To understand how falls occur during walking in older adults, we need to understand how the nervous system maintains stability, and how aging affects walking. Four studies were conducted to better understand the effect of age on gait. Older adults display higher gait variability compared to young adults, possibly because of their slower walking. We compared gait stability at multiple controlled walking speeds. Greater gait variability in healthy elderly existed independent of slower walking. Their diminished strength and flexibility partly explained this difference. To explain slower walking in the elderly, some have suggested that muscle weakness and stiffness may force people to walk slower. Others have suggested that people choose to walk slower to be more stable. We compared dynamic stability of gait at multiple speeds. Healthy older adults also exhibited more stability at slower speeds, yet walked at speeds comparable to young adults despite the lower strength and flexibility. Therefore, weakness and stiffness may not force healthy older adults to walk slower. The goal of the nervous system during walking may be to maintain stability of superior segments. We tested whether superior segments are more stable than inferior segments during walking. Superior segments exhibited less orbital stability during preferred walking speed, in contrast to previous suggestions. This highlighted the importance of trunk control during gait. The effects of aging on the fluctuations in the muscle activity during gait are not well understood. We quantified the stride-to-stride fluctuations of EMG as a measure of muscle activation patterns in state-space. Variability increased with speed except in the gastrocnemius. Orbital stability was less in older adults, suggesting that deviations in the EMG amplitude pattern were not readily corrected. Less local stability was seen in older adults, suggesting that older adults were more sensitive to perturbations. Together, these findings suggest that trunk control is important during gait. Strength and flexibility deficits help explain higher variability and lower stability in older adults. Future work will need to address the effect of strength interventions, neurophysiological decline on gait stability and fall risk.

INTRODUCTION: Older people are a vulnerable population for falls and the risk may be increased by unfamiliar hospital environments. Using a mixed method ergonomic approach to acknowledge the complexity of contemporary hospital environments, this thesis aims to explore the associations between patient characteristics and environmental causal factors of in-patient falls for older people. METHODS: A series of three exploratory pilot studies were carried out, followed by two large scale research projects using nationally collected data from patient incident reports and overnight bedrail audits. The mixed method approach included; secondary data analysis, interviews, surveys, and audits. MAIN FINDINGS: 1. Patients in care of older people wards have different characteristics compared to same age peers in other wards, with higher levels of frailty and confusion. 2. Bedrail use was found to rise with increasing level of confusion which is against general guidance. Staff rationales for bedrail use suggested an underlying intent to restrain confused patients. 3. Up to 92% of patients falls were reported to be un-witnessed. This may be explained by only 24% of patient beds being visible from nursing stations. 4. There were significant differences found in the fall locations between patients who were described as frail and those who were described as confused. CONCLUSION: Patients in care of older people wards have a different set of characteristics compared to same age peers in other wards. This suggests that they will have different requirements for fall prevention in terms of layout, visibility, equipment use and facilitating independence. Further research should focus on designing wards for care of older people patients which improve visibility, layout and way-finding to toilets and investigate whether these design improvements will facilitate independent movement and prevent patient falls.

Falls in the elderly are a major cause of mortality and morbidity. Elderly people with visual impairment have been found to be at increased risk of falling, with poor visual acuity in one eye causing greater risk than poor binocular visual acuity. The present study investigated whether monocular refractive blur, at a level typically used for monovision correction, would significantly reduce stereoacuity and consequently affect gait parameters when negotiating a raised surface. Fourteen healthy subjects (25.8 ± 5.6 years) walked up to and on to a raised surface, under four visual conditions; binocular, +2DS blur over their non-dominant eye, +2DS blur over their dominant eye and with their dominant eye occluded. Analysis focussed on foot positioning and toe clearance parameters. Monocular blur had no effect on binocular acuity, but caused a small decline in binocular contrast sensitivity and a large decline in stereoacuity (p < 0.01). Vertical toe clearance increased under monocular blur or occlusion (p < 0.01) with a significantly greater increase under blur of the dominant eye compared with blur of the non-dominant eye (p < 0.01). Increase in toe clearance was facilitated by increasing maximum toe elevation (p < 0.01). Findings indicate that monocular blur at a level typically used for monovision correction significantly reduced stereoacuity and consequently the ability to accurately perceive the height and position of a raised surface placed within the travel path. These findings may help explain why elderly individuals with poor visual acuity in one eye have been found to have an increased risk of falling.

