Accuracy of Clinical Techniques for Evaluating Lower Limb Sensorimotor Functions Associated With Increased Fall Risk

Donaghy, Alex C.; DeMott, Trina K.; Allet, Lara; Kim, Hogene; Ashton‐Miller, James A.; Richardson, James K.

doi:10.1016/j.pmrj.2015.08.017

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…The findings suggest a plausible mechanism by which impairments in inhibitory executive function can increase fall and injury risk. These neurocognitive variables, which can be obtained at the bedside or in the clinic using RT clin Dev, may be combined with evaluation of critical lower limb neuromuscular attributes 46 so as to allow the clinician a more comprehensive understanding of fall risk.…”

Section: Discussionmentioning

confidence: 99%

Complex and Simple Clinical Reaction Times Are Associated with Gait, Balance, and Major Fall Injury in Older Subjects with Diabetic Peripheral Neuropathy

Richardson

Eckner

Allet

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective To identify relationships between complex and simple clinical measures of reaction time (RTclin), and indicators of balance in older subjects with and without diabetic peripheral neuropathy (DPN). Design Prospective cohort design. Complex RTclin Accuracy, Simple RTclin Latency, and their ratio were determined using a novel device in 42 subjects (age = 69.1 ± 8.3 yrs), 26 with DPN and 16 without. Dependent variables included unipedal stance time (UST), step width variability and range on an uneven surface, and major fall-related injury over 12 months. Results In the DPN subjects the ratio of Complex RTclin Accuracy:Simple RTclin Latency was strongly associated with longer UST (r/p = .653/.004), and decreased step width variability and range (r/p = −.696/.001 and −.782/<.001, respectively) on an uneven surface. Additionally, the two DPN subjects sustaining major injuries had lower Complex RTclin Accuracy:Simple: RTclin Latency than those without. Conclusions The ratio of Complex RTclin Accuracy:Simple RTclin Latency is a potent predictor of UST and frontal plane gait variability in response to perturbations, and may predict major fall injury in older subjects with DPN. These short latency neurocognitive measures may compensate for lower limb neuromuscular impairments, and provide a more comprehensive understanding of balance and fall risk.

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Section: Discussionmentioning

confidence: 99%

Complex and Simple Clinical Reaction Times Are Associated with Gait, Balance, and Major Fall Injury in Older Subjects with Diabetic Peripheral Neuropathy

Richardson

Eckner

Allet

et al. 2017

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Because the ratio of hip strength to ankle proprioception is a predictor of unipedal stance time (frontal plane postural control), 12 falls, 10 and injuries from falls, 10 a simple method of detecting the fibular CMAP above or below 4.0 mV has clinical relevance. Other clinical tools have been shown to predict hip strength (lateral plank time) and ankle proprioceptive threshold (vibration sensation and monofilament testing), 13 and hence fall risk, yet none are as simple as the evaluation of EDB muscle bulk. Our study demonstrates that the mere evaluation of EDB bulk provides objective evidence for distal neuromuscular impairment.…”

Section: Discussionmentioning

confidence: 99%

Extensor digitorum brevis bulk and associations with fibular motor nerve conduction amplitude

