The inter-observer reliability and agreement of lateral balance recovery responses in older and younger adults

Batcir, Shani; Sharon, Hadar; Shani, Guy; Levitsky, Noa; Gimmon, Yoav; Kurz, Ilan; Shapiro, Amir; Melzer, Itshak

doi:10.1016/j.jelekin.2018.03.002

Cited by 20 publications

(38 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 ). Lower single-step and multiple-step thresholds were found earlier in older adults compared with young’s [ 22 ] and in stroke patients compared with age matched healthy controls [ 28 ]. A recovery step at a lower perturbation magnitude in OFs may suggest a lower balance recovery function, i.e., less ability to control the CoM motion over the BoS, or may be due to a past single fall event which resulted in a greater fear of falling (FES-I) that does not actually represent true balance abilities.…”

Section: Discussionmentioning

confidence: 99%

“…We also verified an existence of each recovery step by 3D kinematic data. This method showed excellent inter-observer reliability for single-step and multiple-step thresholds (ICC2,1 = 0.978 and ICC2,1 = 0.971, respectively; p < 0.001), an excellent total inter-observer kappa score for balance recovery strategies (0.896, p < .0.001) and inter-observer percentage agreements of 85–100% for leg strategies among older adults [ 22 ]. The single-step threshold level was defined as the minimum perturbation magnitude that consistently elicited a single compensatory step for at least two consecutive perturbation magnitudes.…”

Section: Methodsmentioning

confidence: 99%

“…When a participant took extra steps to recover his/her balance, i.e., a multiple-step reaction, the following parameters were determined: 5) total balance recovery duration (ms) – the time from surface translation to foot contact on the ground, completing their multiple steps to recover balance; 6) recovery step path length – the Euclidian distance in cm that the ankle markers displaced from step initiation to foot contact on the ground, completing their full balance recovery; and 7) total eCoM path displacement (cm), defined as the distance in cm of the CoM traveled from the initial point prior to stepping to the point where participants completed their full balance recovery. Using this method, Batcir et al [ 22 ] found excellent inter-observer reliability for first-step recovery initiation duration, step duration, step length, and the estimated distance of the eCoM traveled (ICC2,1 = 0.917, ICC2,1 = 0.975, ICC2,1 = 0.978, and ICC2,1 = 0.918, respectively; p < 0.001) and also for total balance recovery duration (ICC2,1 = 0.950, p < 0.001) and total recovery step path length (ICC2,1 = 0.935, p < 0.001) [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Step-recovery responses are critical in preventing falls when balance is lost unexpectedly. We investigated the kinematics and strategies of balance recovery in older adults with a varying history of falls. Methods In a laboratory study, 51 non-fallers (NFs), 20 one-time fallers (OFs), and 12 recurrent-fallers (RFs) were exposed to random right/left unannounced underfoot perturbations in standing of increasing magnitude. The stepping strategies and kinematics across an increasing magnitude of perturbations and the single- and multiple-step threshold trials, i.e., the lowest perturbation magnitude to evoke single step and multiple steps, respectively, were analyzed. Fall efficacy (FES) and self-reported lower-extremity function were also assessed. Results OFs had significantly lower single- and multiple-step threshold levels than NFs; the recovery-step kinematics were similar. Surprisingly, RFs did not differ from NFs in either threshold. The kinematics in the single-step threshold trial in RFs, however, showed a significant delay in step initiation duration, longer step duration, and larger center of mass (CoM) displacement compared with NFs and OFs. In the multiple-step threshold trial, the RFs exhibited larger CoM displacements and longer time to fully recover from balance loss. Interestingly, in the single-stepping trials, 45% of the step-recovery strategies used by RFs were the loaded-leg strategy, about two times more than OFs and NFs (22.5 and 24.2%, respectively). During the multiple-stepping trials, 27.3% of the first-step recovery strategies used by RFs were the loaded-leg strategy about two times more than OFs and NFs (11.9 and 16.4%, respectively), the crossover stepping strategy was the dominated response in all 3 groups (about 50%). In addition, RFs reported a lower low-extremity function compared with NFs, and higher FES in the OFs. Conclusions RFs had impaired kinematics during both single-step and multiple-step recovery responses which was associated with greater leg dysfunction. OFs and NFs had similar recovery-step kinematics, but OFs were more likely to step at lower perturbation magnitudes suggesting a more “responsive” over-reactive step response related from their higher fear of falling and not due to impaired balance abilities. These data provide insight into how a varying history of falls might affect balance recovery to a lateral postural perturbation. Trial registration This study was registered prospectively on November 9th, 2011 at clinicaltrials.gov ( NCT01439451 ).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…It was found earlier that during gait, the pelvis position is a reasonable proxy for the CoM position [42]. Using this method, Batcir et al [43] found excellent inter-observer reliability for first step recovery initiation duration, step duration, step length, and the estimated distance of the CoM from the BoS (ICC2,1 = 0.917, ICC2,1 = 0.975, ICC2,1 = 0.978, and ICC2,1 = 0.918, respectively; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of First Recovery Step Response following Unexpected Loss of Balance during Walking: A Dynamic Approach

