A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale. RESULTS Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling. CONCLUSIONS There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.
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Affiliation(s)
- Eduardo Martínez-Carbonell Guillamón
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Louise Burgess
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Andrés Martínez-Almagro Andreo
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
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