The contribution of postural balance analysis in older adult fallers: A narrative review (original) (raw)
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Postural stability in the elderly: a comparison between fallers and non-fallers
Age and Ageing, 2004
Background: the identification of specific risk factors for falls in community-dwelling elderly persons is required to identify older people at risk of falling. Objective: the aim of the study was to determine the ability of various biomechanical measures of postural stability to identify fallers in the elderly population. Method: 19 subjects (78.4 ± 1.3 years old) who reported having fallen unexpectedly at least twice in the last 6 months, and 124 non-fallers (77.8 ± 0.53 years old) participated in the study. Balance measurements were made in the upright position in six different conditions using a force platform, and the Limits of Stability Test was carried out. Static two-point discrimination (TPD) testing to the underside of the first toe was made to evaluate the innervation density of the slowly adapting receptors. Finally, maximal isometric lower limb strength was measured in major muscle groups. Repeated measures analysis of variance tests were performed to assess the mean differences between the two groups (fallers and non-fallers). The level of significance was set to 0.05. Results and discussion: results suggest that control of balance in narrow base stance may be an important tool in identifying elderly fallers. The findings show an increase in mediolateral sway in narrow base stance in older people who experienced recurrent falls. Also, TPD appears to be impaired in elderly fallers (14.93 ± 1.1 mm versus 12.98 ± 0.3 mm). Conclusions: simple and safe laboratory quantitative tests were able to differentiate between elderly fallers and elderly individuals who did not fall, suggesting a possible clinical application as a preliminary screening tool for predicting future risk of falling.
Dynamic Parameters of Balance Which Correlate to Elderly Persons with a History of Falls
PLoS ONE, 2013
Poor balance in older persons contributes to a rise in fall risk and serious injury, yet no consensus has developed on which measures of postural sway can identify those at greatest risk of falling. Postural sway was measured in 161 elderly individuals (81.8y67.4), 24 of which had at least one self-reported fall in the prior six months, and compared to sway measured in 37 young adults (34.9y67.1). Center of pressure (COP) was measured during 4 minutes of quiet stance with eyes opened. In the elderly with fall history, all measures but one were worse than those taken from young adults (e.g., maximal COP velocity was 2.76 greater in fallers than young adults; p,0.05), while three measures of balance were significantly worse in fallers as compared to older persons with no recent fall history (COP Displacement, Short Term Diffusion Coefficient, and Critical Displacement). Variance of elderly subjects' COP measures from the young adult cohort were weighted to establish a balance score (''B-score'') algorithm designed to distinguish subjects with a fall history from those more sure on their feet. Relative to a young adult B-score of zero, elderly ''non-fallers'' had a B-score of 0.334, compared to 0.645 for those with a fall history (p,0.001). A weighted amalgam of postural sway elements may identify individuals at greatest risk of falling, allowing interventions to target those with greatest need of attention.
Elderly individuals with increased risk of falls show postural balance impairment
Fisioterapia em Movimento, 2015
Introduction: Falls are a serious public health problem. Objective: The aim of this study was to evaluate whether elderly individuals with increased risk of falls have a postural balance deficit, evaluated using a force platform during a one-leg stance. Materials and methods: The sample consisted of 94 physically independent elderly individuals from the EELO project. The instruments used were the Downton scale, in
One-legged stance sway of older adults with and without falls
PloS one, 2018
Postural instability is a common problem among older people, and it is associated with mobility impairments, activity limitation and fear of falling. The evaluation of postural control can contribute to the early detection of balance deficits and help health professionals to manage this problem to prevent falls in older adults. The aim of this study was to identify center of pressure cut-offs to differentiate between older adults with and without falls in the past 12 months. The participants were 170 older adults (mean age 67 years, 50 fallers and 120 non-fallers). Center of pressure area and sway velocity in the anterior-posterior and medio-lateral directions were assessed using a force platform during three 30s one-legged stance trials with eyes open. The mean across trials was used for analysis. The time-limit (how long the participant was able to stay in one-legged stance, up to 30s) was also assessed. Fallers had poorer postural control than non-fallers (effect size ≥ 0.52, P &...
Characteristics of balance control in older persons who fall with injury – A prospective study
Journal of Electromyography and Kinesiology, 2013
Older adults who have recently fallen demonstrate increased postural sway compared with non-fallers. However, the differences in postural control between older adults who were seriously injured (SI) as a result of a fall, compared with those who fell but were not injured (NSI) and non-fallers (NFs), has not been investigated. The objective of the present study was to investigate the underlying postural control mechanisms related to injuries resulting from a fall. Both traditional postural sway measures of foot center-of-pressure (CoP) displacements and fractal measures, the Stabilogram-Diffusion Analysis (SDA), were used to characterize the postural control. One hundred older adults aged 65-91years were tested during narrow base upright stance in eyes closed condition; falls were monitored over a 1-year period. Forty-nine older adults fell during the 1-year follow-up, 13 were seriously injured as a result of a fall (SI), 36 were not injured (NSI), and 49 were non-fallers (NFs); two passed away. The SDA showed significantly higher short-term diffusion coefficients and critical displacements in SI in the anterior-posterior direction compared with both NSI and NF. However, in the medio-lateral direction there were no statistically significant differences between groups. For the traditional measures of sway, the average anterior-posterior CoP range was also larger in SI individuals. This work suggests that older fallers with a deterioration of anterior-posterior postural control may be at higher risk of serious injury following fall events.
Evaluation of balance in fallers and non-fallers elderly
Brazilian Journal of Otorhinolaryngology, 2012
Fal ls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year. Objective: The purpose of this study was to evaluate balance between fallers and non-fallers elderly. Study Design: Clinical study. Methods: We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared. Results: The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05). Conclusion: The CDP and BBS scores in fallers were found to be significiantly lower as compared to the non-fallers elderly.
Relevance of balance measurement tools and balance training for fall prevention in older adults
Journal of Clinical Gerontology and Geriatrics, 2014
Approximately one in three older people fall each year owing to gait/balance disorder/weakness, the second leading cause of falls in older adults. This review evaluates the capability of different balance measurement tools to predict falls in the elderly, which are used routinely for assessing balance impairment. Balance measurement tools reviewed are the Timed Up and Go test, Berg Balance Scale, Tinetti Performance Oriented Mobility Assessment, Functional Reach Test, Clinical Test of Sensory Integration for Balance, and the postural sway measurements or center of pressure. The effect of balance training on the postural control mechanism and its efficacy in fall prevention in older adults were also reviewed. The current evidence is not conclusive enough to favor existing balance measurement tools and balance training implemented for fall prevention in older adults.
Diagnostics, 2020
Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminat...
Balance performance in older adults and its relationship with falling
Aging Clinical and Experimental Research, 2014
Background and aims A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population. Methods A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: youngold (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests. Results The fall rate ([2 in the last year) was 27.0 %. The cutoff point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cutoff point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test. Conclusions This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.