Fall Avoidance Research Articles

Effect of a digital two-dimensional animation program on attitude toward walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities

The study investigated the impact of a two-dimensional animation program on attitudes towards walking aids, performance, and fall avoidance behaviors among older adults in assisted living facilities. A quasi-experimental pretest-posttest control group study was conducted on 128 older adults aged 60 years and above. The intervention group showed more favorable attitudes towards walking aids, improved cane and walker use, and reduced fall concerns. The 2D animation program proved to be an innovative teaching strategy that positively influenced attitudes, performance, and fall-related concerns among elderly residents. Integration into care settings could enhance mobility, reduce fall risks, and contribute to overall well-being.

Cost Analysis of Implementing an Exercise Program for Fall and Fracture Prevention in Older Adults on Proton Pump Inhibitor Therapy.

Falls have significant financial impact. Proton pump inhibitor (PPI) therapy is associated with an increased risk of falls and fractures. Exercise programs have been shown to decrease risk of falls in the elderly population and are recommended by the U.S. Preventive Services Task Force for patients over age 65 to reduce falls. Our study aimed to explore the potential financial benefit of implementing three different Centers for Disease Control and Prevention-recommended exercise-based interventions for fall prevention (Tai Chi, Stepping On, and Otago Exercise Program) in ≥65-year-old patients on PPI therapy. A Markov model was developed to predict the financial implications of fall-related outcomes in the study population. Net cost of the intervention was deducted from the financial savings predicted for fall avoidance relative to the fall reduction conferred by the intervention. Sensitivity analysis was performed on a range of odds ratios between falling and PPI use. Exercise-based interventions were found to offer financial savings when fall reduction rates exceeded 5%, irrespective of variable odds ratios between PPI use and fall rate. Hypothetical implementation of an exercise-based intervention for PPI users ≥65 years of age was estimated to result in annual fall- and fracture-related savings ranging from $10,317.35 to $18,766.28 per individual. Findings suggested an estimated annual reduction in U.S. health care costs of $18 billion to $85 billion. Implementing an exercise-based fall prevention program for elderly PPI users represents a possible strategy to mitigate health care costs in the United States. Future prospective studies are recommended.

Mechanisms and component design of prosthetic knees: A review from a biomechanical function perspective.

Prosthetic knees are state-of-the-art medical devices that use mechanical mechanisms and components to simulate the normal biological knee function for individuals with transfemoral amputation. A large variety of complicated mechanical mechanisms and components have been employed; however, they lack clear relevance to the walking biomechanics of users in the design process. This article aims to bridge this knowledge gap by providing a review of prosthetic knees from a biomechanical perspective and includes stance stability, early-stance flexion and swing resistance, which directly relate the mechanical mechanisms to the perceived walking performance, i.e., fall avoidance, shock absorption, and gait symmetry. The prescription criteria and selection of prosthetic knees depend on the interaction between the user and prosthesis, which includes five functional levels from K0 to K4. Misunderstood functions and the improper adjustment of knee prostheses may lead to reduced stability, restricted stance flexion, and unnatural gait for users. Our review identifies current commercial and recent studied prosthetic knees to provide a new paradigm for prosthetic knee analysis and facilitates the standardization and optimization of prosthetic knee design. This may also enable the design of functional mechanisms and components tailored to regaining lost functions of a specific person, hence providing individualized product design.

Perceptual Biases as the Side Effect of a Multisensory Adaptive System: Insights from Verticality and Self-Motion Perception.

