This thesis investigates walking patterns in healthy young people and in people with an increased risk of falling, and determines the physiological contributions to walking stability. First, a review of the relevant literature on techniques for assessing walking stability, age-related changes in balance and gait, and the contributions of vision, vestibular function, peripheral sensation and strength was undertaken. In response to a critical analysis of these findings, a new technique and protocol for the assessment of walking stability was developed. This involved measuring and analysing head and pelvis accelerations while subjects walked on a level surface and an irregular surface. Gait patterns were studied in 30 young healthy subjects and two groups known to be at increased risk of falling - 100 subjects over the age of 75, and 30 subjects with diabetic peripheral neuropathy. A series of vision, sensation, strength, reaction time and balance tests were also undertaken to identify subjects??? physiological abilities and risk of falls. Acceleration patterns of the head and pelvis differed according to physiological risk of falling, particularly when walking on the irregular surface. Those with a high risk of falling walked with a reduced velocity, cadence and step length, and exhibited less rhythmic acceleration patterns at the head and pelvis. Gait patterns were significantly associated with leg strength, peripheral sensation and reaction time. It is concluded that subjects with a high physiological risk of falling exhibit characteristic patterns of walking that indicate an impaired ability to control the movement of the pelvis and head, which may predispose to loss of balance.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1990.

INTRODUÇÃO: Frente ao aumento gradativo de quedas da própria altura com o avançar da idade, torna-se imprescindível conhecer os fatores de risco implicados na sua ocorrência em mulheres na transição e após menopausa, com o intuito de contribuir com estratégias de prevenção e promoção da saúde no cotidiano. OBJETIVO: Estimar a prevalência de quedas referidas e caracterizar a associação entre as quedas com variáveis clínicas e epidemiológicas das mulheres da Estratégia de Saúde da Família do Município de Pindamonhangaba, SP. MÉTODOS: Em estudo com delineamento observacional do tipo transversal vinculado ao Projeto de Saúde de Pindamonhangaba (PROSAPIN), foram utilizados dados secundários randomizados de 875 mulheres com idade entre 35 a 65 anos e investigadas por meio de um inquérito domiciliar e medidas antropométricas. A variável queda foi incluída como dependente, enquanto que as independentes foram representadas pela idade, estado civil, renda, escolaridade, raça, ocupação, histórico ginecológico, doenças crônicas referidas e mensuradas, medicamentos, obesidade (índice de massa corpórea), hábito alimentar, consumo de bebidas alcoólicas, tabagismo, sono, depressão e atividade física habitual. RESULTADOS: Participaram do estudo 749 mulheres com média de 47,7 anos (com desvio padrão de 8,1); a prevalência de quedas da própria altura foi de 17,6 por cento (IC de 14,9 - 20,5), sendo a maioria (54,6 por cento) na pós menopausa. Das mulheres que caíram, a prevalência de recorrência foi de 45,2 por cento. As principais causas foram escorregões (29,4 por cento) e tropeços (19,8 por cento). Após análise multivariada constatou-se associação das quedas com a idade (p=0,018), qualidade do sono ruim (0,007) e comorbidades como a hipertensão arterial (p=0,032) e depressão (p=0,003). As comorbidades hipertensão arterial (p=0,055) e depressão (p=0,001) associaram-se também as quedas recorrentes, bem como restrições às atividades de vida diária (p=0,000). CONCLUSÃO: A maior prevalência de quedas ocorreu após a menopausa e entre os principais fatores associados à sua gênese emergiram a idade, hipertensão arterial, depressão e sono ruim / INTRODUCTION: Faced the gradual increase of falls from height with advancing age, it becomes essential to know the risk factors of the falls on women in transition and after menopause, in order to contribute with strategies for prevention and health promotion in their daily routine. OBJECTIVE: To estimate the prevalence of referred falls and characterize the association between falls and clinical and epidemiological variables of women of the Family Health Strategy of Pindamonhangaba City, SP. METHODS: In a study with observational design of the type cross-sectional linked to Health Project of Pindamonhangaba (PROSAPIN), it was used secondary randomized data from 875 women from 35 to 65 years old and they were investigated through a household survey and anthropometric measurements. The falls were included as a dependent variable and age, marital status, income, education, race, occupation, gynecologic history, chronic disease and those measured, medicines, obesity (body mass index), dietary habits, alcohol consumption, smoking, sleep, depression and physical activity. RESULTS: There were 749 women investigated with average age of 47.7 years (standard deviation 8.1); the prevalence of falls from height was 17.6 percent (95 percentCI: 14.9 - 20.5), the majority (54.2 percent) of the fallers were in the post menopausal. Of the women who fell, the prevalence of recurrence was 45.2 percent. The main causes were slipping (29.4 percent) and setbacks (19.8 percent). After multivariate analysis, it was found an association of falls with age (p=0.018), poor sleep quality (p=0.007) and comorbidities as hypertension (p=0.032) and depression (p=0.003). The comorbidities hypertension (p=0.055) and depression (p=0,001) associated too with recurrent falls, as well restricted the activities of daily living (p=0.000). CONCLUSION: The highest prevalence of falls occurred after the menopause and among the main factors associated its genesis emerged the age, hypertension, depression and bad sleep

Abstract Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease which is characterized by resting tremor, rigidity, bradykinesia and postural instability. Advanced PD is often complicated by falls, immobilisation and progressive deterioration of overall physical capability that may jointly contribute to a reduced quality of life and even to increased mortality. The purpose of this study was to identify risk factors for falls and mortality in PD, to assess the clinical correlates of balance and mobility, and to evaluate the association between orthostatic hypotension (OH), balance and mobility. From a total population of approximately 205 000 inhabitants, 125 patients with idiopathic PD were included in the study. Baseline medical data including occurrence of recent falls were collected, and patients were clinically tested for balance, mobility and orthostatic blood pressure reactions. Falls were thereafter prospectively recorded for two years using fall diaries and follow-up calls. Mortality was documented by reviewing the hospital charts four years after the baseline examination. In the cross-sectional part of the study, one-third of the patients reported recent falling. Disease duration and severity, recent falling and use of a walking aid were predictors of increased postural sway in PD. Advanced age and severity of the disease were related to impaired balance and mobility in PD patients. Severity of the disease and increased postural sway were independent risk factors for recent falling in PD, whereas measures of mobility were less important in this manner. Fifty-three percent of the patients had OH in the orthostatic test. Patients with OH had significantly increased postural sway in standing compared to patients without OH. On the contrary, OH was not associated with mobility and walking speed. In the present data, OH was not associated with the risk of falling in PD. Sixty-three percent of the study patients experienced falls and almost half of the subjects fell recurrently during the two-year follow-up. History of falling and disease severity indicated increased risk of recurrent falls in PD, while patients with slow walking speed had an increased risk of mortality. The results show that balance impairment and falls are common features in PD. Slow walking speed may be associated with increased mortality in PD.