The relationship of fear of falling and balance confidence with balance and dual tasking performance.

Abstract

According to traditional conceptualizations of the relationship between fear of falling and falls in older adults, fear of falling is considered to be predictive of falls because it leads to activity avoidance which, in turn, leads to de-conditioning that increases fall risk. The recent literature has begun to challenge such conceptualizations. Specifically, it has been argued that fear of falling and anxiety, in and of themselves, have a direct negative effect on balance. In this study we manipulated anxiety level by asking older research participants to walk either on the floor (low anxiety condition) or an elevated platform (high anxiety condition). Half the time participants carried a tray (dual tasking) and half the time they did not. Manipulation checks (involving heart rate, galvanic skin response, and self-reported anxiety measurement) confirmed that the experimental manipulation was successful in affecting anxiety level. The results demonstrate that the experimental manipulation (platform vs. floor) affected balance parameters and dual tasking performance with the platform condition resulting in a less stable gait. In addition, increased task demand (i.e., dual tasking) also had a negative effect on balance performance. Finally, the results demonstrate that the paper and pencil measures of fear can also predict balance performance (although the variance accounted for is small) even after controlling for medical risk factors for falling. Implications for models of fear of falling are discussed.

Relationships between fear of falling, balance confidence, and control of balance, gait, and reactive stepping in individuals with sub-acute stroke

“…Therefore, both FOF and balance confidence were analyzed in the present study [26]. While balance confidence was related to several outcome measures, no differences were identified between the FOF groups.…”

Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults

“…Loss of balance confidence is a cause for concern as it may result in activity restriction, which can consequently increase sensorimotor deconditioning and subsequently increase the older person's risk of falls [8][9][10][11].…”

Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke

“…One promising objective approach is to measure task-related increases in sympathetic nervous system (SNS) activity. Increased SNS activity is a physiological stress response (i.e., the ‘fight or flight’ response) that occurs under conditions of heightened attention, state anxiety, cognitive loading, and/or physical exertion [16, 17]. SNS activity can be robustly measured by recording changes in skin conductance on the palmar surface of the hands [18, 19].…”

“…Several prior studies have demonstrated that skin conductance is increased during walking tasks with greater task demands and/or perceived challenges. For instance, studies requiring participants to step over obstacles or to dual-task while walking have reported marked increases in skin conductance during performance of those tasks [17, 20]. Task demands are not the only factors contributing to perceived challenge.…”

“…Prior studies have shown an increase in perceived challenge in the absence of a change in physical demands of a task. Most notably, self-reported anxiety and skin conductance have been reported to increase when the perceived challenge is increased by asking participants to perform walking or postural tasks on an elevated platform [20, 21]. Although the physical demands of walking/balancing on an elevated platform are identical to when performed at ground level, the consequences of falling are potentially much more serious and likely account for the perceived challenge.…”