Thresholds for inducing protective stepping to force-controlled perturbations in young and old adults

Abstract

In previous studies of stairway handrails, data were derived from static experiments which characterized the influence of the handrail design on ability to generate stabilizing force. This paper describes a novel and safe experimental approach developed to study the biomechanical efficacy of handrail use under dynamic conditions, wherein support-surface motion is used to perturb the balance of the subject who stands on a small (three step), heavily padded mock staircase. A primary objective of this initial study was to determine the influence of factors such as perturbation magnitude, stance leg (left or right), proximity to the handrail, initial hand position (on or off the rail), and ability to complete a step while grabbing the rail. The study was also intended to address a more basic issue: is it even possible to grab a handrail with sufficient speed and accuracy to prevent a fall after losing balance on a stairway? Testing of four healthy young adults demonstrated that sizeable stabilizing handrail force can be generated very quickly (up to 60% of body weight in less than 1 second) in response to loss of balance. Furthermore, these grabbing responses were clearly of functional significance, resulting in a marked reduction in the incidence of ‘falls’ (i.e. landing on the padded surface) compared to trials where the handrail was absent. The most consistent aspect of the force generation was the tendency to exert a forward axial force along the rail. An unexpected finding was that this force often appears to be exerted through a pulling, rather than pushing, action, because of the posterior location of the grip relative to the body. Although most of the force components tended to increase with perturbation magnitude, the lateral forces appeared to be most dependent on whether a step was taken. Stance leg had few effects, but variation in proximity to the rail was found to influence the angle at which the hand approached the rail. Gripping the rail prior to perturbation led to a greater tendency to pull upwards. Implications of these findings for safer handrail design are discussed.