et al. 2020

Self Cite

View full text Add to dashboard Cite

Introduction: Many falls in older adults occur during walking and result in lateral falls. The ability to perform a recovery step after balance perturbation determines whether a fall will occur. Aim: To investigate age-related changes in first recovery step kinematics and kinematic adaptations over a wide range of lateral perturbation magnitudes while walking. Methods: Thirty-five old (78.5 ± 5 years) and 19 young adults (26.0 ± 0.8 years) walked at their preferred walking speed on a treadmill. While walking, the subjects were exposed to announced right/left perturbations in different phases of the gait cycle that were gradually increased in order to trigger a recovery stepping response. The subjects were instructed to react naturally and try to avoid falling. Kinematic analysis was performed to analyze the first recovery step parameters (e.g., step initiation, swing duration, step length, and the estimated distance of the center of mass from the base of support [dBoS]). Results: Compared with younger adults, older adults displayed a significantly lower step threshold and at lower perturbation magnitudes during the experiment. Also, they showed slower compensatory step initiation, shorter step length, and dBoS with similar step recovery times. As the perturbation magnitudes increased, older adults showed very small, yet significant, decreases in the timing of the step response, and increased their step length. Younger adults did not show changes in the timing of stepping, with a tendency toward a significant increase in step length. Conclusions: First compensatory step performance is impaired in older adults. In terms of the dynamic approach, older adults were more flexible, i.e., less automatic, while younger adults displayed more automatic behavior.

show abstract

“…40 Also, high interobserver reliability for step threshold, multiple step threshold and fall threshold was found in older adults. 33 The spatiotemporal events extracted from the collected data were analyzed by customized semiautomated program written in C# (Microsoft, 2000) specifically for this study protocol 33 : (1) The surface translation was detected as the first horizontal deviation of the marker placed on the treadmill greater than 3 standard deviations from the average baseline noise. (2) First step lift-off the ground was defined at the first deviation of the marker placed on the swinging leg ankle joint in the vertical direction, greater than 4 mm from the average baseline after the surface translation.…”

Section: Methodsmentioning

confidence: 99%

Insufficient Balance Recovery Following Unannounced External Perturbations in Persons With Stroke

Handelzalts

Steinberg-Henn

Levy

et al. 2019

Neurorehabil Neural Repair

Self Cite

View full text Add to dashboard Cite

Background. Persons with stroke (PwS) are at increased risk of falls, especially toward the paretic side, increasing the probability of a hip fracture. The ability to recover from unexpected loss of balance is a critical factor in fall prevention. Objectives. We aimed to compare reactive balance capacity and step kinematics between PwS and healthy controls. Methods. Thirty subacute PwS and 15 healthy controls were exposed to forward, backward, right, and left unannounced surface translations in 6 increasing intensities while standing. Single step threshold, multiple step threshold, and fall threshold (ie, perturbation intensity leading to a fall into harness system) were recorded as well as reactive step initiation time, step length, and step velocity. Results. Twenty-five PwS fell into harness system during the experiment while healthy controls did not fall. Fourteen out of 31 falls occurred in response to surface translations toward the nonparetic side, that is, falling toward the paretic side. Compared with healthy controls, PwS demonstrated significantly lower fall threshold and multiple step threshold in response to forward, backward, and lateral surface translations. Impairments were more pronounced in response to forward surface translation and toward the nonparetic side (ie, loss of balance toward the paretic side). A trend toward significant shorter step length in response to lateral surface translations was found in PwS compared with healthy controls. Conclusions. Findings highlight the importance of assessing reactive balance capacity in response to perturbations in different directions and intensities in addition to the routine assessment in PwS.

show abstract

The inter-observer reliability and agreement of lateral balance recovery responses in older and younger adults

Cited by 20 publications

References 35 publications

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

Characteristics of First Recovery Step Response following Unexpected Loss of Balance during Walking: A Dynamic Approach

Insufficient Balance Recovery Following Unannounced External Perturbations in Persons With Stroke

Contact Info

Product

Resources

About