Levin

Lowe

Tamura

et al. 2021

PM&R

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Introduction: Prior work demonstrates that fibular compound motor action potential (CMAP) amplitude <4.0 mV predicts impairment of ankle proprioceptive precision and increased fall risk. Extensor digitorum brevis (EDB) inspection may present a simple clinical surrogate for CMAP amplitude. Objective: (1) To estimate the inter-rater reliability of assessment of EDB bulk. (2) To determine whether inspection of EDB bulk is associated with fibular CMAP amplitude. Design: Prospective inter-rater reliability study. Setting: Academic center outpatient Physical Medicine & Rehabilitation electromyography (EMG) clinics. Participants: Fifty-two adult participants (102 feet). Main Outcome Measures: (1) Inter-rater reliability of assessment of EDB bulk.(2) Mean fibular CMAP amplitude. (3) A binary measure of fibular CMAP amplitude at/above or below a 4.0 mV threshold. Results: Inter-rater reliability of EDB bulk grading was moderate (kappa: 0.65 [95% confidence interval (CI) 0.48-0.82]). The mean CMAP value was 5.9 AE 2.2 mV when bulk was normal, 3.4 AE 2.1 mV when diminished, and 0.6 AE 0.9 mV when atrophied. A multivariable analysis demonstrated that EDB bulk, distal symmetric polyneuropathy (DSP), and lumbar radiculopathy were all associated with CMAP amplitude. The sensitivity and specificity of grading muscle bulk as normal versus abnormal in detecting CMAP amplitude above or below 4.0 mV were 0.86 (95% CI 0.78-0.94) and 0.71 (95% CI 0.54-0.88), respectively. An atrophied EDB was a highly specific indicator that CMAP amplitude was abnormal (<4.0 mV) in 100% of cases (8/8). Conclusions: EDB bulk was associated with fibular CMAP amplitude. Atrophy was a highly specific indicator for CMAP amplitude below 4.0 mV. Evaluation of EDB bulk may represent a quick and easy clinical surrogate marker for CMAP amplitude and distal neuromuscular impairment.

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“…Age-related declines in sensory acuity and neuromuscular efficiency can predispose older adults to an increased risk of falling (Daly et al 2013;Dhital et al 2010;Lusardi et al 2017;Ortman et al 2014). Therefore, it is essential to develop an efficient sensory-motor test that assesses not only the neural interplay between the sensory and motor systems (Donaghy et al 2016) but also the speed of the integration.…”

Section: Introductionmentioning

confidence: 99%

The reactive leg drop: a simple and novel sensory-motor assessment to predict fall risk in older individuals

Magrini

Thiele

Colquhoun

et al. 2018

Journal of Neurophysiology

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There is need for a functional ability test that appropriately assesses the rapid integration of the sensory and motor systems required for older adults to recover from a slip. The purpose of this study was to assess the efficacy and reliability of a novel test, the reactive leg drop, for assessing sensory-motor function in older adults. Fourteen young (YW; mean age = 20 yr) and 11 older women (OW; mean age = 76 yr) participated in this study. For each drop, the leg was passively moved to full extension and then released. The subjects had to recognize their leg was free-falling and reactively kick up as quickly as possible during varying sensory conditions. To assess the leg drop's reliance on proprioception, other proprioceptive tests (e.g., patellar tendon reflexes and balance) were separately performed. Leg drops performed with the eyes closed ( P = 0.011) and with a blocked view of the leg ( P = 0.033) showed significant differences in drop angle between YW and OW. Significant relationships between leg drop conditions and balance were observed in OW that were not present within YW. When collapsed across groups, reflex latency was correlated with drop angle when the eyes were closed. The reactive leg drop was age sensitive, reliable, and likely reliant on proprioception, as shown by relationships to other sensory-motor assessments, such as balance and the patellar reflex. Although more research is needed, we propose that the reactive leg drop is an effective tool to assess sensory-motor integration in a manner that may mimic fall recovery. NEW & NOTEWORTHY The reactive leg drop was age sensitive and was significantly related to other sensory-motor assessments. The ability to accurately assess sensory-motor integration may aid clinicians, practitioners, and researchers in developing new interventions. The reactive leg drop presented in the current study is a potentially effective tool to assess sensory and motor integration in a manner that may mimic fall recovery.

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Accuracy of Clinical Techniques for Evaluating Lower Limb Sensorimotor Functions Associated With Increased Fall Risk

Cited by 8 publications

References 39 publications

Complex and Simple Clinical Reaction Times Are Associated with Gait, Balance, and Major Fall Injury in Older Subjects with Diabetic Peripheral Neuropathy

Complex and Simple Clinical Reaction Times Are Associated with Gait, Balance, and Major Fall Injury in Older Subjects with Diabetic Peripheral Neuropathy

Extensor digitorum brevis bulk and associations with fibular motor nerve conduction amplitude

The reactive leg drop: a simple and novel sensory-motor assessment to predict fall risk in older individuals

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