Perceptual biases can be interpreted as adverse consequences of optimal processes which otherwise improve system performance. The review presented here focuses on the investigation of inaccuracies in multisensory perception by focusing on the perception of verticality and self-motion, where the vestibular sensory modality has a prominent role. Perception of verticality indicates how the system processes gravity. Thus, it represents an indirect measurement of vestibular perception. Head tilts can lead to biases in perceived verticality, interpreted as the influence of a vestibular prior set at the most common orientation relative to gravity (i.e., upright), useful for improving precision when upright (e.g., fall avoidance). Studies on the perception of verticality across development and in the presence of blindness show that prior acquisition is mediated by visual experience, thus unveiling the fundamental role of visuo-vestibular interconnections across development. Such multisensory interactions can be behaviorally tested with cross-modal aftereffect paradigms which test whether adaptation in one sensory modality induces biases in another, eventually revealing an interconnection between the tested sensory modalities. Such phenomena indicate the presence of multisensory neural mechanisms that constantly function to calibrate self-motion dedicated sensory modalities with each other as well as with the environment. Thus, biases in vestibular perception reveal how the brain optimally adapts to environmental requests, such as spatial navigation and steady changes in the surroundings.

Impact of a Clinical Text-Based Fall Prediction Model on Preventing Extended Hospital Stays for Elderly Inpatients: Model Development and Performance Evaluation.

BackgroundFalls may cause elderly people to be bedridden, requiring professional intervention; thus, fall prevention is crucial. The use of electronic health records (EHRs) is expected to provide highly accurate risk assessment and length-of-stay data related to falls, which may be used to estimate the costs and benefits of prevention. However, no studies to date have investigated the extent to which hospital stays could be shortened through fall avoidance resulting from the use of prediction tools.ObjectiveWe first estimated the extended length of hospital stay caused by falls among elderly inpatients. Next, we developed a model that predicts falls using clinical text as input and evaluated its accuracy. Finally, we estimated the potentially shortened hospital stay that would be made possible by appropriate interventions based on the prediction model.MethodsPatients aged 65 years or older were selected as subjects, and the EHRs of 1728 falls and 70,586 nonfalls were subjected to analysis. The extended-stay lengths were estimated using propensity score matching of 49 associated variables. Bidirectional encoder representations from transformers and bidirectional long short-term memory methods were used to predict falls from clinical text. The estimated length of stay and the outputs of the prediction model were used to determine stay reductions.ResultsThe extended length of hospital stay due to falls was estimated to be 17.8 days (95% CI 16.6-19.0), which dropped to 8.6 days when there were unobserved covariates at an odds ratio of 2.0. The accuracy of the prediction model was as follows: area under the receiver operating characteristic curve, 0.851; F-value, 0.165; recall, 0.737; precision, 0.093; and specificity, 0.839. When assuming interventions with 25% or 100% effectiveness against cases where the model predicted a fall, the stay reduction was estimated at 0.022 and 0.099 days/day, respectively.ConclusionsThe accuracy of the prediction model using clinical text is considered to be higher than the prediction accuracy of conventional assessments. However, our model’s precision remained low at 9.3%. This may be due, in part, to the inclusion of cases in which falls did not occur because of preventative interventions during hospitalization. Nonetheless, it is estimated that interventions for cases when falls were predicted will reduce medical costs by 886 Yen/day (~US $6.50/day) of intervention, even if the preventative effect is 25%. Limitations include the fact that these results cannot be extrapolated to short- or long-term hospitalization cases, and that this was a single-center study.

Viability, task switching, and fall avoidance of the simplest dynamic walker

Walking humans display great versatility when achieving task goals, like avoiding obstacles or walking alongside others, but the relevance of this to fall avoidance remains unknown. We recently demonstrated a functional connection between the motor regulation needed to achieve task goals (e.g., maintaining walking speed) and a simple walker’s ability to reject large disturbances. Here, for the same model, we identify the viability kernel—the largest state-space region where the walker can step forever via at least one sequence of push-off inputs per state. We further find that only a few basins of attraction of the speed-regulated walker’s steady-state gaits can fully cover the viability kernel. This highlights a potentially important role of task-level motor regulation in fall avoidance. Therefore, we posit an adaptive hierarchical control/regulation strategy that switches between different task-level regulators to avoid falls. Our task switching controller only requires a target value of the regulated observable—a “task switch”—at every walking step, each chosen from a small, predetermined collection. Because humans have typically already learned to perform such goal-directed tasks during nominal walking conditions, this suggests that the “information cost” of biologically implementing such controllers for the nervous system, including cognitive demands in humans, could be quite low.

