Compensatory stepping responses during real-life falls in older adults

Te, Bianca; Komisar, Vicki; Aguiar, Olivia M G; Shishov, Nataliya; Robinovitch, Stephen N.

doi:10.1016/j.gaitpost.2023.01.005

Cited by 7 publications

(8 citation statements)

References 36 publications

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“…Forty-five articles included were quasi-experimental studies [21][22][23][24][26][27][28][29][30][31], six articles were randomized controlled trials studies [71][72][73][74][75][76], and two article were observational studies [77,78].…”

Section: Study Design and Methods Of Perturbationsmentioning

confidence: 99%

“…Also, the trip method was reported in 13 studies [21,31,39,42,[54][55][56]62,64,69,71,72,74] and the surface translation method was reported in 12 studies [24,26,36,37,44,49,53,62,72,73,75,77]. Other methods reported were the waist-pull method used by 11 articles [22,23,38,[48][49][50]57,66,67,73,76], the slip method used by 8 articles [27,28,[63][64][65]71,74,79], the perturbing shoes method used by 2 articles [31,47], the perturbations of the support surface used in one article [59], and only one article used a video camera [78].…”

Section: Study Design and Methods Of Perturbationsmentioning

confidence: 99%

“…The aims of the present scoping review were to compile all the compensatory protective step strategies for loss of balance in older adults and to identify perturbation methods and spatiotemporal variables used to analyze the collected strategies. This review included 53 articles, 45 of them were quasi-experimental studies [21][22][23][24][26][27][28][29][30][31]69,70], 6 articles were randomized controlled trial studies [71][72][73][74][75][76], and 2 articles were observational studies [77,78].…”

Section: Principal Findingsmentioning

confidence: 99%

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Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review

Melo-Alonso,

Murillo-Garcia,

Leon-Llamas

et al. 2024

JCM

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Background: The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. Objectives: (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. Methods: The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O’Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. Results: A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. Conclusions: There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.

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Section: Study Design and Methods Of Perturbationsmentioning

confidence: 99%

Section: Study Design and Methods Of Perturbationsmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review

Melo-Alonso,

Murillo-Garcia,

Leon-Llamas

et al. 2024

JCM

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“…Mechanically, Hof (2007) demonstrated three mechanisms of standing balance control, namely, moving the centre of pressure under the feet, counter rotation of body segments about the centre of mass and applying an external force other than the ground reaction forces (for example, by grasping a handrail). In principle, similar solutions are available for reactive gait recovery, though due to the moving centre of mass, similar to unperturbed gait (Bruijn and van Dieen 2018;van den Bogaart et al 2022;van Leeuwen et al 2020), foot placement by stepping as a means to move the centre of pressure appears to dominate during real falls, at least when nearby external support such as handrails are not available (Te et al 2023). According to the earlier framework presented by Maki and McIlroy (1997), which characterised balance recovery strategies in terms of the nature of support employed, stepping during reactive gait recovery (and grasping during reactive gait recovery) represent "change-in-support" strategies.…”

Section: Reactive Gait Recoverymentioning

confidence: 99%

How Older Adults can Avoid Falls via Proactive and Reactive Gait Adaptability: A Brief Introduction

McCrum,

van der Hulst

2023

Preprint

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To understand and intervene on the problem of falls among older adults, we must consider in what ways falls can be avoided. In this chapter, we discuss how people can avoid obstacle-induced falls like trips and slips via proactive and reactive gait adaptation. We introduce each concept and detail how gait adaptation pre and post contact with obstacles can be implemented in order to avoid or reduce falls risk. We also discuss how ageing may affect proactive and reactive gait adaptation and adaptability, particularly in the context of the sensory systems and movement execution. We conclude each section with some thoughts on interventions to improve these skills in older adults. Overall, both proactive and reactive gait adaptation to acute balance-threatening obstacles appear to be compromised with ageing. However, healthy older adults demonstrate the ability to improve in both aspects and this retained adaptability with ageing drives interest and research on these task-specific approaches to fall prevention.

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“… 38 In a recent study of real-life falls in older adults in care homes, one-third of all falls were due to external perturbation. 39 Therefore, environmental adjustments aiming to reduce the risk of falls are of great importance. These adjustments have been shown to be effective in reducing falls among older adults and adding to a broader approach to person-centered fall prevention.…”

Section: Introductionmentioning

confidence: 99%

Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention

Arkkukangas

2023

CIA

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Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a “train-The-trainer” approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative approach should be used in the natural environment, before social and healthcare services are required.

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Compensatory stepping responses during real-life falls in older adults

Cited by 7 publications

References 36 publications

Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review

Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review

How Older Adults can Avoid Falls via Proactive and Reactive Gait Adaptability: A Brief Introduction

Involvement of Older Adults, the Golden Resources, as a Primary Measure for Fall Prevention

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