Falls not only present a considerable health threat, but the resulting treatment and loss of working days also place a heavy economic burden on society. Gait instability is a major fall risk factor, particularly in geriatric patients, and walking is one of the most frequent dynamic activities of daily living. To allow preventive strategies to become effective, it is therefore imperative to identify individuals with an unstable gait. Assessment of dynamic stability and gait variability via biomechanical measures of foot kinematics provides a viable option for quantitative evaluation of gait stability, but the ability of these methods to predict falls has generally not been assessed. Although various methods for assessing gait stability exist, their sensitivity and applicability in a clinical setting, as well as their cost-effectiveness, need verification. The objective of this systematic review was therefore to evaluate the sensitivity of biomechanical measures that quantify gait stability among elderly individuals and to evaluate the cost of measurement instrumentation required for application in a clinical setting. To assess gait stability, a comparative effect size (Cohen's d) analysis of variability and dynamic stability of foot trajectories during level walking was performed on 29 of an initial yield of 9889 articles from four electronic databases. The results of this survey demonstrate that linear variability of temporal measures of swing and stance was most capable of distinguishing between fallers and non-fallers, whereas step width and stride velocity prove more capable of discriminating between old versus young (OY) adults. In addition, while orbital stability measures (Floquet multipliers) applied to gait have been shown to distinguish between both elderly fallers and non-fallers as well as between young and old adults, local stability measures (λs) have been able to distinguish between young and old adults. Both linear and nonlinear measures of foot time series during gait seem to hold predictive ability in distinguishing healthy from fall-prone elderly adults. In conclusion, biomechanical measurements offer promise for identifying individuals at risk of falling and can be obtained with relatively low-cost tools. Incorporation of the most promising measures in combined retrospective and prospective studies for understanding fall risk and designing preventive strategies is warranted.

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Kinematic measures for assessing gait stability in elderly individuals: a systematic review.

Objectives: To determine whether a specific, standardized training regimen can improve muscle strength and physical functioning in people with dementia.
Design: Double-blinded, randomized, controlled trial with 3-month intervention and 3-month follow-up period in 2006 to 2009.
Setting: Outpatient geriatric rehabilitation.
Participants: Individuals with confirmed mild to moderate dementia, no severe somatic or psychological disease, and ability to walk 10 m. Most participants were still living independently with or without supportive care.
Intervention: Supervised, progressive resistance and functional group training for 3 months specifically developed for people with dementia (intervention, n = 62) compared with a low-intensity motor placebo activity (control, n = 60).
Measurements: Primary outcome measures were one-repetition maximum in a leg press device for maximal strength and duration of the five-chair-stand test for functional performance. Secondary outcome measures were assessed for a number of established parameters for maximal strength, physical function, and physical activity.
Results: Training significantly improved both primary outcomes (percentage change from baseline: maximal strength, intervention group (IG): +51.5 ± 41.5 kg vs control group (CG): �1.0 ± 28.9 kg, P < .001; functional performance, IG: �25.9 ± 15.1 seconds vs CG: +11.3 ± 60.4 seconds, P < .001). Secondary analysis confirmed effects for all strength and functional parameters. Training gains were partly sustained during follow-up. Low baseline performance on motor tasks but not cognitive impairment predicted positive training response. Physical activity increased significantly during the intervention (P < .001).
Conclusion: The intensive, dementia-adjusted training was feasible and substantially improved motor performance in frail, older people with dementia and may represent a model for structured rehabilitation or outpatient training.

Physical Training Improves Motor Performance in People with Dementia: A Randomized Controlled Trial

Objective: The aim is to examine the validity and reliability of the Timed Up and Go Test with dual task for predicting the risk of falls. Standard values for the TUG with dual task were determined, taking account of age and gender.Design: Validation studySetting: Data was recorded for 120 volunteers in an outpatient physiotherapy centre.Subjects: The sample comprised 120 healthy men and women aged 60 to 87 years living at home. Twenty-three subjects selected at random were tested again, after one day and after one week, in order to ascertain the retest reliability.Main measures: Berg Balance Scale, times for Timed Up and Go Test with manual dual task (TUGman) and with cognitive dual task (TUGcog).Results: Strong correlations between the TUGman and the BBS (r = -0.72) and between the TUGcog and the BBS (r = -0.66) indicate high criterion validity. The retest reliability of the TUGman (rT1-T2 = 0.97 and rT1-T3 = 0.98) and TUGcog (rT1-T2 = 0.98 and rT1-T3 = 0.98) is very good. The intra-rater reliability is...

Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements:

Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits. Indeed, everyday walking in complex environments utilizes executive function, dual tasking, planning and scanning, all while walking forward. Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction. The proposed randomized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk. Three hundred older adults with a history of falls will be recruited to participate in this study. This will include older adults (n=100), patients with mild cognitive impairment (n=100), and patients with Parkinson’s disease (n=100). These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits. Subjects will be randomly assigned to the intervention group (treadmill training with virtual reality) or to the active-control group (treadmill training without virtual reality). Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks. Assessments will take place before, after, and 1 month and 6 months after the completion of the training. A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence (i.e., the number of falls, multiple falls and falls rate). In addition, we will measure gait under usual and dual task conditions, balance, community mobility, health related quality of life, user satisfaction and cognitive function. This randomized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality reduces fall risk, improves mobility and enhances cognitive function in a diverse group of older adults. In addition, the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit. (NIH)–
 NCT01732653

https://dash.harvard.edu/bitstream/handle/1/10591652/3602099.pdf?sequence=1

V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial

Background. Persons with spinal cord injury who are able to walk are at risk for falls. Objective . The objectives were to investigate if the Berg Balance Scale (BBS) can discriminate those with a propensity to fall; to determine whether the BBS is associated with mobility measures, fear of falling, and muscle strength; and to assess interobserver reliability. Methods. The measurement tools used were the BBS, the Spinal Cord Independence Measure, the Falls Efficacy Scale (FES-I), the Walking Index for Spinal Cord Injury, the 10-m walk test, and the standard neurological classification including motor scores (MS). Falls were recorded retrospectively for the previous month and prospectively for the subsequent 4 months. To determine interobserver reliability, BBS performance was videotaped and analyzed by additional physical therapists. Associations between BBS and the number of falls, measures of mobility, FES-I, and MS were calculated using Spearman correlations. The interobserver reliability was quantifie...

https://journals.sagepub.com/doi/pdf/10.1177/1545968309341059

Falls in Persons With Spinal Cord Injury: Validity and Reliability of the Berg Balance Scale

Background: Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The lack of adequate, validated instr

Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in Geriatric Patients with and without Cognitive Impairment: Results of Self-Report and Interview-Based Questionnaires.

Vorgestellt wird die deutsche Version der Falls Efficacy Scale-International Version (FES-I). Dieser Fragebogen zur Erfassung sturzassoziierter Selbstwirksamkeit bei alteren Menschen wurde im Rahmen eines Experten- Netzwerks zur Sturzpravention (Prevention of Falls Network Europe ProFaNE) entwickelt. Die FES-I stellt eine Erweiterung der Falls Efficacy Scale (FES) dar, in der zum einen komplexere funktionelle Aktivitaten und zum anderen soziale Aspekte der Selbstwirksamkeit zusatzlich aufgenommen wurden. Die FES-I zeigt sowohl eine hohe interne Konsistenz (Cronbachs α = 0,96) als auch eine hohe Retest-Reliabilitat (r = 0,96). Die Item-Interkorrelation betrug im Mittel r = 0,55 (Range r = 0,29– 0,79). Ergebnisse von Validierungsstudien bei zu Hause lebenden Alteren aus unterschiedlichen europaischen Landern und von geriatrischen Patienten mit kognitiver Schadigung werden in Kurze publiziert.

The German version of the falls efficacy scale-international version (FES-I)

Effects of home-based isometric handgrip training or aerobic training on office blood pressure among older adults with high normal bp to established hypertension -preliminary results of the holdage trial

N. Dias

Papers

Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in Geriatric Patients with and without Cognitive Impairment: Results of Self-Report and Interview-Based Questionnaires.

The German version of the falls efficacy scale-international version (FES-I)

Effects of home-based isometric handgrip training or aerobic training on office blood pressure among older adults with high normal bp to established hypertension -preliminary results of the holdage trial