Strategies for obstacle crossing in older adults with high and low risk of falling (original) (raw)
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Kinematic and kinetic characteristics of stepping over a 10-cm-high obstacle in older adults
Aino Journal, 2010
The purpose of this research was to clarify the common responses shared by a high-falldown-risk group of older adults and develop an exercise-learning program to prevent falls. [Subjects] Thirty-four subjects were chosen from those who use the daycare program of a nursing home at least once a week. [Methods] All subjects were categorized in longer or shorter-MSL groups. Ninety-second stepping from two force plates to a 10-cmhigh box was executed under three conditions. The locus length of the COP, toe-obstacle distance, and step length were used as experimental data. [Results] The coefficient between the MSL and COP was from 0.69 to 0.73. The shorter-MSL group showed smaller COP movements in the A-P direction and a smaller toe-obstacle distance between the single stepping and stepping with the visual task and between the single stepping and stepping with the auditory task. No significant difference was noted in the step length between the two groups. [Conclusion] The shorter-MSL group was easily affected by the dual-task, suggesting that the shorter-MSL group has a high risk of falling when negotiating obstacles. Stepping exercise with the dual-task using the COP movements as a feedback index may be useful for older adults who have a smaller MSL.
Obstacle crossing deficits in older adults: A systematic review
Gait & Posture, 2009
This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions. ß
Gait & Posture, 2004
Previous research suggests that older adults may have difficulty attending to simultaneous tasks. This study was conducted to determine how concurrent performance of a secondary cognitive task influences walking and stepping over an obstacle in community dwelling older adults. Twenty-one men and women with a mean age of 73.4 years (S.D. = 5.3) participated in the study. Subjects performed a gait task both alone (single-task condition) and in combination with a cognitive task that involved reciting numbers (dual-task condition). In the gait task, each subject walked at his/her fastest speed along a 10-m walkway and stepped over an obstacle designed to simulate a door threshold. Paired t-tests were used to compare gait parameters (10 m gait speed, gait speed during obstacle approach and negotiation, medial-lateral center of pressure excursion and velocity during obstacle negotiation, foot clearance over the obstacle, step length and foot position relative to the obstacle) and cognitive task performance under single and dual-task conditions. Toe-obstacle distance was greater and obstacle-heel distance was reduced under dual-task conditions. Performance of the remaining gait parameters did not change with the addition of a secondary cognitive task. Cognitive task performance decreased under dual-task conditions. These community dwelling older adults demonstrated minimal or no change in measured gait parameters during simultaneous performance of a cognitive task. The observed decrement in cognitive task performance suggests that subjects may have placed a higher priority on gait performance.
The Bulletin of Chiang Mai Associated Medical Sciences, 2010
Objective: To compare gait parameters between elderly women with and without balance impairment during walking on level surface, and walking and stepping over obstacle. Methods: The Berg Balance Scale (BBS) was used as a criterion to assign subjects into the balance-impaired group (BBS scale £ 45 points, n=15) and the non-balance-impaired group (BBS scale > 45 points, n=15). Participants were tested on three walking conditions including walking on level surface, and walking and step- ping over the low and high obstacles (10% and 30% of individual leg length) with their self-selected walking speed. Two-dimensional (2D) motion analysis system was used to measure all gait parameters. Gait parameters of level walking included walking speed, step length and toe-floor clearance from the floor. Gait parameters of crossing step included crossing speed, crossing step length, leading and trailing limb elevations and pre- and post-obstacle distances. Results: The balance-impaired group disp...
Age-related changes in gait adaptability in response to unpredictable obstacles and stepping targets
Gait & Posture, 2016
Background: A large proportion of falls in older people occur when walking. Limitations in gait adaptability might contribute to tripping; a frequently reported cause of falls in this group. Objective: To evaluate age-related changes in gait adaptability in response to obstacles or stepping targets presented at short notice, i.e.: approximately two steps ahead. Methods: Fifty older adults (aged 74 AE 7 years; 34 females) and 21 young adults (aged 26 AE 4 years; 12 females) completed 3 usual gait speed (baseline) trials. They then completed the following randomly presented gait adaptability trials: obstacle avoidance, short stepping target, long stepping target and no target/obstacle (3 trials of each). Results: Compared with the young, the older adults slowed significantly in no target/obstacle trials compared with the baseline trials. They took more steps and spent more time in double support while approaching the obstacle and stepping targets, demonstrated poorer stepping accuracy and made more stepping errors (failed to hit the stepping targets/avoid the obstacle). The older adults also reduced velocity of the two preceding steps and shortened the previous step in the long stepping target condition and in the obstacle avoidance condition. Conclusion: Compared with their younger counterparts, the older adults exhibited a more conservative adaptation strategy characterised by slow, short and multiple steps with longer time in double support. Even so, they demonstrated poorer stepping accuracy and made more stepping errors. This reduced gait adaptability may place older adults at increased risk of falling when negotiating unexpected hazards.
