O treinamento de respostas posturais reativas por perturbações posturais é um paradigma inovador para prevenir quedas. Entretanto, há carência de informação sobre como organizar a prática para obter os maiores benefícios. O objetivo deste experimento foi comparar os efeitos de sequências de perturbações posturais com baixa (BIC) versus alta (AIC) interferência contextual na aquisição de estabilidade de movimentos compensatórios de braços e pernas em indivíduos jovens saudáveis. Trinta e oito participantes foram distribuídos de forma pseudoaleatória em 3 grupos: AIC, BIC, e controle (CON). A tarefa consistiu em recuperar o equilíbrio corporal após perturbações imprevisíveis da base de apoio no sentido mediolateral, para ambos os lados em diferentes velocidades (20, 30 e 40 cm/s [o/s]). Os grupos experimentais realizaram sessão única com 24 tentativas de prática para cada uma das seguintes modalidades de perturbação postural: rotação, translação e combinação translação-rotação. O grupo CON permitiu a avaliação das primeiras respostas às perturbações posturais e foi usado como linha de base das respostas posturais sem treinamento para comparação com os grupos experimentais. Os participantes foram avaliados em pós-teste, retenção e transferência para os seguintes contextos: (1) tarefa dual de contagem regressiva durante perturbações, e (2) velocidade mais alta do que aquelas treinadas (50 cm/s [o/s]). Os movimentos compensatórios de braços e pernas foram avaliados utilizando a escala CALM e cinemática. Os resultados mostraram o seguinte: (a) o treinamento levou a escores de estabilidade mais altos; (b) os ganhos por treinamento perturbatório foram evidentes em perturbações mais desafiadoras à manutenção da postura ereta; (c) perturbações repetitivas induziram efeitos imediatos, porém não persistentes e generalizáveis; e (d) perturbações aleatorizadas induziram ganhos persistentes e generalizáveis de estabilidade de movimentos compensatórios. Como conclusão, o treinamento perturbatório do equilíbrio corporal com alta em comparação com baixa interferência contextual se mostrou mais efetivo em promover ganhos mais persistentes e transferíveis de estabilidade de movimentos compensatórios / Perturbation-based training of reactive postural responses is an innovative paradigm for preventing falls. However, there is scarce information on how to organize the practice to obtain the greatest benefits. The objective of this experiment was to compare different schedules of postural perturbations, with low (BIC) versus high (AIC) contextual interference, on the acquisition of stability of arm and leg compensatory movements in healthy young individuals. Thirty-eight participants were distributed pseudorandomly in three groups: AIC, BIC, and control (CON). The task consisted in recovering body balance after unpredictable perturbations through support base displacements in mediolateral direction, for both sides in different speeds (20, 30 e 40 cm/s [o/s]). The experimental groups performed a single session with 24 practice trials for each of the following modalities of postural perturbation: rotation, translation and combination translation-rotation. The CON group allowed the evaluation of the first responses to postural perturbations was used as a baseline of postural responses without training for comparison with the experimental groups. Participants were evaluated in post-test, retention and transfer to the following contexts: (1) dual task, of counting down during perturbations; and (2) speed higher than those trained (50 cm/s [o/s]). The compensatory arm and leg movements were evaluated using the CALM scale and kinematics. Results showed the following: (a) training led to higher stability scores; (b) gains from perturbation training were evident in the most challenging perturbations to stance; (c) repetitive perturbations induced immediate but not persistent and generalizable effects; and (d) random perturbations induced persistent and generalizable gains in stability of compensatory movements. In conclusion, perturbation-based balance training with high as compared to low contextual interference was shown to be more effective in promoting more persistent and transferable compensatory movement stability gains

