BACKGROUND: A previous study found that, with repeated exposure to slipping during a sit-to-stand task, fall incidence decreased at a similar exponential rate in young and older adults. This study investigated the adaptations responsible for this decrease. METHODS: Slips were induced, using bilateral low-friction platforms, during a sit-to-stand in 60 young and 41 older healthy safety-harnessed adults. Participants underwent 5 slips, then a 6th slip (reslip) after 3-4 nonslipping trials. Between-trial adjustments in body center of mass state at seat-off were examined and correlated to the likelihoods of falling and stepping. Changes in reactive response between the first slip and reslip were investigated. RESULTS: With repeated slipping, both young and older adults adjusted to increase their center of mass anterior position and forward velocity at seat-off (p <.001), contributing to decreased fall incidence and changes in step incidence and direction (p <.001). These proactive adjustments predicted fall incidence well in later trials, but underpredicted fall incidence upon the first slip by 9%-21%, suggesting that reactive response deficiencies also initially contributed to falls by both age groups. Ten participants who initially fell without stepping adapted by stepping to recover upon the reslip. Thirty-six participants who stepped backward initially and upon the reslip altered their nonstepping limb reactive response to reduce hip vertical descent during the step (p <.001). CONCLUSIONS: Young and older adults rapidly learned to avoid falling through similar proactive and reactive adaptations that persisted in the short term. Both proactive and reactive adaptations should be targeted in interventions to reduce older adult fall incidence.
BACKGROUND: A previous study found that, with repeated exposure to slipping during a sit-to-stand task, fall incidence decreased at a similar exponential rate in young and older adults. This study investigated the adaptations responsible for this decrease. METHODS: Slips were induced, using bilateral low-friction platforms, during a sit-to-stand in 60 young and 41 older healthy safety-harnessed adults. Participants underwent 5 slips, then a 6th slip (reslip) after 3-4 nonslipping trials. Between-trial adjustments in body center of mass state at seat-off were examined and correlated to the likelihoods of falling and stepping. Changes in reactive response between the first slip and reslip were investigated. RESULTS: With repeated slipping, both young and older adults adjusted to increase their center of mass anterior position and forward velocity at seat-off (p <.001), contributing to decreased fall incidence and changes in step incidence and direction (p <.001). These proactive adjustments predicted fall incidence well in later trials, but underpredicted fall incidence upon the first slip by 9%-21%, suggesting that reactive response deficiencies also initially contributed to falls by both age groups. Ten participants who initially fell without stepping adapted by stepping to recover upon the reslip. Thirty-six participants who stepped backward initially and upon the reslip altered their nonstepping limb reactive response to reduce hip vertical descent during the step (p <.001). CONCLUSIONS: Young and older adults rapidly learned to avoid falling through similar proactive and reactive adaptations that persisted in the short term. Both proactive and reactive adaptations should be targeted in interventions to reduce older adult fall incidence.
Authors: Karen L Troy; Stephanie J Donovan; Jane R Marone; Mary Lou Bareither; Mark D Grabiner Journal: Gait Posture Date: 2008-04-18 Impact factor: 2.840