Most Falls of Active Elderly People are not Caused by Decreases in Physical Function

Several healthy, community-dwelling elderly people who live independently experience falls. However, their falls are not always attributed to decreased physical function. We aimed to examine the cause of falls in active elderly people. They were divided into fallers (n = 49) and non-fallers (n = 170) based on their fall experience during the previous year. The subjects participated in the following tests: transferring velocity during the sit-to-stand, one-leg stand time, functional reach, 10-m maximal walking time, muscle strength (foot grip, ankle plantar flexion, hip flexion, knee extension strength), systemic reaction time, agility stepping, and maximal side step length after completing the ADL questionnaire, fall risk assessment sheet, fall risk profile from Demura et al, and life-space assessment sheet. No significant differences were observed in physical functions, which were the basis of fall prevention (muscle strength, balance, and gait) and fall avoidance (systemic reactions, agility stepping, and maximal side step length) between both groups. A significant difference was observed in the ADL score but not between both fall risk scores, and the Life-Space Assessment scores. Moreover, no significant differences were observed between the high risk ratio for falls and nursing care based on each questionnaire. In conclusion, the differences in physical function and fall risk factors between the fallers and non-fallers in active, independent elderly people living in the community were not observed. The cause of these falls (22.4%) was not attributed to physical function decreases or other fall risk factors. These may mainly depend on accidents resulting from high activity.

Age-Related Vestibular Dysfunction; Vestibulo-Ocular Reflex, Dynamic Visual Acuity, Dizziness and Falls: A Review

Background: Vestibular and vision functions are important contributors to posture control and fall avoidance. This review examines how the vestibulo-ocular reflex can be rehabilitated to help restore postural control. Methods: PubMed searches (7th April 2021) using the terms ‘vestibulo-ocular reflex’, ‘imbalance and vestibular dysfunction’, ‘vestibular dysfunction and dizziness’, ‘dynamic visual acuity’, ‘vestibular dysfunction rehabilitation’, and ‘gaze stabilization exercises’ yielded 4986, 495, 3576,1830, 3312, and 137 potentially useful publications respectively. Selections of those which were found to be the most relevant and representative of a balanced and current account of these topics, as well as selections from the most relevant reports referenced in those publications, were included in this review. Results: Just as there are age-related losses of static visual acuity even when there are no specific visual pathologies diagnosed, patients may also present with age-related loss of vestibular functions in the absence of specific vestibular pathologies. For example, cases of dizziness which are diagnosed as idiopathic might be usefully classified as age-related as the basis for the initiation of rehabilitation exercises. Conclusions: Apart from age-related loss of vestibular functions, cases diagnosed as having a particular form of vestibular pathology may have that condition exacerbated by age-related losses of vestibular functions. The effects of vestibular rehabilitation gaze stability exercises in patients with vestibular dysfunction are well established and include both improved dynamic acuity and postural stability. Improvements in posture control following rehabilitation of the vestibulo-ocular reflex are apparently due to improved peripheral and/or central vestibular balance control which has occurred in conjunction with enhanced gaze stability. The complex nature of increased fall risk suggests that an interdisciplinary approach to rehabilitation that includes vestibulo-ocular reflex rehabilitation appears likely to be associated with optimum outcomes for both pathological and age-related cases.