Numerous Thai older people fall each year. Although it has been shown that only 3.1% of fallers sustained fractures (Nevitt, Cumming, Kidd, & Black, 1989), injuries in older people are often more serious. For example, hospital charges for older adult fall injuries are about US $2,000 per person higher than for young fallers (Ellis & Trent, 2001). Moreover, falling can lead to social isolation, physical restraint, disability and institutionalisation (Donald & Bulpitt, 1999; Tideiksaar, 1994). Therefore falling in old age results in a considerable burden on, not only the individual concerned, but also the whole society. Internationally, a successful falls prevention program usually employs a multidimensional approaches (Alexander & Edelberg, 2002; Mosley, Galindo- Ciocon, Peak, & West, 1998). However, limited information about fall prevention has been reported in Thailand. A survey indicated that Thai elderly fall outside their homes which is different from the findings in Western countries (Jitapunkul et al., 1998). This suggests that adoption of fall prevention strategies from Western countries might not be successful in Thailand. Prior to this study, details of fall circumstances in terms of location, time, associated activity, hazards and type of falls in Thai older people were not available. Moreover, there was no information about fear of falling and activity restriction. These are important fall consequences that impact on quality of life and themselves are risk factors for falls. The purpose of this study was to determine the prevalence of fear of falling, and to describe activity restriction in fallers and non-fallers, and the circumstances associated with falls in Thailand. No fear of falling measurement tools for Thai older people were available prior to the study. / Therefore the Survey of Activities and Fear of Falling in the elderly (SAFE) has been modified for use with Thai elderly people. The SAFE was translated to Thai by a certified translator, checked for cultural relevance and back-translated by a second translator; reliability testing then took place in Thailand. Face validity and cultural appropriateness were tested with a sample of convenience of 10 bilingual Thai elderly people living in Perth, Australia. After translation into Thai, 4 items showed less than 80% agreement and required adjustment to capture the equivalent meaning of the original version. The ‘take a show/wash yourself with a basin of water’ was added because the participants reported that taking a tub bath is not common or traditional in Thailand. However, the item ‘take a tub bath’ was retained until the examination in the main study confirmed that less than 1% of Thai older persons had taken a tub bath and inclusion of the item confounded actual fear of falling results. Interrater reliability was tested; nine 4th year occupational therapy students and 15 older persons living in the Chiang Mai community were recruited. The intraclass correlation coefficient of fear of falling of activities done, activities not done and activity restriction scores were .9845, .9236 and .9718 respectively (p < 0.001). Four raters and 50 older community dwellers participated in the intrarater and test-retest reliability tests. The results showed that intrarater reliability of all raters exceed 0.8 in every scores (p < .001). / The test-retest also demonstrated good reliability: .9960, .9376 and .9849 (p < 0.0001) for fear of falling of activities done, activities not done and activity restriction scores respectively. Five hundreds and forty six Thai older adults were then recruited by multistage random sampling. Fall history, fall circumstances, fear of falling and activity restriction data were obtained by structured interview and using the Thai version of the SAFE. The results demonstrated that prevalence of falls, fear of falling and activity restriction in Thai older people were 21%, 48% and 18%, respectively. Comparison between fallers and non-faller showed that fallers were more likely to be older (p < .001), female [χ2(1, N = 546) = 6.133; p = .013], not married [χ2 (4,N=546)=61.102;~= .001], living alone[χ2 (l,N=546)=4.313;p= ,041, rated their health as poorer [χ2 (4, N = 546) = 13.232; p < .001], had fear of falling [χ2 (1, N = 546) = 6.265; p = .015] and activity restriction [χ2 (1, N = 546) = 5.488; p = ,0271]. Older persons with a fear of falling tended to be older (p = .005), lower educated (p < .001), female [χ2 (1, N = 546) = 29.602; p = .001], rated their health as poorer [χ2 (4, N = 546) = 69.70; p < .001], had fallen [? (1, N = 546) = 6.265; p = ,0151 and had activity restriction [χ2 (l, N = 546) = 23.267; p < .001]. Older adults who curtailed their activities tended to be married [χ2 (1, N = 546) = 6.188; p = ,0131, rated their health as poorer [χ24, N = 546) = 14.302; p = ,0061, have a fall history [χ2 (1, N = 546) = 5.488; p = ,0271 and have a fear of falling [χ2(1, N = 546) = 23.267; p < .001]. / Using Chi-square test, the results showed that there were significant associations between falls and fear of falling χ2(l,N=546)=6.265;p=.015], falls and activity restriction [χ2 (l,N= 546) = 5.488; p = ,0271] and fear of falling and activity restriction [χ2 (1, N = 546) = 23.267; p < .001]. Fall circumstances of 114 falls demonstrated that most falls took place outdoors (65%), were associated with work (40%), involved environmental hazards (76%), occurred during the daytime (90%). Moreover most falls were falls on the same level from slipping, tripping or stumbling (61%). Logistic regression analysis indicated that risk factors for fear of falling in Thai older people were age (odds ratio = 1.025), unmarried-female (odds ratio = 5.979), married female (odds ratio = 1.903), poor self perceived health (odds ratio = 3.383) and more than 2 falls experience (odds ratio = 7.202). The protective factors were unmarried marital status for men (odds ratio = 0.344) and level of education (odds ratio = 0.933 2 or less falls and = 0.5625 if more than 2 falls in 12 months). The logistic model also provided a logistic equation for individual prediction of probability of fear of falling. To calculate the probability of having fear of falling, 6 parameters are required: age, gender, marital status, level of education, self-perceived health and number of falls in the past 12 months. The equation predicts with 70% accuracy and can be used for screening fear of falling in Thai elderly people. In conclusion, this study has modified a measurement tool (the SAFE Thai version) and developed a screening tool (logistic equation) for fear of falling. Both of them appear to be appropriate to further examine FOF in Thai elderly. The survey results showed a considerably number of Thai elderly people have fall experiences, fear of falling and activity restriction. / The predisposing factors for each problem have been identified. The association between 3 problems implicated that fear of falling and activity restriction interventions are necessary for fall prevention. The fall circumstances data show that conditions of falls in Thai elderly people were similar and dissimilar to those in Western countries. The preventive efforts to reduce falls should consider these distinctive fall circumstances.

The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

This study enabled the development of a brief, clinically fesible screening tool for falls and injury risk identification in older community-dwelling adults through a range of methods that included a literature review, a Case Note Audit of 128 people attending Falls and Balance clinic, and group,processes (Nominal Group and Delphi Panel with 12 and 10 participants respectively). These methods focussed on developing specifications for the screening tool, selecting key modifiable risk factors and associated tests for both falls and injury and considering questions that would determine self-perception of falls risk, general health and balance. The range of methods and process of triangulation ensured content validity of the tool. / thesis (MPhysiotherapy)--University of South Australia, 2002.

