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5 - Biomechanics of Balance and Falling

from Part I - Epidemiology and Risk Factors for Falls

Published online by Cambridge University Press:  04 November 2021

Stephen R. Lord
Affiliation:
Neuroscience Research Australia, Sydney
Catherine Sherrington
Affiliation:
Sydney Medical School
Vasi Naganathan
Affiliation:
Concord Hospital
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Summary

In biomechanical terms, balance control is the maintenance of the body’s centre of mass (COM: the point around which the body’s mass is equally distributed) within the limits of the base of support (BOS: the area circumscribed by parts of the body that are in contact with a support surface) in the horizontal plane. Simply put, the vertical line of gravity acting through the COM (also termed the centre of gravity), must remain within the BOS for a body to remain in postural equilibrium. Falling is the loss of balance control, i.e. when the vertical projection of the COM moves beyond the BOS. Without a successful balance-correcting response or external intervention to arrest the falling state and regain postural equilibrium, a fall (to the ground or some other lower level) will result. Biomechanical investigations have sought to understand falling by characterizing balance control while standing, walking, during postural transitions, and following unexpected perturbations. These studies complement epidemiological and physiological investigations of fall risk. Findings can help to inform the development of intervention strategies and in turn, biomechanical investigations can enable the evaluation of their effects.

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Chapter
Information
Falls in Older People
Risk Factors, Strategies for Prevention and Implications for Practice
, pp. 105 - 118
Publisher: Cambridge University Press
Print publication year: 2021