Effects of Aging on the Obstacle Negotiation Strategy while Stepping over Multiple Obstacles
Scientific Reports, 2018
Forty-seven percent of falling accidents in older adults are caused by tripping over obstacles. Understanding what strategies are involved in obstacle negotiation in older adults could reduce fall risks. There is a paucity of research investigating how healthy adults negotiate multiple obstacles, which may better reflect the complexity of the real environment. The presence of a second obstacle has induced mixed results in the obstacle negotiation of healthy older adults with the interval between obstacles two steps apart. This study extended the knowledge to understand what strategies healthy younger and older adults used to step over two obstacles placed at three-step-length apart. Twenty healthy subjects performed 2 tasks: level ground walking and stepping over two obstacles. The height of each obstacle was set at 10% of subjects’ leg height. We found that aging significantly increased the toe clearance in leading and trailing legs when stepping over the obstacles at a three-step-...
Obstacle Crossing Characteristics in the Healthy Young Female and Elderly Female Subjects
Objective: To investigate obstacle crossing characteristics in the young and the elderly subjects. Methods: Twenty young and 20 elderly subjects were investigated for their obstacle crossing characteristics by using a 3D motion analysis system. Markers were placed on the bony prominences of the feet and obstacles. Obstacle crossing characteristics were determined with the obstacle crossing time, the vertical distance between toe and obstacle, and the maximum vertical toe clearance. The main effects and interaction effect of age (young and elderly) and limb [leading limb (LL) and trailing limb (TL)] were examined by two way analysis of variance. The obstacle crossing characteristics were also compared in each condition by using Independent sample t-test and Paired t-test. Results: There were main effects of the age and the limb on the obstacle crossing time. No interaction effect of the age and limb was found in any variables. In each condition of age and limb, there was a significant difference (p<0.05) in the obstacle crossing time between the limbs in both the young and the elderly. Furthermore, the vertical distance between toe and obstacle between the LL and TL was found to be significantly different (p<0.05) in the young, but not in the elderly (p>0.05). Conclusion: Age and limb were found to be the factors which related to the obstacle crossing time characteristic. The present findings suggested that the TL's clearance is critical and should pay more consideration for the elderly.
Leg preference associated with protective stepping responses in older adults
Clinical Biomechanics, 2013
Background-Asymmetries in dynamic balance stability have been previously observed. The goal of this study was to determine whether leg preference influenced the stepping response to a waist-pull perturbation in older adult fallers and non-fallers. Methods-39 healthy, community-dwelling, older adult (>65 years) volunteers participated. Participants were grouped into non-faller and faller cohorts based on fall history in the 12 months prior to the study. Participants received 60 lateral waist-pull perturbations of varying magnitude towards their preferred and non-preferred sides during quiet standing. Outcome measures included balance tolerance limit, number of recovery steps taken and type of recovery step taken for perturbations to each side. Findings-No significant differences in balance tolerance limit (P ≥ 0.102) or number of recovery steps taken (η 2 partial ≤ 0.027; P ≥ 0.442) were observed between perturbations towards the preferred and non-preferred legs. However, non-faller participants more frequently responded with a medial step when pulled towards their non-preferred side and cross-over steps when pulled towards their preferred side (P = 0.015). Interpretation-Leg preference may influence the protective stepping response to standing balance perturbations in older adults at risk for falls, particularly with the type of recovery responses used. Such asymmetries in balance stability recovery may represent a contributing factor for falls among older individuals and should be considered for rehabilitation interventions aimed at improving balance stability and reducing fall risk.
Toe clearance and velocity profiles of young and elderly during walking on sloped surfaces
Journal of NeuroEngineering and Rehabilitation, 2010
Background: Most falls in older adults are reported during locomotion and tripping has been identified as a major cause of falls. Challenging environments (e.g., walking on slopes) are potential interventions for maintaining balance and gait skills. The aims of this study were: 1) to investigate whether or not distributions of two important gait variables [minimum toe clearance (MTC) and foot velocity at MTC (Vel MTC )] and locomotor control strategies are altered during walking on sloped surfaces, and 2) if altered, are they maintained at two groups (young and elderly female groups).