A Review of the Significance of Vision in the Remediation of Balance Control and Associated Falls Avoidance

Background: Loss of balance and falls are the primary cause of accidental death in persons over 65 years of age. This review examines the role of visual functions in the maintenance of a balanced posture and associated fall avoidance, including how visual functions interact with proprioceptive, tactile, vestibular and cognitive factors under a range of environmental circumstances and conditions. Methods: Reference to relevant articles from a wide range of sources were used to examine how vision functions are usually integrated with other senses in avoiding falls. Results: Under most conditions vision can make an important contribution to posture control and fall avoidance although such contributions have not always been recognized in the past. However, successful balance training has been shown to be associated with multi-component programs. Conclusions: Given the complexity of posture control and the multiple changes (physiological- and disease-related) which occur with age, as well as the capacity for different professional groups to contribute more or less dissimilar fall prevention strategies, it is not surprising that there appears to be great potential for improved interdisciplinary coordination of remedial interventions which reduce the risk of fall-related injuries and death. Similarly, overcoming age- or frailty-related difficulties in standing from a seated position can be best handled by interdisciplinary approaches.

Effect of Gait Speed on Recovery Motion from Tripping on a Treadmill

The analysis of the mechanism of fall avoidance motion is required to prevent fall-related injuries. To investigate the factors that affect fall avoidance motion, tripping was induced among 10 healthy male subjects during treadmill walking at gait speeds of 3.5 and 4.0 km/h. The posture of the subjects and ground reaction force of the recovery steps were recorded using a motion capture system and force plate to analyze the effect of gait speed on recovery motion. The gait parameters of the recovery steps were calculated and compared between gait speeds. Principal component analysis was performed to identify the parameters that represent the recovery motion and the magnitude of the first and second recovery steps, and the balance of recovery steps were extracted as defining characteristics. Of the 18 gait parameters, such as step time, five differed depending on gait speeds. However, the other gait parameters and all four principal components did not differ significantly with respect to gait speeds. Furthermore, the distribution of principal components and gait parameters across subjects and gait speeds suggested that the variability between trials was greater than the effect of gait speed and individual characteristics on recovery motion.

Exploring factors influencing physiotherapists’ perceptions of measuring reactive balance following a theory-based multi-component intervention: a qualitative descriptive study

Purpose: Reactive balance is a critical consideration for mobility and fall avoidance, but is under-assessed among physiotherapists. The objective of this study was to explore factors influencing physiotherapist perceptions about measuring reactive balance upon completion of a 12-month theory-based, multi-component intervention to increase use of a measure of reactive balance. Methods: A qualitative descriptive approach was used. Semi-structured interviews were conducted with 28 physiotherapists treating adults with balance impairment in three urban Canadian rehabilitation hospitals that participated in the intervention. Interviews explored perceptions of reactive balance measurement and perceived changes in clinical behavior. Thematic analysis involved multiple rounds of coding, review and discussion, theme generation, and interpretation of findings through individual analysis and team meetings. Findings: Participants expressed contrasting views about integrating reactive balance measurement in their practice, despite consistent acknowledgement of the importance of reactive balance for function. Three themes were identified highlighting factors that mediated perceptions about measuring reactive balance: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear. Conclusions: The findings highlight that decision making for measuring reactive balance in rehabilitation settings is complex. There is a need for additional work to facilitate long-term implementation of clinical reactive balance measurement, such as refining patient criteria for administration, ensuring sufficient time to establish a trusting relationship, and developing and testing strategies to address physiotherapist fear. IMPLICATIONS FOR REHABILITATION Reactive balance is important for falls prevention and mobility, but is under-assessed among physiotherapists. This study identified three factors that influenced uptake of reactive balance measurement among physiotherapists in rehabilitation settings: patient characteristics; trust between physiotherapist and patient; and the role of physiotherapist fear. Knowledge of the identified factors may assist with design and use of reactive and other balance measurements. Strategies aimed at developing trusting relationships between physiotherapist and patient along with addressing physiotherapist fear could facilitate the uptake of clinical reactive balance measurement.