Collaboration has become a critical trend in the field of distance education. Many studies indicated that academic administrators believe in the positive impact of distance education, but they did not consider their roles in making distance learning programs effective. It is beneficial to investigate the administrators’ perceptions of establishing relationships with the other partners for enhancing the competitive advantages of their distance learning programs. This study examines the incentives that drive distance education administrators to consider collaboration. It also reveals how the administrator’s role influences the function and development of collaboration. In order to uncover administrators’ incentives for interorganizational coordination, this study implemented semi-structured interviews and document reviews for data collection through a case named INAC, which was an international academic joint venture by using videoconferencing technology. Eight interviewees comprised two higher-level administrators, 4 mid-level administrators, and 2 lower administrators. The open and axial coding techniques were used to process collected data. The findings indentified four administrative incentives: the opportunity of international exchanges, technology, organizational prestige, and commercialization. These incentives influenced the interorganizational coordination in terms of goals development, participant recruitment, resource leveraging, communication enhancing, and course design. In addition, the INAC project was compared with the literature based on Mattessich’s model (2003). It illustrated how the collaboration components, such as leadership, evaluation, communication, goals, budget, and technology, influenced the development of interorganizational coordination in the practical context. / Department of Educational Studies

Healthy spiritual development of adolescents is lacking in our society. Research shows that the topic of spiritual development for adolescents has been neglected for some time. It is clear from Scripture that spiritual development needs to take place in the life of a believer and that it is in fact an ongoing process. Even though spirituality has not been classified as something scientific during the modern era, spirituality has made its way back in scientific circles. The scientific disciplines of sociology and psychology have indicated that adolescents have a need for spiritual development and that spiritual issues are important to them. However, adolescents of the twenty-first century also face some unique challenges that have an impact on their spiritual development. Both the quantitative and qualitative methods of research were used and it was clear from both these studies that there were certain areas with regard to spiritual development that needed attention. The results in particular showed that the majority of those adolescents who took part in the research did not spend enough time on spiritual practices and most of them have taken part in some form of risky behaviour. The overall influences from family, friends and youth leaders were positive and in general it seemed that the majority of adolescents who took part in the research had a good relationship with parents and youth leaders. Adolescents need help in their spiritual development and according to Scripture parents and youth/church leaders have the responsibility to assist them. Guidance was given to adolescents and to major role players in their lives to assist them in the process of spiritual development. / Thesis (MA (Pastoral Studies))--North-West University, Potchefstroom Campus, 2013

