Does local dynamic stability during unperturbed walking predict the response to balance perturbations? An examination across age and falls history

Abstract

BackgroundOlder adults are at an exceptionally high risk of falls, and most falls occur during locomotor activities such as walking. Reduced local dynamic stability in old age is often interpreted to suggest a lessened capacity to respond to more significant balance challenges encountered during walking and future falls risk. However, it remains unclear whether local dynamic stability during normal, unperturbed walking predicts the response to larger external balance disturbances. Research questionWe tested the hypothesis that larger values of local dynamic instability during unperturbed walking would positively correlate with larger changes thereof due to optical flow balance perturbations. MethodsWe used trunk kinematics collected in subjects across a spectrum of walking balance integrity – young adults, older non-fallers, and older fallers – during walking with and without mediolateral optical flow perturbations of four different amplitudes. ResultsWe first found evidence that optical flow perturbations of sufficient amplitude appear capable of revealing independent effects of aging and falls history that are not otherwise apparent during normal, unperturbed walking. We also reject our primary hypothesis; a significant negative correlation only in young adults indicated that individuals with more local dynamic instability during normal, unperturbed walking exhibited smaller responses to optical flow perturbations. In contrast, most prominently in older fallers, the response to optical flow perturbations appeared independent of their baseline level of dynamic instability. SignificanceWe propose that predicting the response to balance perturbations in older fallers, at least that measured using local dynamic stability, likely requires measuring that response directly.