Objective
We sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.
Methods
For this longitudinal, observational study, 125 community-dwelling women age ≥ 65 years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.
Results
More than half (59%) of participants fell, with 30% of participants falling more than once (fall rate=1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41 % of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR=12.6; 95% CI: 4.7-33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR=2.6; 95% CI: 1.2-5.9).
Conclusion
Falls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.
Our main interest is to identify how humans maintain upright while walking. Balance during standing and walking is different, primarily due to a gait cycle which the nervous system must contend with a variety of body configurations and frequent perturbations (i.e., heel-strike). We have identified three mechanisms that healthy young adults use to respond to a visually perceived fall to the side. The lateral ankle mechanism and the foot placement mechanism are used to shift the center of pressure in the direction of the perceived fall, and the center of mass away from the perceived fall. The push-off mechanism, a systematic change in ankle plantarflexion angle in the trailing leg, results in fine adjustments to medial-lateral balance near the end of double stance. The focus here is to understand how the three basic balance mechanisms are coordinated to produce an overall balance response. The results indicate that lateral ankle and foot placement mechanisms are inversely related. Larger lateral ankle responses lead to smaller foot placement changes. Correlations involving the push-off mechanism, while significant, were weak. However, the consistency of the correlations across stimulus conditions suggest the push-off mechanism has the role of small adjustments to medial-lateral movement near the end of the balance response. This verifies that a fundamental feature of human bipedal gait is a highly flexible balance system that recruits and coordinates multiple mechanisms to maintain upright balance during walking to accommodate extreme changes in body configuration and frequent perturbations.
Trip-specific perturbation training reduces trip-related falls after laboratory-induced trips and, prospectively, in the community. Based on an emerging body of evidence, we hypothesize that using task-specific perturbation training as a stand-alone approach or in conjunction with conventional exercise-based approaches will improve the effectiveness of fall prevention interventions significantly.
Accurate and precise knee flexion axis identification is critical for prescribing and assessing tibial and femoral derotation osteotemies, but is highly prone to marker misplacement-induced error. The purpose of this study was to develop an efficient algorithm for post hoc correction of the knee flexion axis and test its efficacy relative to other established algorithms. Gait data were collected on twelve healthy subjects using standard marker placement as well as intentionally misplaced lateral knee markers. The efficacy of the algorithm was assessed by quantifying the reduction in knee angle errors. Crosstalk error was quantified from the coefficient of determination (r2) between knee flexion and adduction angles. Mean rotation offset error (αo) was quantified from the knee and hip rotation kinematics across the gait cycle. The principal component analysis (PCA)-based algorithm significantly reduced r2 (p<0.001) and caused αo,knee to converge toward 11.9±8.0 degrees of external rotation, demonstrating improved certainty of the knee kinematics. The within-subject standard deviation of αo,hip between marker placements was reduced from 13.5±1.5 to 0.7±0.2 degrees (p<0.001), demonstrating improved precision of the knee kinematics. The PCA-based algorithm performed at levels comparable to a knee abduction-adduction minimization algorithm (Baker et al., 1999) and better than a null space algorithm (Schwartz and Rozumalski, 2005) for this healthy subject population.
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