The Kinematics and Strategies of Recovery Steps During Lateral Losses of Balance in Standing at Different Perturbation Magnitudes in Older Adults with Varying History of Falls

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2020 Jul 22

PMID 32689965

Citations 10

Authors

Shani Batcir

Guy Shani

Amir Shapiro

Neil Alexander

Itshak Melzer

Affiliations

Soon will be listed here.

Abstract

Background: Step-recovery responses are critical in preventing falls when balance is lost unexpectedly. We investigated the kinematics and strategies of balance recovery in older adults with a varying history of falls.

Methods: In a laboratory study, 51 non-fallers (NFs), 20 one-time fallers (OFs), and 12 recurrent-fallers (RFs) were exposed to random right/left unannounced underfoot perturbations in standing of increasing magnitude. The stepping strategies and kinematics across an increasing magnitude of perturbations and the single- and multiple-step threshold trials, i.e., the lowest perturbation magnitude to evoke single step and multiple steps, respectively, were analyzed. Fall efficacy (FES) and self-reported lower-extremity function were also assessed.

Results: OFs had significantly lower single- and multiple-step threshold levels than NFs; the recovery-step kinematics were similar. Surprisingly, RFs did not differ from NFs in either threshold. The kinematics in the single-step threshold trial in RFs, however, showed a significant delay in step initiation duration, longer step duration, and larger center of mass (CoM) displacement compared with NFs and OFs. In the multiple-step threshold trial, the RFs exhibited larger CoM displacements and longer time to fully recover from balance loss. Interestingly, in the single-stepping trials, 45% of the step-recovery strategies used by RFs were the loaded-leg strategy, about two times more than OFs and NFs (22.5 and 24.2%, respectively). During the multiple-stepping trials, 27.3% of the first-step recovery strategies used by RFs were the loaded-leg strategy about two times more than OFs and NFs (11.9 and 16.4%, respectively), the crossover stepping strategy was the dominated response in all 3 groups (about 50%). In addition, RFs reported a lower low-extremity function compared with NFs, and higher FES in the OFs.

Conclusions: RFs had impaired kinematics during both single-step and multiple-step recovery responses which was associated with greater leg dysfunction. OFs and NFs had similar recovery-step kinematics, but OFs were more likely to step at lower perturbation magnitudes suggesting a more "responsive" over-reactive step response related from their higher fear of falling and not due to impaired balance abilities. These data provide insight into how a varying history of falls might affect balance recovery to a lateral postural perturbation.

Trial Registration: This study was registered prospectively on November 9th, 2011 at clinicaltrials.gov ( NCT01439451 ).

Citing Articles

Older Fallers' Comprehensive Neuromuscular and Kinematic Alterations in Reactive Balance Control: Indicators of Balance Decline or Compensation? A Pilot Study.

Zhu R, Hung T, Lam F, Li J, Luo Y, Sun J Bioengineering (Basel). 2025; 12(1).

PMID: 39851340 PMC: 11762401. DOI: 10.3390/bioengineering12010066.

The Stepping Threshold Test for assessing reactive balance discriminates between older adult fallers and non-fallers.

Hezel N, Buchner T, Becker C, Bauer J, Sloot L, Steib S Front Sports Act Living. 2024; 6:1462177.

PMID: 39465209 PMC: 11502312. DOI: 10.3389/fspor.2024.1462177.

Characteristics of Unsuccessful Balance Reactive Responses to Lateral Loss of Balance in Older Adults.

Batcir S, Berdichevsky Y, Bachner Y, Lubovsky O, Debi R, Melzer I Gerontology. 2024; 70(7):689-700.

PMID: 38657580 PMC: 11239142. DOI: 10.1159/000535968.

Curvilinear walking elevates fall risk and modulates slip and compensatory step attributes after unconstrained human slips.

Rasmussen C, Mun S, Ouattas A, Walski A, Curtze C, Hunt N J Exp Biol. 2024; 227(6).

PMID: 38456285 PMC: 11006391. DOI: 10.1242/jeb.246700.

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

Melo-Alonso M, Murillo-Garcia A, Leon-Llamas J, Villafaina S, Gomez-Alvaro M, Morcillo-Parras F J Clin Med. 2024; 13(2).

PMID: 38276141 PMC: 10816706. DOI: 10.3390/jcm13020635.

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