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References

Hellebrandt, FA, Braun, GL. The influence of sex and age on the postural sway of man. Am J Phys Anthrolpol. 1939;24:347–60.Google Scholar
Winter, DA, Patla, AE, Ishac, M et al. Motor mechanisms of balance during quiet standing. J Electromyogr Kinesiol. 2003;13:4956.Google Scholar
Winter, DA. The Biomechanics and Motor Control of Human Gait: Normal, Elderly and Pathological. Waterloo, Ontario: University of Waterloo Press; 1991.Google Scholar
Piirtola, M, Era, P. Force platform measurements as predictors of falls among older people: a review. Gerontology. 2006;52:116.Google Scholar
Thapa, PB, Gideon, P, Brockman, KG et al. Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents. J Gerontol A Biol Sci Med Sci. 1996;51:M239–46.Google ScholarPubMed
Maki, BE, Holliday, PJ, Topper, AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol. 1994;49:M7284.CrossRefGoogle Scholar
Era, P, Schroll, M, Ytting, H et al. Postural balance and its sensory-motor correlates in 75-year-old men and women: a cross-national comparative study. J Gerontol A Biol Sci Med Sci. 1996;51:M5363.Google Scholar
Era, P, Heikkinen, E. Postural sway during standing and unexpected disturbance of balance in random samples of men of different ages. J Gerontol. 1985;40:287–95.CrossRefGoogle ScholarPubMed
Era, P, Heikkinen, E, Gause-Nilsson, I et al. Postural balance in elderly people: changes over a five-year follow-up and its predictive value for survival. Aging Clin Exp Res. 2002;14:3746.Google Scholar
Baloh, RW, Corona, S, Jacobson, KM et al. A prospective study of posturography in normal older people. J Am Geriatr Soc. 1998;46:438–43.CrossRefGoogle ScholarPubMed
Lord, SR, Clark, RD. Simple physiological and clinical tests for the accurate prediction of falling in older people. Gerontology. 1996;42:199203.Google Scholar
Lord, SR, Rogers, MW, Howland, A et al. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc. 1999;47:1077–81.Google Scholar
Duncan, G, Wilson, JA, MacLennan, WJ et al. Clinical correlates of sway in elderly people living at home. Gerontology. 1992;38:160–6.Google Scholar
Lichtenstein, MJ, Shields, SL, Schiavi, R et al. Clinical determinants of biomechanics platform measures of balance in aged women. J Am Geriat Soc. 1988;36:9961002.Google Scholar
Lord, SR, Clark, RD, Webster, IW. Visual acuity and contrast sensitivity in relation to falls in an elderly population. Age Ageing. 1991;20:175–81.Google Scholar
Stelmach, GE, Phillips, J, DiFabio, RP et al. Age, functional postural reflexes, and voluntary sway. J Gerontol. 1989;44:B100–6.Google Scholar
Maki, BE, Holliday, PJ, Topper, AK. Fear of falling and postural performance in the elderly. J Gerontol. 1991;46:M123–31.CrossRefGoogle ScholarPubMed
Adkin, AL, Carpenter, MG. New insights on emotional contributions to human postural control. Front Neurol. 2018;9:789.Google Scholar
Lord, SR, Sambrook, PN, Gilbert, C et al. Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust. 1994;160:684–5, 68891.CrossRefGoogle ScholarPubMed
Lord, SR, Castell, S. Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time. Arch Phys Med Rehabil. 1994;75:648–52.Google Scholar
Lord, SR, Clark, RD, Webster, IW. Physiological factors associated with falls in an elderly population. J Am Geriatr Soc. 1991;39:1194–200.Google Scholar
Horak, FB, Diener, HC, Nashner, LM. Influence of central set on human postural responses. J Neurophysiol. 1989;62:841–53.CrossRefGoogle ScholarPubMed
Bothner, KE, Jensen, JL. How do non-muscular torques contribute to the kinetics of postural recovery following a support surface translation? J Biomech. 2001;34:245–50.Google Scholar
Runge, CF, Shupert, CL, Horak, FB et al. Ankle and hip postural strategies defined by joint torques. Gait Posture. 1999;10:161–70.CrossRefGoogle ScholarPubMed
Brown, LA, Jensen, JL, Korff, T et al. The translating platform paradigm: perturbation displacement waveform alters the postural response. Gait Posture. 2001;14:256–63.Google Scholar
Tokuno, CD, Cresswell, AG, Thorstensson, A et al. Age-related changes in postural responses revealed by support-surface translations with a long acceleration-deceleration interval. Clin Neurophysiol. 2010;121:109–17.Google Scholar
Luchies, CW, Alexander, NB, Schultz, AB et al. Stepping responses of young and old adults to postural disturbances: kinematics. J Am Geriatr Soc. 1994;42:506–12.CrossRefGoogle Scholar
Rogers, MW, Hedman, LD, Johnson, ME et al. Lateral stability during forward-induced stepping for dynamic balance recovery in young and older adults. J Gerontol A Biol Sci Med Sci. 2001;56:M589–94.Google Scholar
McIlroy, WE, Maki, BE. Age-related changes in compensatory stepping in response to unpredictable perturbations. J Gerontol A Biol Sci Med Sci. 1996;51A:M289–96.Google Scholar
Hsiao-Wecksler, ET, Robinovitch, SN. The effect of step length on young and elderly women’s ability to recover balance. Clin Biomech. 2007;22:574–80.Google Scholar
Thelen, DG, Wojcik, LA, Schultz, AB et al. Age differences in using a rapid step to regain balance during a forward fall. J Gerontol A Biol Sci Med Sci. 1997;52:M813.Google Scholar
Sturnieks, DL, Menant, J, Delbaere, K et al. Force-controlled balance perturbations associated with falls in older people: a prospective cohort study. PloS One. 2013;8:e70981.CrossRefGoogle ScholarPubMed
Hilliard, MJ, Martinez, KM, Janssen, I et al. Lateral balance factors predict future falls in community-living older adults. Arch Phys Med Rehabil. 2008;89:1708–13.Google Scholar
Carty, CP, Cronin, NJ, Nicholson, D et al. Reactive stepping behaviour in response to forward loss of balance predicts future falls in community-dwelling older adults. Age Ageing. 2015;44:109–15.CrossRefGoogle ScholarPubMed
Alexander, NB, Shepard, N, Gu, MJ et al. Postural control in young and elderly adults when stance is perturbed: kinematics. J Gerontol. 1992;47:M7987.Google Scholar
Pai, YC, Patton, J. Center of mass velocity-position predictions for balance control. J Biomech. 1997;30:347–54.Google Scholar
Hof, AL, Gazendam, MG, Sinke, WE. The condition for dynamic stability. J Biomech. 2005;38:18.Google Scholar
Rogers, MW, Mille, M-L. Chapter 5 – Balance perturbations. In: Day, BL, Lord, SR, Eds. Handbook of Clinical Neurology. Netherlands: Elsevier; 2018; 159:85105.Google Scholar
