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18.8 Fear of falling and strategies used by older adults tochange travel direction
Chapter 18. Fear of falling, fall and prevention This study was supported by ZonMW and a EU grant (Eurokinesis, number QLK6-CT-2002 00151).
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Fear of falling and strategies used by older adults to change travel direction
by MA fall techniques. Hand impact was not essential for the MA technique to reduce hip impact force. Teaching MA fall techniques to elderly might prevent hip fractures. This study was supported by the POM Nijmegen and ZonMW.
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J.R. Fuller 1, L.A. Vallis 1, A.L. Adkin 2. 1Department of Human
Biology and Nutritional Sciences', University of Guelph, Canada; 2Department of Physical Education and Kinesiology, Brock University, Canada Falls and fear of falling remain significant issues for older adults. A fall often occurs during a challenge to wholebody stability such as steering to change travel direction. This study describes strategies used by older adults to initiate a voluntary change in travel direction during ongoing walking and determines if these strategies are associated with fear of falling. Methods: Thirteen participants (81.5±6.4 years) were recruited from local retirement residences. The Activities-specific Balance Confidence scale was administered to assess fear of falling. Participants were video-taped executing self-paced walking trials 3-m along a straight path, continuing for an additional 2-m straight ahead or turning 40 degrees left or right. Foot placement strategies to change travel direction were categorized as single- or multiple-step turns. Results: Older adults selected a multiple-step turn to change travel direction 69.2% of the time. Selection of this strategy was associated with fear of falling; older adults who reported higher fear levels more often chose to use multiple steps to change travel direction (R-square 0.41). Discussion and Conclusion: Our results suggest that older adults were challenged when changing travel direction during ongoing walking as evidenced by strong reliance on a multiple-step strategy. Similar observations are reported when older adults are required to perform a 180-degree turn [1]. Fear of falling measures may identify whole-body instability and fall risk when changing travel direction. Introduction:
References [1] Thigpen, Light, Creel, Flynn. Phys Ther 2000; 80:1174 87.
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Hip impact velocity and trunk orientation play a role in the reduction of hip impact force by martial arts fall techniques
B. Groen 1.2, V. Weerdesteyn 1.2, W. van Lankveld 1, J.E.J. Duysens 1,2,3.
1Sint Maartenskliniek Research, Nijmegen, 2Institutefor Fundamental and Clinical Human Movement Sciences', Vrije Universiteit Amsterdam, 3Department of Rehabilitation Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Falls to the side with impact on the hip are risky for
hip fractures in elderly. Martial arts (MA) fall techniques can reduce hip impact force, but the underlying mechanism is unknown. The role of impact velocity, trunk orientation, and hand impact was studied. Methods: Six experienced judokas performed three techniques of sideways falls from kneeling height: block with arm technique (control), MA technique with use of the arm to break the fall (MA-a), and MA technique with no arm (MA-na). One subject performed an additional series of MA falls with use of the arm from standing height (MA-s). Kinematic and force on impact data were obtained for each fall. Results: The MA-a and MA-na technique reduced the impact force by 27.5 and 30%, respectively. Impact velocity was significantly reduced in the MA falls. Trunk orientation was significantly less vertical in the MA-a falls. No significant differences were found between the MA techniques. For the MA-s falls, the impact forces were comparable with those of the control falls from kneeling height, while the impact velocities were clearly higher. Trunk orientation was more horizontal than in the control falls. Discussion and Conclusion: In conclusion, both impact velocity and trunk orientation played a role in the reduction of hip impact force
$115
Idiopathic "cautious" gait disorder of the elderly: more than fear of falling
