Elderly fall risk prediction using static posturography

Abstract

Maintaining and controlling postural balance is important for activities of daily living, with poor postural balance being predictive of future falls. This study investigated eyes open and eyes closed standing posturography with elderly adults to identify differences and determine appropriate outcome measure cut-off scores for prospective faller, single-faller, multi-faller, and non-faller classifications. 100 older adults (75.5 ± 6.7 years) stood quietly with eyes open and then eyes closed while Wii Balance Board data were collected. Range in anterior-posterior (AP) and medial-lateral (ML) center of pressure (CoP) motion; AP and ML CoP root mean square distance from mean (RMS); and AP, ML, and vector sum magnitude (VSM) CoP velocity were calculated. Romberg Quotients (RQ) were calculated for all parameters. Participants reported six-month fall history and six-month post-assessment fall occurrence. Groups were retrospective fallers (24), prospective all fallers (42), prospective fallers (22 single, 6 multiple), and prospective non-fallers (47). Non-faller RQ AP range and RQ AP RMS differed from prospective all fallers, fallers, and single fallers. Non-faller eyes closed AP velocity, eyes closed VSM velocity, RQ AP velocity, and RQ VSM velocity differed from multi-fallers. RQ calculations were particularly relevant for elderly fall risk assessments. Cut-off scores from Clinical Cut-off Score, ROC curves, and discriminant functions were clinically viable for multi-faller classification and provided better accuracy than single-faller classification. RQ AP range with cut-off score 1.64 could be used to screen for older people who may fall once. Prospective multi-faller classification with a discriminant function (-1.481 + 0.146 x Eyes Closed AP Velocity—0.114 x Eyes Closed Vector Sum Magnitude Velocity—2.027 x RQ AP Velocity + 2.877 x RQ Vector Sum Magnitude Velocity) and cut-off score 0.541 achieved an accuracy of 84.9% and is viable as a screening tool for older people at risk of multiple falls.

Effect of Cervical Kinesthetic Motor Imagery on Postural Control of Healthy Young Adults with Fear of Falling

“…The increase in the CoP mean velocity (as observed in the present study, Figure 2B) has been considered an important predictor of the risk of falls in the elderly [26,43]. In addition, high levels of anxiety can modulate oculomotor control [47] and influence orthostatic postural control in young adults [48] as in the elderly [49], partially explaining the results observed in the present study.…”

“…Recently, a posturography study using the WBB showed that changes in CoP (increased SD and MV) may predict the risk of falls in the elderly [43]. The FoF consists of a psychoemotional response to a previous event, which can modulate the reflex activity of the neuromuscular spindle [18] and influence the anticipatory postural control [19,20] in threatening situations (elevating participants at different heights) [11][12][13][14][15]44] or functional (unipodal and bipodal supports) [16,17] situations.…”

Feature selection for the classification of fall-risk in older subjects: a combinational approach using static force-plate measures

“…Recent studies on fall-risk predictors have recognised the necessity for multiple features and non-linear algorithms in classifying fall-risk by exploring the potential of machine-learning to create effective classification models (25)(26)(27)(28)(29). The majority of these studies have focused on dynamic movement analysis to predict elderly fall-risk (25,26), while the presence of a thorough feature selection process has been lacking with one study of note using principal component analysis (30).…”

Dynamic Balance Measures and Sensing for Humans in Fall Detection and Prevention

“…The Romberg Quotient is the ratio of postural sway with eyes-closed and eyes-opened and measures how reliant a person is on vision to maintain balance. The Romberg Quotient has been used to classify fallers, non-fallers, and multiple fallers [26].…”

“…In bipedal locomotion, this represents the average of the pressures acting on the ground contact area, weighted by the ground reaction under each foot [19]. COP-based measures are commonly used to determine fall risk in posturography [18,26].…”