Dietz, V, Schubert, M, Trippel, M. Visually induced destabilization of human stance: neuronal control of leg muscles. Neuroreport. 1992;3:449–52.Google Scholar
Mille, ML, Rogers, MW, Martinez, K et al. Thresholds for inducing protective stepping responses to external perturbations of human standing. J Neurophysiol. 2003;90:666–74.CrossRefGoogle ScholarPubMed
Maki, BE, Edmondstone, MA, McIlroy, WE. Age-related differences in laterally directed compensatory stepping behavior. J Gerontol A Biol Sci Med Sci. 2000;55:M270–7.Google Scholar
Mille, ML, Johnson, ME, Martinez, KM et al. Age-dependent differences in lateral balance recovery through protective stepping. Clin Biomech. 2005;20:607–16.Google Scholar
Rogers, MW, Mille, ML. Lateral stability and falls in older people. Exerc Sport Sci Rev. 2003;31:182–7.Google Scholar
Talbot, LA, Musiol, RJ, Witham, EK et al. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health. 2005;5:86.Google Scholar
Prudham, D, Evans, JG. Factors associated with falls in the elderly: a community study. Age Ageing. 1981;10:141–6.Google Scholar
Campbell, AJ, Reinken, J, Allan, BC et al. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981;10:264–70.CrossRefGoogle ScholarPubMed
Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.Google Scholar
Blake, A, Morgan, K, Bendall, M et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988;17:365–72.Google Scholar
Lord, SR, Ward, JA, Williams, P et al. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health. 1993;17:240–54.CrossRefGoogle ScholarPubMed
Teno, J, Kiel, DP, Mor, V. Multiple stumbles: a risk factor for falls in community-dwelling elderly: a prospective study. J Am Geriatr Soc. 1990;38:1321–5.Google Scholar
Chen, HC, Ashton-Miller, JA, Alexander, NB et al. Effects of age and available response time on ability to step over an obstacle. J Gerontol. 1994;49:M227–33.Google Scholar
Chen, HC, Schultz, AB, Ashton-Miller, JA et al. Stepping over obstacles: dividing attention impairs performance of old more than young adults. J Gerontol A Biol Sci Med Sci. 1996;51:M116–22.Google Scholar
van Dieën, JH, Pijnappels, M, Bobbert, MF. Age-related intrinsic limitations in preventing a trip and regaining balance after a trip. Safety Sci. 2005;43:437–53.Google Scholar
Eng, JJ, Winter, DA, Patla, AE. Strategies for recovery from a trip in early and late swing during human walking. Exp Brain Res. 1994;102:339–49.CrossRefGoogle ScholarPubMed
Grabiner, MD, Koh, TJ, Lundin, TM et al. Kinematics of recovery from a stumble. J Gerontol. 1993;48:M97102.Google Scholar
Pijnappels, M, Bobbert, MF, van Dieen, JH. Contribution of the support limb in control of angular momentum after tripping. J Biomech. 2004;37:1811–18.Google Scholar
Pijnappels, M, Bobbert, MF, van Dieen, JH. Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture. 2005;21:388–94.Google Scholar
Brady, RA, Pavol, MJ, Owings, TM et al. Foot displacement but not velocity predicts the outcome of a slip induced in young subjects while walking. J Biomech. 2000;33:803–8.Google Scholar
Moyer, BE, Chambers, AJ, Redfern, MS et al. Gait parameters as predictors of slip severity in younger and older adults. Ergonomics. 2006;49:329–43.CrossRefGoogle ScholarPubMed
Lockhart, TE, Woldstad, JC, Smith, JL. Effects of age-related gait changes on the biomechanics of slips and falls. Ergonomics. 2003;46:1136–60.CrossRefGoogle ScholarPubMed
Pavol, MJ, Runtz, EF, Edwards, BJ et al. Age influences the outcome of a slipping perturbation during initial but not repeated exposures. J Gerontol A Biol Sci Med Sci. 2002;57:M496503.Google Scholar
Lockhart, TE, Smith, JL, Woldstad, JC. Effects of aging on the biomechanics of slips and falls. Hum Factors. 2005;47:708–29.Google Scholar
Lord, SR, Ward, JA, Williams, P et al. An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health. 1993;17:240–5.Google Scholar
Overstall, PW, Exton-Smith, AN, Imms, FJ et al. Falls in the elderly related to postural imbalance. Br Med J. 1977;1:261–4.CrossRefGoogle ScholarPubMed
Berg, WP, Alessio, HM, Mills, EM et al. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing. 1997;26:261–8.Google Scholar
Topper, AK, Maki, BE, Holliday, PJ. Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall? J Am Geriatr Soc. 1993;41:479–87.Google Scholar
Nevitt, MC, Cummings, SR. Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 1993;41:1226–34.Google Scholar
Robinovitch, SN, Feldman, F, Yang, Y et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet. 2013;381:4754.Google Scholar
O’Neill, TW, Varlow, J, Silman, AJ et al. Age and sex influences on fall characteristics. Ann Rheum Dis. 1994;53:773.CrossRefGoogle ScholarPubMed
Vellas, BJ, Wayne, SJ, Garry, PJ et al. A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol A Biol Sci Med Sci. 1998;53A:M264–74.Google Scholar
Palvanen, M, Kannus, P, Parkkari, J et al. The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int. 2000;11:822–31.Google Scholar
Hayes, WC, Myers, ER, Morris, JN et al. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int. 1993;52:192–8.Google Scholar
Choi, WJ, Wakeling, JM, Robinovitch, SN. Kinematic analysis of video-captured falls experienced by older adults in long-term care. J Biomech. 2015;48:911–20.Google Scholar
DeGoede, KM, Ashton-Miller, JA. Fall arrest strategy affects peak hand impact force in a forward fall. J Biomech. 2002;35:843–8.Google Scholar
Hsiao, ET, Robinovitch, SN. Common protective movements govern unexpected falls from standing height. J Biomech. 1998;31:19.Google Scholar
Pai, YC, Bhatt, T, Yang, F et al. Perturbation training can reduce community-dwelling older adults’ annual fall risk: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2014;69:1586–94.Google Scholar
Gatts, SK, Woollacott, MH. How tai chi improves balance: biomechanics of recovery to a walking slip in impaired seniors. Gait Posture. 2007;25:205–14.Google Scholar
Groen, BE, Smulders, E, de Kam, D et al. Martial arts fall training to prevent hip fractures in the elderly. Osteoporos Int. 2010;21:215–21.Google Scholar
Lauritzen, JB, Petersen, MM, Lund, B. Effect of external hip protectors on hip fractures. Lancet. 1993;341:1113.Google Scholar

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