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.

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.

Although research evidence clearly indicates support surface properties are a major factor contributing to fall risk among the elderly, investigations examining the influence of variations in surface conditions on the postural control of older adults during task performance have been limited. Thus, the primary purpose of the present studies was to determine whether the coordination and control of body kinematics exhibited by older adults during upright leaning (i.e., leaning forward through the region of stability) and gait would be different across variations in support surface properties. Secondary objectives of these studies included, examining if coordination and control measures of body kinematics differed as a function of the participants' level of postural stability and/or repeated exposure to the support surface properties. Three support surface conditions were selected for inclusion based on resistance properties to applied forces (i.e., normal and shear): rigid, high friction; compliant; and rigid, low friction. For both tasks performed, body kinematics for trials 1-3 (T1) and 10-12 (T2) from 12 completed trials on each support surface were analyzed using three-dimensional (3-D) video analyses. Results of separate univariate repeated measures analyses of variance yielded significant surface condition main effects for lower extremity coordination patterns and postural control strategies in the gait and leaning task, respectively. Additionally, a significant surface condition main effect and an interaction effect of surface condition by trial block were identified for the measure of head stability in the gait and leaning tasks, respectively. Differences in head stability and the control of lower extremity joint motions as a function of level of postural stability (i.e., group differences) were observed only during the walking task. Present findings indicate that during goal-directed behavior, the coordinated movements of the body and its segments emerge from constraints imposed by the interaction of the support surface, the task and the individual. The observed adaptations in the coordination and control of posture in response to support surface constraints evidenced in the present studies provide support for the theory of perception and the control of bodily orientation (Riccio & Stoffregen, 1988). / Graduation date: 1998

Background and Purpose: Falls are the leading cause of accidental death among older adults. Reducing falls risk is one of the major safety concerns for older persons. More than one-third of people 65 years and older will experience one or more falls per year and nearly half of the people over 80 years of age will fall at least once each year. A key initial step in reducing falls is identifying those persons at highest risk so that they can be assessed and prescribed appropriate interventions. Therefore, the purpose of this study was to examine the capacity of a number of field and laboratory tests to identify fallers in a sample of older independently-living, community-dwelling persons. Participants: 66 healthy, independently living older persons, ages 60 and older. Method: During three visits to the laboratory, participants performed various field and laboratory balance tests. Field tests included the Timed Up and Go Test (TUG), the One-Leg Stand Test (OLS), the Functional Reach Test (FR), and the Tinetti Performance Oriented Mobility Assessment (POMA). The laboratory tests included a center of pressure (COP) test with time-to-boundary (TTB) measurements on a force platform, and dynamic posturography using the Proprio 5000. Each participant was classified as a “faller” or “non-faller” based on whether he or she recalled experiencing a fall within the past year. Results: Receiver-operated characteristics (ROC) curve analyses (specificity and sensitivity throughout the measurement ranges) revealed the OLS and TUG field tests and selected Proprio 5000 and TTB variables had the best capacity to distinguish fallers from non-fallers. For both field and laboratory tests one-way ANOVA revealed between-group differences similar to those indicated by the ROC results. Discussion and Conclusion: Both selected field and laboratory tests could identify fallers (16 out of 66). In addition, the laboratory tests revealed balance decrements in specific planes of motion that provide information concerning directional falls risk and a offer a framework for the prescription of interventions to reduce that risk.

Thesis (Ph. D.)--Oregon State University, 2007. / Printout. Includes bibliographical references (leaves 86-88). Also available on the World Wide Web.

Seniors are a growing segment of the population of the United States. By 2030 they will make up nearly 20% of the general population. Senior citizens face many health challenges as they age. Injury due to falling is a major concern for many in this age group. Research shows that approximately one third of seniors will fall each year. Injuries that result from falls have been identified as the number one cause of accidental death in this age group each year. While falls have been studied by researchers for a number of years, and some progress has been made in finding ways to improve balance in seniors, the high incidence of falls continues to plague this demographic. Many of the current treatments to improve balance are too expensive, not accessible, or not motivating for seniors. This research project explored the effect of using a readily available video-game system to address these barriers. The Wii Fit gaming system was used with participants three times each week for 30 minutes and the resulting changes were documented. The Berg Balance Scale and Timed Up and Go test, both frequently used by professionals to assess balance in seniors, were used to document balance change. Every participant showed improvement. The Activities-specific Balance Confidence scale, which is used to measure a person's fear of falling, was also used to assess the participant's confidence in their balance as well as the level of fear associated with falling. The results of this test were positive but not to the extent of the balance tests. Finally, each participant was interviewed to assess how easy to use the participants felt the Wii Fit was as well as the motivational qualities of the Wii Fit as a balance tool. Answers given by the participants in the interview were generally positive. These results indicate that the Wii Fit gaming system may be beneficial for improving balance in seniors.