M. Hadar-Frumer 1'2, N. Giladi 1'2'3, J.M. Hausdorff 1'2'4. 1Movement Disorders Unit, Tel-Aviv Sourasky Medical Cente~ brad; 2Dept of Physical Therapy, Tel-Aviv University, Israel," 3 Dept of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Israel; 4 Division on Aging, Harvard Medical School, Boston, MA, USA Previous work has shown that elderly with highlevel gait disorders (HLGD) have increased stride-to-stride variability and reduced gait stability compared to healthy aged-match controls. This increased variability has been associated with fear of falling (FOF). We hypothesized that a reduction in FOF would improve gait variability. Methods: 21 HLGD patients with FOF were compared to 10 healthy controls. Stride-to-stride variability of each subject was quantified in response to 3 interventions intended to reduce FOF: walking while being guarded, walking with a walker, and walking while holding a physical therapist's hand. Results: Under usual walking condition, stride variability was significantly (p <0.001) increased in the patient group. For all three interventions, patients reported significantly reduced fear compared to usual walking, but controls did not. Hand holding significantly reduced stride variability in the patients (p 0. 021), but not in controls. Nonetheless, stride variability remained significantly higher in the patients under all walking conditions. Interestingly, while the patients agreed with the objective measures that "hand holding" improved gait stability, patients also reported that the walker and guarding improved their feeling of stability, even though these did not consistently reduce stride variability. Conclusions: Reducing fear of falling may enhance gait stability, but even when assistance is provided, gait variability remains markedly high in patients with HLGD. This finding is consistent with the idea that the source of this gait disturbance is not simply fear of falling, but rather a neurodegenerative, pathological process is responsible for the observed gait changes. Introduction:
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Changes in gait characteristics following cataract surgery
J.L. Helbostad 1,2, O. Sletvold 1,2, M. OdegSrd 1 , S.S. Western 1,
R. Moe-Nilssen 3. 1St. Olav Hospital, Trondheim, 2Norwegian
University of Science and Technology, Trondheim, 3University of Bergen, Norway Introduction: Visual impairment is an independent risk factor for falls
in older people. There is some evidence that cataract surgery reduces fall risk. Few studies have assessed whether gait characteristics are changed after cataract surgery. The aim of the study was to assess changes in trunk and step variables following cataract surgery. Methods: 80 persons of 70 years or more (mean 79.5, SD 5.0) undergoing cataract surgery on one or both eyes participated. Vision and gait were assessed before surgery and 6 weeks after surgery. Walking under three different speed conditions was assessed when walking in full lighting (>250 lux) and subdued lighting (5 10 lux). Outcome measures were trunk acceleration amplitude, interstep trunk acceleration repeatability, and temporal and spatial step parameters, all compared at a common normalised speed. Results: Visual acuity, stereopsis, field vision and contrast vision improved (p < 0.02), mediolateral trunk accelerations (p 0.037) and step-to-step single support variability (0.02) decreased, interstride trunk acceleration repeatability increased (p 0.022), while gait speed did not change when walking in subdued lighting. Visual acuity and field vision explained the changes in gait parameters.
[•]
Fear of falling and strategies used by older adults to change travel direction
by MA fall techniques. Hand impact was not essential for the MA technique to reduce hip impact force. Teaching MA fall techniques to elderly might prevent hip fractures. This study was supported by the POM Nijmegen and ZonMW.
•
J.R. Fuller 1, L.A. Vallis 1, A.L. Adkin 2. 1Department of Human
Biology and Nutritional Sciences', University of Guelph, Canada; 2Department of Physical Education and Kinesiology, Brock University, Canada Falls and fear of falling remain significant issues for older adults. A fall often occurs during a challenge to wholebody stability such as steering to change travel direction. This study describes strategies used by older adults to initiate a voluntary change in travel direction during ongoing walking and determines if these strategies are associated with fear of falling. Methods: Thirteen participants (81.5±6.4 years) were recruited from local retirement residences. The Activities-specific Balance Confidence scale was administered to assess fear of falling. Participants were video-taped executing self-paced walking trials 3-m along a straight path, continuing for an additional 2-m straight ahead or turning 40 degrees left or right. Foot placement strategies to change travel direction were categorized as single- or multiple-step turns. Results: Older adults selected a multiple-step turn to change travel direction 69.2% of the time. Selection of this strategy was associated with fear of falling; older adults who reported higher fear levels more often chose to use multiple steps to change travel direction (R-square 0.41). Discussion and Conclusion: Our results suggest that older adults were challenged when changing travel direction during ongoing walking as evidenced by strong reliance on a multiple-step strategy. Similar observations are reported when older adults are required to perform a 180-degree turn [1]. Fear of falling measures may identify whole-body instability and fall risk when changing travel direction. Introduction:
References [1] Thigpen, Light, Creel, Flynn. Phys Ther 2000; 80:1174 87.