Analysis of the fall avoidance motion focusing on the angular momentum induced by tripping during gait

Fall is one of the greatest causes of nursing care for the elderly. Thus, the reduction of fall injury of the elderly is required. In some previous researches on trip, angular momentum is used as an evaluation parameter. However, the relation between fall avoidance motion and angular momentum is not focused. Thus, in this research, we focus on angular momentum as an index of fall evaluation. To reveal the influence of angular momentum on fall avoidance motion, angular momentum is increased in different ways. One is attaching weights to subject and another is having subjects walk faster and the other is pulling subject from the front. The result suggested that the trend of reaction motion differed among conditions. However, there are some common feature among the reaction motion of these conditions according to the analysis of correlation coefficients

Characterization of Fall and Refall Risk Factors in the Elderly Presenting to the Emergency Department: Retrospective Chart Review Protocol

Background/Objective: Falls are a major contributor to morbidity and mortality of the elderly population. Aside from the direct burden of falls on the patients, the CDC estimates falls cost around $50 billion annually, most of which is covered by Medicare/Medicaid. There are, however, fall prevention clinics that are focused on prevention and fall avoidance training in order to decrease the risk of falls. The goal of this work is to identify the population that is at a heightened risk of falls and analyze how this risk is mitigated with completion of a fall prevention program. 
 Methods: Men and women over the age of 65 who presented to the ED from January 2015- January 2019 were considered for the chart review. Approximately 480 charts are to be analyzed assuming 10% loss due to lack of data in chart or expiration of the patient. Medical history, fall history, and demographics will be input into a data collection tool designed by the researchers. Statistical significance will be identified by Fishers test, unpaired t-test, Χ2 test appropriately. Fall risk factors that are identified as significant will be used in univariate and multivariate logistic regression to test for predictive value. 
 Results: This work produced an IRB submission draft, RedCap data collection tool and is pending approval by Parkview Health IRB for Fall 2020. The researchers anticipate beginning work on the study in Spring 2021. 
 Impact and Implications: Identification of risk factors associated with falls and refall events may be used to better distinguish the patient population that would benefit from a fall clinic referral. Increased knowledge of risk factors and protocolization of referrals may lead to decreased morbidity and mortality among the elderly as well as relieve some.

‘PDSAFE’ - a multi-dimensional model of falls-rehabilitation for people with Parkinson’s. A mixed methods analysis of therapists’ delivery and experience

ObjectiveTo explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson’s (PwP). DesignA descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists’ experiences. SettingA two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all. ParticipantsPhysiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE InterventionA multi-dimensional, individually tailored and progressive, home-based programme. ResultsFifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were ‘Avoiding tripping’, ‘Turning’ and ‘Freezing Cues’ and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity.Therapists considered the focus on fall events and fall avoidance strategies an improvement on ‘impairment only’ treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention. ConclusionFalls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words)The trial registration number is ISRCTN 48152791

Fall Protection Framework of Lower Extremity Exoskeleton Walking System Based on Differential Motion Planning

Exoskeleton is a wearable power-assisted supporting device that is used to enhance human motion functions such as walking. This research work is an attempt to provide the paraplegic patients with a more stable human-like hands-free walking function. An exoskeleton model for lower extremities, called a Lower Extremity Exoskeleton Robot (LEE Robot), is developed to feature an automatic posture adjustment and walking balance capability. In order to design a better hands free exoskeleton, the advanced modeling, comprehensive analysis and 3D walking simulations for a humanoid bipedal robot are carried out as a basic research to direct the performance improvement and validate the walking stability and posture optimization. The law of balance is also applied in the analysis of kinematics, statics and dynamics to enhance the new exoskeleton design. Moreover, a conceptual framework is proposed and further developed based on the robot differential motion planning and the zero-moment point (ZMP) stability criterion to realize and test for better fall detection, fall protection and fall avoidance when it is walking. The 3D graphical simulation results demonstrate a success for the new exoskeleton design to offer a better hands free and more stable paraplegic walking.

