Abstract
Given that falls most commonly occur during walking due to unexpected balance perturbations like trips and slips, walking-based balance assessment including walking stability and adaptability to such perturbations could be beneficial for fall risk assessment in older adults. This cross-sectional study reanalyzed data from two larger studies conducted with the same walking protocol. Participants completed unperturbed walking trials at speeds of 0.4 m/s up to 1.8 m/s in 0.2 m/s steps. Ten unannounced treadmill belt acceleration perturbations were then applied while participants walked at equivalent stability, assessed using the margins of stability. Retrospective (12 months) falls incidence was collected to divide participants into people with and without a history of falls. Twenty older adults (mean age 70.2 ± 2.9 years) were included in this analysis; eight people with one or more recent falls and 12 people without, closely matched by sex, age and height. No significant differences were found in unperturbed walking parameters or their variability. Overall perturbation-recovery step behavior differed slightly (not statistically significant) between the groups after the first perturbation and differences became more pronounced and significant after repetition of perturbations. The No-Falls group significantly reduced the number of recovery steps needed across the trials, whereas the Falls group did not show these improvements. People with a previous fall tended to have slightly delayed and more variable recovery responses after perturbation compared to non-fallers. Non-fallers demonstrate more signs of adaptability to repeated perturbations. Adaptability may give a broader indication of the ability of the locomotor system to respond and improve responses to sudden walking perturbations than unperturbed walking variability or recovery to a single novel perturbation. Adaptability may thus be a more useful marker of falls history in older adults and should be considered in further research.
Highlights
Falls are a principal cause of injury, leading to disability and hospitalization in older adults (Berry and Miller, 2008)
All subjects provided written informed consent. Both studies were approved by the medical ethics committee (METC) at Maastricht University Medical Centre (MUMC+) (NL58205.068.16 & NL59895.069.17) and were conducted in accordance with the declaration of Helsinki
Prior to the walking measurements, participants were given a short falls history questionnaire based on the recommendations of Lamb et al (2005) and Lord et al (2011), that led with the question: “In the past year, have you had any fall including a slip or trip in which you lost your balance and landed on the floor or ground or lower level?” This was followed by other questions about the number, location and cause of the fall(s) and about any injuries sustained
Summary
Falls are a principal cause of injury, leading to disability and hospitalization in older adults (Berry and Miller, 2008). The literature reports that older adults seem fully capable of improving their responses when exposed to repeated perturbations (Pai et al, 2014; Bohm et al, 2015; McCrum et al, 2017). Pai et al (2010a) associated adaptability to repeated slip perturbations during a sit-to-stand task with a lower likelihood of future falls in daily life in older adults. Adaptability was indicated by less balance loss and falls during the task and improved recovery performance during the final slip. This association has not yet been thoroughly investigated for mechanical perturbations during walking, which are more task-specific to the most common causes of falls in older adults
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