[•]
Hip impact velocity and trunk orientation play a role in the reduction of hip impact force by martial arts fall techniques
B. Groen 1.2, V. Weerdesteyn 1.2, W. van Lankveld 1, J.E.J. Duysens 1,2,3.
1Sint Maartenskliniek Research, Nijmegen, 2Institutefor Fundamental and Clinical Human Movement Sciences', Vrije Universiteit Amsterdam, 3Department of Rehabilitation Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Falls to the side with impact on the hip are risky for
hip fractures in elderly. Martial arts (MA) fall techniques can reduce hip impact force, but the underlying mechanism is unknown. The role of impact velocity, trunk orientation, and hand impact was studied. Methods: Six experienced judokas performed three techniques of sideways falls from kneeling height: block with arm technique (control), MA technique with use of the arm to break the fall (MA-a), and MA technique with no arm (MA-na). One subject performed an additional series of MA falls with use of the arm from standing height (MA-s). Kinematic and force on impact data were obtained for each fall. Results: The MA-a and MA-na technique reduced the impact force by 27.5 and 30%, respectively. Impact velocity was significantly reduced in the MA falls. Trunk orientation was significantly less vertical in the MA-a falls. No significant differences were found between the MA techniques. For the MA-s falls, the impact forces were comparable with those of the control falls from kneeling height, while the impact velocities were clearly higher. Trunk orientation was more horizontal than in the control falls. Discussion and Conclusion: In conclusion, both impact velocity and trunk orientation played a role in the reduction of hip impact force
$115
Idiopathic "cautious" gait disorder of the elderly: more than fear of falling
M. Hadar-Frumer 1'2, N. Giladi 1'2'3, J.M. Hausdorff 1'2'4. 1Movement Disorders Unit, Tel-Aviv Sourasky Medical Cente~ brad; 2Dept of Physical Therapy, Tel-Aviv University, Israel," 3 Dept of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Israel; 4 Division on Aging, Harvard Medical School, Boston, MA, USA Previous work has shown that elderly with highlevel gait disorders (HLGD) have increased stride-to-stride variability and reduced gait stability compared to healthy aged-match controls. This increased variability has been associated with fear of falling (FOF). We hypothesized that a reduction in FOF would improve gait variability. Methods: 21 HLGD patients with FOF were compared to 10 healthy controls. Stride-to-stride variability of each subject was quantified in response to 3 interventions intended to reduce FOF: walking while being guarded, walking with a walker, and walking while holding a physical therapist's hand. Results: Under usual walking condition, stride variability was significantly (p <0.001) increased in the patient group. For all three interventions, patients reported significantly reduced fear compared to usual walking, but controls did not. Hand holding significantly reduced stride variability in the patients (p 0. 021), but not in controls. Nonetheless, stride variability remained significantly higher in the patients under all walking conditions. Interestingly, while the patients agreed with the objective measures that "hand holding" improved gait stability, patients also reported that the walker and guarding improved their feeling of stability, even though these did not consistently reduce stride variability. Conclusions: Reducing fear of falling may enhance gait stability, but even when assistance is provided, gait variability remains markedly high in patients with HLGD. This finding is consistent with the idea that the source of this gait disturbance is not simply fear of falling, but rather a neurodegenerative, pathological process is responsible for the observed gait changes. Introduction:
[]•
Changes in gait characteristics following cataract surgery
J.L. Helbostad 1,2, O. Sletvold 1,2, M. OdegSrd 1 , S.S. Western 1,
R. Moe-Nilssen 3. 1St. Olav Hospital, Trondheim, 2Norwegian
University of Science and Technology, Trondheim, 3University of Bergen, Norway Introduction: Visual impairment is an independent risk factor for falls
in older people. There is some evidence that cataract surgery reduces fall risk. Few studies have assessed whether gait characteristics are changed after cataract surgery. The aim of the study was to assess changes in trunk and step variables following cataract surgery. Methods: 80 persons of 70 years or more (mean 79.5, SD 5.0) undergoing cataract surgery on one or both eyes participated. Vision and gait were assessed before surgery and 6 weeks after surgery. Walking under three different speed conditions was assessed when walking in full lighting (>250 lux) and subdued lighting (5 10 lux). Outcome measures were trunk acceleration amplitude, interstep trunk acceleration repeatability, and temporal and spatial step parameters, all compared at a common normalised speed. Results: Visual acuity, stereopsis, field vision and contrast vision improved (p < 0.02), mediolateral trunk accelerations (p 0.037) and step-to-step single support variability (0.02) decreased, interstride trunk acceleration repeatability increased (p 0.022), while gait speed did not change when walking in subdued lighting. Visual acuity and field vision explained the changes in gait parameters.