Force-Controlled Balance Perturbations Associated with Falls in Older People: A Prospective Cohort Study

Balance recovery from an unpredictable postural perturbation can be a challenging task for many older people and poor recovery could contribute to their risk of falls. This study examined associations between responses to unpredictable perturbations and fall risk in older people. 242 older adults (80.064.4 years) underwent assessments of stepping responses to multi-directional force-controlled waist-pull perturbations. Participants returned monthly falls calendars for the subsequent 12 months. Future falls were associated with lower force thresholds for stepping in the posterior and lateral but not anterior directions. Those with lower posterior force thresholds for stepping were 68% more likely to fall at home than those with higher force thresholds for stepping. These results suggest that amount of force that can be withstood following an unpredictable balance perturbation predicts future falls in community-dwelling older adults. Perturbations in the posterior direction best discriminated between future fallers and non-fallers

Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: A systematic literature review

<p>Abstract</p> <p>Background</p> <p>Muscle fatigue reduces muscle strength and balance control in young people. It is not clear whether fatigue resistance seen in older persons leads to different effects. In order to understand whether muscle fatigue may increase fall risk in older persons, a systematic literature review aimed to summarize knowledge on the effects of lower extremity and trunk muscle fatigue on balance and functional tasks in older people was performed.</p> <p>Methods</p> <p>Studies were identified with searches of the PUBMED and SCOPUS data bases.</p> <p>Papers describing effects of lower extremity or trunk muscle fatigue protocols on balance or functional tasks in older people were included. Studies were compared with regards to study population characteristics, fatigue protocol, and balance and functional task outcomes.</p> <p>Results</p> <p>Seven out of 266 studies met the inclusion criteria. Primary findings were: fatigue via resistance exercises to lower limb and trunk muscles induces postural instability during quiet standing; induced hip, knee and ankle muscle fatigue impairs functional reach, reduces the speed and power of sit-to-stand repetitions, and produces less stable and more variable walking patterns; effects of age on degree of fatigue and rate of recovery from fatigue are inconsistent across studies, with these disparities likely due to differences in the fatigue protocols, study populations and outcome measures.</p> <p>Conclusion</p> <p>Taken together, the findings suggest that balance and functional task performance are impaired with fatigue. Future studies should assess whether fatigue is related to increased risk of falling and whether exercise interventions may decrease fatigue effects.</p

smart±step: A randomised controlled trial of cognitive-only and cognitive-motor training to prevent falls in older people

A 3-arm single blind randomised controlled trial of cognitive-only and cognitive-motor training to prevent falls in older people: understanding physical, neuropsychological and neural mechanisms

Validity and reliability of the Swaymeter device for measuring postural sway

Abstract Background This study aimed to examine: 1) Swaymeter concurrent validity in discriminating between young and older adult populations; 2) Swaymeter convergent validity against a forceplate system; and 3) the immediate test-retest repeatability of postural sway measures obtained from the Swaymeter. Methods Twenty-nine older adults aged 71 to 83 years and 11 young adults aged 22 to 47 years had postural sway measured simultaneously with the Swaymeter and a forceplate for three repeat 30 second trials, under four conditions (floor eyes open, floor eyes closed, foam eyes open, foam eyes closed). Results Age-related differences in sway parameters across the four conditions were evident using the Swaymeter. Moderate-to-good correlations were found between Swaymeter and forceplate sway measures across conditions (r = 0.560-0.865). Good agreement between the Swaymeter and forceplate were found for anteroposterior and mediolateral sway displacement measures (average offset = 6 mm). Sway path length measures were longer for the forceplate compared to the Swaymeter (average offset = 376 mm), but these data showed good agreement following log-transformation. The Swaymeter was reliable across trials, with intraclass correlation coefficients ranging from 0.654 to 0.944. Conclusions The Swaymeter is a reliable tool for assessing postural sway and discriminates between performance of young and older people across multiple sensory conditions.</p

Detection of simultaneous movement at two human arm joints

To detect joint movement, the brain relies on sensory signals from muscle spindles that sense the lengthening and shortening of the muscles. For single-joint muscles, the unique relationship between joint angle and muscle length makes this relatively straightforward. However, many muscles cross more than one joint, making their spindle signals potentially ambiguous, particularly when these joints move in opposite directions. We show here that simultaneous movement at adjacent joints sharing biarticular muscles affects the threshold for detecting movements at either joint whereas it has no effect for non-adjacent joints. The angular displacements required for 70% correct detection were determined in 12 subjects for movements imposed on the shoulder, elbow and wrist at angular velocities of 0.25-2 deg s -1. When moved in isolation, detection thresholds at each joint were similar to those reported previously. When movements were imposed on the shoulder and wrist simultaneously, there were no changes in the thresholds for detecting movement at either joint. In contrast, when movements in opposite directions at velocities greater than 0.5 deg s -1 were imposed on the elbow and wrist simultaneously, thresholds increased. At 2 deg s -1, the displacement threshold was approximately doubled. Thresholds decreased when these adjacent joints moved in the same direction. When these joints moved in opposite directions, subjects more frequently perceived incorrect movements in the opposite direction to the actual. We conclude that the brain uses potentially ambiguous signals from biarticular muscles for kinaesthesia and that this limits acuity for detecting joint movement when adjacent joints are moved simultaneously