Abstract
Falling is one of the most common causes of hip fracture and death in older adults. A comparison of the biomechanics of the gait in fallers and non-fallers older adults, especially joint coordination and coordination variability, enables the understanding of mechanisms that underpin falling. Therefore, we compared lower-extremity intra-joint coordination and its variability between fallers and non-fallers older adults during gait. A total of 26 older adults, comprising 13 fallers, took part in this study. The participants walked barefoot at a self-selected speed on a 10-m walkway. Gait kinematics in the dominant leg during 10 cycles were captured with 10 motion tracking cameras at a sampling rate of 100 Hz. Spatiotemporal gait parameters, namely, cadence, walking speed, double support time, stride time, width, and length, as well as intra-joint coordination and coordination variability in the sagittal plane were compared between the two groups. Results showed that fallers walked with significant lower cadence, walking speed, and stride length but greater double support and stride time than non-fallers. Significant differences in the ankle-to-knee, knee-to-hip, and ankle-to-hip coordination patterns between fallers and non-fallers and less coordination variability in fallers compared to non-fallers in some instants of the gait cycles were observed. The differences in spatiotemporal gait parameters in fallers compared to non-fallers may indicate an adaptation resulting from decreased efficiency to decrease the risk of falling. Moreover, the differences in segment coordination and its variability may indicate an inconsistency in neuromuscular control. It may also indicate reduced ability to control the motion of the leg in preparation for foot contact with the ground and the knee and ankle motions during loading response. Finally, such differences may show less control in generating power during the push-off phase in fallers.
Highlights
No significant differences between fallers and non-fallers were found for ankle, knee, and hip ROMs (Table 1)
Fallers walked with lower cadence, gait speed, and stride length but greater double support and stride time than non-fallers, indicating a cautious gait pattern adopted by fallers during walking
Our results showed that the coordination variability (CoordV) in the ankle-to-knee pattern was significantly lower in fallers than in non-fallers in the late swing phase (Figure 4b), which is in agreement with the results of Chiu et al, who reported a lower variability of knee–ankle inter-joint coordination during the swing phase in older adults [28]
Summary
According to the World Health Organization, falling is one of major health challenges of old age, raising extensive discussions among gerontologists and physical therapists [1]. Yamada et al [2] noted that about one-third of adults aged 65 years and 50% of adults older than 80 falls at least once a year, and 6% of such falls cause fractures. Falling among older adults can lead to severe consequences such as hip and wrist fractures, permanent disability, fear of falling, reduced quality of life, and even death [3,4]. The economic burden of falling among older adults is considerable, with annual direct medical costs about
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