Methods and Strategies for Reconditioning Motor Output and Postural Balance in Frail Older Subjects Prone to Falls

Abstract

In frail older subjects, the motor output of the antigravity muscles is fundamental in resisting falls. These muscles undergo accelerated involutions when they are inactive and the risk of falling increases during leisure and domestic physical activity. In order to reduce their risk of falling, frail older subjects limit their physical activities/exercises. The problem is that the less they exercise, the less they are able to exercise and the greater the risk in exercising. Hence, a vicious circle sets up and the antigravity muscles inevitably continue to deteriorate. This vicious circle must be broken by starting a reconditioning program based on developing the strength of antigravity muscles (especially lower-limb muscles). To begin with, for each increase in muscle strength, postural balance is improved. Once this increase reaches the threshold beyond which postural balance no longer improves, it seems appropriate to implement exercises aimed at concomitantly improving motor output and postural balance in order to counteract or even reverse the involution process of the postural balance system. Methods and strategies toward this end are proposed in this present communication. However, the transfer effects between strength increase and postural balance ability are not yet totally known and future research should evaluate the relationship between muscle strength and postural balance throughout rehabilitation programs (i.e., program follow-ups) in frail older subjects in order to advance knowledge of this relationship.

Retrospective Investigation and Research on Fall Events Among Hospitalized Patients in the Rehabilitation Department

“…There is a significant body of evidence suggesting that decreased motor abilities are closely tied to the risk of falls. 13 , 14 Our analysis, which used binary logistic regression, revealed that motor dysfunction, sensory impairment, and speech disorders were significant influencing factors linked to falls (P < 0.01, as noted in Tables 1 and 2 ). Within our cohort of 60 patients who experienced falls, a striking 95% (or 57 patients) had motor dysfunctions.…”

Relação entre fragilidade física e síndromes geriátricas em idosos da assistência ambulatorial

“…Estes músculos sofrem declínios acelerados quando estão inativos durante o lazer e a atividade física doméstica, ocasionando o risco de queda, tendo como resultado para a pessoa idosa a perda da independência, uma vez que em idosos frágeis, o menor distúrbio postural pode causar uma queda. (28) Quanto à disfunção familiar, o estudo conduzido pela Rede de Vigilância à Saúde da pessoa idosa (REVISI) em Goiânia (GO) analisou a prevalência e os fatores associados à disfuncionalidade familiar (APGAR Familiar), bem como a capacidade funcional da comunidade idosa. Foram investigadas 934 pessoas idosas, e os resultados indicaram percentual semelhante ao encontrado no presente estudo, 18,1% apresentaram disfunção familiar.…”

The optimal method for improving postural balance in healthy young and older people: specific training for postural tasks encountered in personal physical practice

“…With regard to the motor component of the postural function, the motor output (muscle strength and power, rate of force development, force variability, and movement control), the joint contribution (mobility, amplitude, stabilization, stiffness), the synergistic muscle command (agonist/antagonist co-activation reduction), and the inter-segmental coordination (phase, anti-phase) are optimized with training and experience ( Field, 2011 ; Nagai et al, 2012 ; Freyler et al, 2014 ; Verhoeven and Newell, 2016 ; Paillard, 2021 ).…”

“…Moreover, frail and/or older subjects clearly displaying a weakness of the lower-limb muscles need multimodal training with stimulation of neuromuscular function (aimed at improving muscle strength, muscle power/rate of force development, force variability/coordination) combined with stimulation of the postural function to improve postural balance in order to reduce the risk of falling (cf. Paillard, 2021 ). In any case, muscle strength and especially muscle power should be developed or maintained through the regular practice of physical/sport activities throughout adult life since the force-velocity (force rapidly) quality would be associated with postural performance in healthy older subjects ( Orr et al, 2006 ) and young subjects ( Johnson and Woollacott, 2011 ).…”