Reactive balance responses to an unexpected slip perturbation in individuals with incomplete spinal cord injury

BackgroundFrequent falls while walking among individuals with incomplete spinal cord injury may suggest impairments in reactive balance control; however, reactive balance control during walking has not been studied in this population. The objective was to compare reactive balance control with respect to changes in margin of stability, onset of arm and heel responses, and onset and magnitude of muscle activity following an unexpected slip perturbation in individuals with incomplete spinal cord injury and able-bodied individuals. MethodsKinematic and electromyography data were obtained during normal walking and one unexpected slip. Changes in margin of stability following a compensatory or aborted step, onset of arms and trail heel responses, and onset and magnitude of activation of the tibialis anterior, soleus and gluteus medius were calculated. Multivariate analyses compared responses between incomplete spinal cord injury and able-bodied groups. FindingsData from 16 participants with incomplete spinal cord injury (all American Spinal Injury Association Impairment Scale Grade D, 8 with tetraplegia) and 13 age-and-sex matched able-bodied individuals were included. Individuals with incomplete spinal cord injury demonstrated limited ability to increase margin of stability in the lateral direction during a compensatory or aborted step, and a smaller magnitude of soleus activity compared to able-bodied individuals. InterpretationThere are limitations in reactive balance control of individuals with incomplete spinal cord injury, which may be a reason for the high frequency of falls in this population. Reactive balance assessment should be included as a component of routine balance assessment and fall avoidance strategies in this population.

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

People with Parkinson's disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson's disease. A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. A total of 474 people with Parkinson's disease (i.e. Hoehn and Yahr scale stages 1-4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson's Disease Questionnaire. PDSAFE is the largest RCT of falls management among people with Parkinson's disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale - International: mean difference 1.6, 95% CI -3.0 to -0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson's disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. Further trials of falls prevention on targeted groups of people with Parkinson's disease are recommended. Current Controlled Trials ISRCTN48152791. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.

Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s

ObjectiveTo estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson’s (PwP).MethodsPeople at risk of falls with confirmed Parkinson’s were recruited to this multicentre, pragmatic, investigator blind,...

Understanding the Agility of Running Birds: Sensorimotor and Mechanical Factors in Avian Bipedal Locomotion.

Birds are a diverse and agile lineage of vertebrates that all use bipedal locomotion for at least part of their life. Thus birds provide a valuable opportunity to investigate how biomechanics and sensorimotor control are integrated for agile bipedal locomotion. This review summarizes recent work using terrain perturbations to reveal neuromechanical control strategies used by ground birds to achieve robust, stable, and agile running. Early experiments in running guinea fowl aimed to reveal the immediate intrinsic mechanical response to an unexpected drop (“pothole”) in terrain. When navigating the pothole, guinea fowl experience large changes in leg posture in the perturbed step, which correlates strongly with leg loading and perturbation recovery. Analysis of simple theoretical models of running has further confirmed the crucial role of swing-leg trajectory control for regulating foot contact timing and leg loading in uneven terrain. Coupling between body and leg dynamics results in an inherent trade-off in swing leg retraction rate for fall avoidance versus injury avoidance. Fast leg retraction minimizes injury risk, but slow leg retraction minimizes fall risk. Subsequent experiments have investigated how birds optimize their control strategies depending on the type of perturbation (pothole, step, obstacle), visibility of terrain, and with ample practice negotiating terrain features. Birds use several control strategies consistently across terrain contexts: (1) independent control of leg angular cycling and leg length actuation, which facilitates dynamic stability through simple control mechanisms, (2) feedforward regulation of leg cycling rate, which tunes foot-contact timing to maintain consistent leg loading in uneven terrain (minimizing fall and injury risks), (3) load-dependent muscle actuation, which rapidly adjusts stance push-off and stabilizes body mechanical energy, and (4) multi-step recovery strategies that allow body dynamics to transiently vary while tightly regulating leg loading to minimize risks of fall and injury. In future work, it will be interesting to investigate the learning and adaptation processes that allow animals to adjust neuromechanical control mechanisms over short and long timescales.

Trajectory Generation for Fall Avoidance of Bipedal Robots Considering Vertical Center-of-Mass Motion

Trajectory Generation for Fall Avoidance of Bipedal Robots Considering Vertical Center-of-Mass Motion