The high incidence of falls and fall-related injuries among Canadians over the age of 65 continues to be a key public health issue. As the current proportion of individuals within this cohort of the population is predicted to double by the year 2031, the absolute number of individuals experiencing falls, fall-related injuries and subsequent hospitalization will increase dramatically. While a fall in any direction can lead to injury and reduced quality of life, lateral falls have been shown to be prevalent and can be particularly devastating because of the increased probability of hip fracture. Forward stepping tasks, whether initiated volitionally or by external perturbation, pose a challenge to stability, as they require the precise regulation of the spatial and temporal characteristics of the whole body centre of mass (COM) in relation to a changing base of support (BOS). Despite our understanding of both proactive and reactive mechanisms for balance control at movement initiation during such stepping tasks, there appears to be little understanding or consensus regarding the origins of age-related decline in mediolateral stability, which can manifest during the restabilisation phase, at movement termination. From this, the global objective of this thesis was to develop further understanding regarding such age-related differences in mediolateral dynamic stability control during the restabilisation phase of forward stepping. Notwithstanding the well documented differences between volitional and perturbation-evoked stepping until the time of foot-contact, we have proposed the control of the COM during the restabilisation phase of such stepping tasks to be a central determinant of age-related differences in mediolateral dynamic stability, common to both forms of stepping. We quantified the COM kinematics during the restabilisation phase and calculated the magnitude of incongruity between the peak and final, stable, COM position, in addition to the intertrial variability of this incongruity. Further, we analysed the orientation of the net ground reaction force (GRF) with respect to the COM, which allowed us to draw conclusions regarding the mechanisms that may be responsible for the age-related differences in the COM kinematics. To vary the challenge to control, we included conditions in which individuals were required to step with altered step width. In addition, we attempted to probe the extent and means by which individuals could alter the dynamics of stepping over time, with trial repetition. In general, we found that overshoots of the final COM position were common to all forms of stepping and may serve the functional role of simplifying reactive control during the restabilisation phase. The magnitude and intertrial variability of incongruity, however, were greater among the older adults during all forms of stepping. We believe such increased COM incongruity is likely indicative of greater instability within this group, which may be associated with the increased time required to reorient the net GRF in a manner necessary to oppose the total body angular momentum that developed during the swing phase. Particularly interesting was the use of proactive strategies by older adults, which may have the potential to offset instability that arises due to difficulty with reactive control during the restabilisation phase. The present work provides support for previous studies, which have suggested that the control of mediolateral stability may be particularly challenging for older adults. Further, our work provides evidence that the challenges associated with mediolateral stability control have important links to the restabilisation phase and are common to both volitional and reactive stepping. This work highlights the need to further explore the control of mediolateral stability and develop therapeutic interventions to reduce such incidence of instability among older adults.

No description available.

Although footwear has been recognised as a risk factor for falls in older people, it remains unclear as to which features of shoes are beneficial or detrimental to balance. This project aimed to systematically investigate the effects of common shoe features, namely: an elevated heel, a soft sole, a hard sole, a flared sole, a bevelled heel, a high-collar and a tread sole, on balance and gait in older community-dwelling people. The experimental shoes were compared to standard shoes in three studies examining: (i) standing balance, leaning balance and stepping in 29 older people, (ii) centre of mass (COM)-base of support (BOS) margins, vertical and braking loading rates, and perceived shoe comfort and stability in 11 young and 15 older people walking on even and uneven surfaces, and (iii) temporal-spatial gait variables, pelvis acceleration, and gait termination in 10 young and 26 older people, on level, irregular and wet surfaces. Elevated heel shoes impaired overall performance in functional tests of balance and stepping. They were also perceived as lacking comfort and stability and led to a conservative walking pattern characterised by increased step width and double-support time, reduced braking and vertical loading rates and medio-lateral (ML) pelvis accelerations on various surfaces. Soft sole shoes increased lateral COM-BOS margin and step width, indicating reduced ML walking stability. When wearing these shoes, subjects had longer total stopping times and on the wet surface, smaller step lengths and shoe/floor angles at heel strike, suggesting a potential risk of slipping. When wearing high-collar shoes, subjects had better balance as demonstrated by small but significant increases in lateral COM-BOS margin, double-support time and step width, and decreases in ML pelvis accelerations on varying surfaces and in total stopping time on the wet surface. Shoes with hard, flared or tread soles or a bevelled heel did not affect balance. In conclusion, providing that they are fitted, have adequate fastening and perhaps a slip-resistant sole, shoes with a low square heel, a sole of medium hardness (shore A-40) and a high-collar provide the greatest stability for older people when walking on dry, wet and irregular surfaces.

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.

Balance dysfunction and the resultant falls and injuries, loss of confidence, alternations lifestyle and the overall costs are a major problem to older people in Australia. The studies in this thesis investigate discrete but inter-linked aspects of the problems of falls among community dwelling older people, including measurement issues, prediction of fallers, types of dysfunction related to clinical diagnoses, and the effect of multidisciplinary intervention. Preliminary studies of older people from both healthy and clinical samples identified high retest reliability for the dynamic balance tests on the Chattecx Balance System, high retest reliability and concurrent validity for a new clinical test of dynamic standing balance, and high retest reliability and predictive validity for an expanded scale to measure fear of falling. (For complete abstract open document)