Underlying mechanisms of fall risk on stairs with inconsistent going size

Francksen, Natasha C.; Ackermans, Thijs; Holzer, Denis; Maganaris, Constantinos N.; Hollands, Mark A.; Roys, Mike; O’Brien, Thomas D.

doi:10.1016/j.apergo.2022.103678

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…Moreover, a review of 80 stairway falls from 1992 to 2007 found that 60% of riser height and 34% of step depth inconsistencies were greater than 9.525 mm (Cohen et al, 2009). Francksen et al, (2022) found that adults were able to adjust their stepping behavior for increases in depth, but they could not adjust for step riser height variation over 10 mm (Francksen et al, 2020). This suggests that inconsistent step risers (> 10 mm), could increase one’s risk of a trip in ascent, or over-stepping during descent (Francksen et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Inter-step Variations of Stairways and Associations of High-Contrast Striping and Fall-related Event Observations

Brown

Poulsen

Barrett³

et al. 2023

Preprint

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Background: Variability in the riser and depth of each step in a stairway can decrease step predictability, and increase users fall risk. Unfortunately, inconsistencies in inter-step riser height and depth are common, but their impact may be lessened by adding high-contrast tread edges and vertical, monochrome striping applied to the bottom and top steps faces. Such contrast enhancement may draw greater attention to the steps edges or enhance the precision of the edges estimated location. Purpose: To determine if greater inconsistency in inter-step riser height and depth are associated with more frequent slips, trips, and falls, and if these events are reduced in flights of stairs with contrast-enhanced step edges. Methods: Stair users were videotaped on two public stairways. One stairway had black vinyl strips applied to the steps edges and black-and-white vertical stripes on the first and last steps faces. The intervention stairway was switched halfway through data collection. Stair users were coded for whether they experienced a fall-related event. A Monte Carlo simulation was used to determine the probability of observing a range of plausible distributions of fall-related events. Results: Flights of stairs with riser height variability of 14 mm and tread depth variability of 38 mm were associated with 80% of the observed fall-related events. 13 of 16 (81%) fall-related events occurred on the control stairway compared to 3 of 16 (19%) on the intervention stairway. The distribution of fall-related events observed between conditions had a probability of occurring by random chance of less than 0.04. Conclusion: These data suggest a vision-based strategy (i.e., striping) may counteract fall risk associated with inter-step riser height and depth inconsistencies. While the mechanisms of its action remain unclear, the high-contrast striping appears to reduce the incidence of fall-related events in the presence of inter-step riser height and depth inconsistencies.

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Section: Discussionmentioning

confidence: 99%

Inter-step Variations of Stairways and Associations of High-Contrast Striping and Fall-related Event Observations

Brown

Poulsen

Barrett³

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…The included stair climbing studies reported significantly increased foot clearance with age and significantly increased foot clearance variability with age and fall risk (Begg and Sparrow, 2000;Zietz et al, 2011;Ackermans et al, 2019;Francksen et al, 2020). In stair descent older adults ascended with reduced foot contact on the shorter step, which may cause an increased slip risk (Ackermans et al, 2019(Ackermans et al, , 2021Francksen et al, 2022). Therefore, the percentage of foot length on the stair should be assessed.…”

Section: Recommendationsmentioning

confidence: 99%

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

Dubbeldam

Lee

Pennone³

et al. 2022

Preprint

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Falling in the older population occurs frequently. Prospective and cohort studies have investigated the cause of such falls and have attempted to predict fall risk in the older population based on their performance during gait in daily life or during gait and simple tasks in the lab. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. The objective of this systematic review is to identify motion analysis parameters measured during challenging locomotion tasks which can predict fall risk in the older population. A systematic review was conducted in the databases of Pubmed, Scopus and IEEEexplore. Articles studying motion analysis parameters of healthy older and young adults during stair climbing, perturbed walking, and obstacle crossing were included. Study characteristics were extracted, and level of evidence assessed. In total 36 articles were included: 13 on stair climbing, 8 on perturbed walking and 15 on obstacle crossing. Only 2 prospective and 5 retrospective studies were included. Risk of bias was low in one article, moderate in 25 articles and serious in 10 articles. Outcome measures included spatiotemporal, dynamic stability, force plate, joint kinematic and kinetic, as well as success rate and step accuracy outcomes. Significant differences between low and high fall risks groups were reported for: foot (toe) clearance during stair ascent; foot contact during stair descent; stair climbing velocity: double stance phase and lower extremity joint force moments in stair climbing, obstacle crossing; and step width variability in all three tasks. Several other motion analysis parameters were significantly difference between young and older adults. There was a large variety in parameter assessment methods, so a meta-analysis was not possible. Future studies on challenging locomotion tasks should focus on long-term follow-up fall risk assessment including an initial assessment of mental and physical characteristics of the older participants. In addition, a consensus on candidate prognostic fall risk parameters and their corresponding assessment method is needed. First recommendations were made based on the findings in this review.

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Underlying mechanisms of fall risk on stairs with inconsistent going size

Cited by 2 publications

References 26 publications

Inter-step Variations of Stairways and Associations of High-Contrast Striping and Fall-related Event Observations

Inter-step Variations of Stairways and Associations of High-Contrast Striping and Fall-related Event Observations

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

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