ORCID Profile
0000-0003-1767-0230
Current Organisations
Neuroscience Researvh Australia
,
University of Tsukuba
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Publisher: SAGE Publications
Date: 21-10-2023
Publisher: IOP Publishing
Date: 12-12-2016
DOI: 10.1088/1361-6579/38/1/45
Abstract: Falls and physical deconditioning are two major health problems for older people. Recent advances in remote physiological monitoring provide new opportunities to investigate why walking exercise, with its many health benefits, can both increase and decrease fall rates in older people. In this paper we combine remote wearable device monitoring of daily gait with non-linear multi-dimensional pattern recognition analysis to disentangle the complex associations between walking, health and fall rates. One week of activities of daily living (ADL) were recorded with a wearable device in 96 independent living older people prior to completing 6 months of exergaming interventions. Using the wearable device data the quantity, intensity, variability and distribution of daily walking patterns were assessed. At baseline, clinical assessments of health, falls, sensorimotor and physiological fall risks were completed. At 6 months, fall rates, sensorimotor and physiological fall risks were re-assessed. A non-linear multi-dimensional analysis was conducted to identify risk-groups according to their daily walking patterns. Four distinct risk-groups were identified: The Impaired (93% fallers), Restrained (8% fallers), Active (50% fallers) and Athletic (4% fallers). Walking was strongly associated with multiple health benefits and protective of falls for the top performing Athletic risk-group. However, in the middle of the spectrum, the Active risk-group, who were more active, younger and healthier were 6.25 times more likely to be fallers than their Restrained counterparts. Remote monitoring of daily walking patterns may provide a new way to distinguish Impaired people at risk of falling because of frailty from Active people at risk of falling from greater exposure to situations were falls could occur, but further validation is required. Wearable device risk-profiling could help in developing more personalised interventions for older people seeking the health benefits of walking without increasing their risk of falls.
Publisher: SAGE Publications
Date: 06-06-2020
Abstract: Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P .0001, I 2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I 2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P .0001, I 2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times ( P .001) and training effects on response times could be retained for 24 hours ( P .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.
Publisher: Oxford University Press (OUP)
Date: 09-03-2023
Publisher: Elsevier BV
Date: 08-2023
Publisher: SAGE Publications
Date: 06-11-2020
Abstract: People with Parkinson’s disease (PD) have difficulties generating quick and accurate steps in anticipation of and/or in response to environmental hazards. However, neural mechanisms underlying performance in cognitively demanding stepping tasks are unclear. This study compared activation patterns in cognitive and motor cortical regions using functional near-infrared spectroscopy (fNIRS) between people with PD and age-matched healthy older adults (HOA) during stepping tasks. Fifty-two people with PD and 95 HOA performed a simple choice stepping reaction time test (CSRT) and 2 cognitively demanding stepping tests (inhibitory CSRT [iCSRT] and Stroop stepping test [SST]) on a computerized step mat. Cortical activation in the dorsolateral prefrontal cortex (DLPFC), Broca’s area, supplementary motor area (SMA), and premotor cortex (PMC) were recorded using fNIRS. Stepping performance and cortical activity were contrasted between groups and between the CSRT and the iCSRT and SST. The PD group performed worse than the HOA in all 3 stepping tests. A consistent pattern of interactions indicated differential hemodynamic responses between the groups. Compared with the CSRT, the PD group exhibited reduced DLPFC activity in the iCSRT and reduced SMA and PMC activity in the SST. The HOA exhibited increased DLPFC, SMA, and PMC activity when performing the SST in comparison with the CSRT task. In contrast to the HOA, the PD group demonstrated reduced cortical activity in the DLPFC, SMA, and PMC during the more complex stepping tasks requiring inhibitory control. This may reflect subcortical and/or multiple pathway damage with subsequent deficient use of cognitive and motor resources.
Publisher: Frontiers Media SA
Date: 06-10-2022
Publisher: Springer Science and Business Media LLC
Date: 31-07-2017
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.GAITPOST.2022.04.014
Abstract: Pathological conditions can impair responses to postural perturbations and increase risk of falls. To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes? MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861). Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3). This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms) pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2011
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-07-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
DOI: 10.1519/JPT.0000000000000095
Abstract: Exercise participation and adherence in older people is often low. The integration of technology-based exercise programs may have a positive effect on adherence as they can overcome perceived barriers to exercise. Previous systematic reviews have shown preliminary evidence that technology-based exercise programs can improve physical functioning. However, there is currently no in-depth description and discussion of the potential this technology offers to improve exercise adherence in older people. This review examines the literature regarding older adults' acceptability and adherence to technology-based exercise interventions. A comprehensive systematic database search for randomized controlled trials, clinical controlled trials, and parallel group trials was performed, including MEDLINE, PsycINFO, EMBASE, CINAHL, EMB Reviews, and Cochrane Library, completed in May 2015. Trials reporting adherence to technology-based exercise programs aimed at improving physical function were included. Adherence was defined as the percentage of exercise sessions attended out of the total number of sessions prescribed. Twenty-two studies were included. The mean cohort age range was 67 to 86 years. Studies were conducted in research facilities, aged care facilities, and people's homes. Ten studies compared outcomes between technology-based and traditional exercise programs. Adherence to both types of interventions was high (median 91.25% and 83.58%, respectively). Adherence was higher for technology-based interventions than traditional interventions independent of study site, level of supervision, and delivery mode. The majority of the studies used commercially available gaming technologies, and both types of exercise interventions were mostly supervised. A lack of detailed reporting of adherence and the pilot nature of most studies did not allow computation of a comprehensive adherence rate. This systematic review provides evidence that technology offers a well-accepted method to provide older adults with engaging exercise opportunities, and adherence rates remain high in both supervised and unsupervised settings at least throughout the first 12 weeks of intervention. The higher adherence rates to technology-based interventions can be largely explained by the high reported levels of enjoyment when using these programs. However, the small s le sizes, short follow-up periods, inclusion of mostly healthy older people, and problems related to the methods used to report exercise adherence limit the generalizability of our findings. This systematic review indicates that technology-based exercise interventions have good adherence and may provide a sustainable means of promoting physical activity and preventing falls in older people. More research is required to investigate the feasibility, acceptability, and effectiveness of technology-based exercise programs undertaken by older people at home over extended trial periods.
Publisher: Wiley
Date: 23-10-2019
DOI: 10.1111/GGI.13785
Abstract: The present study aimed to determine whether measures of chronic pain are associated with social frailty in community-dwelling older adults. Participants comprised 248 older adults who enrolled for community-based exercise classes. Chronic pain was defined as the presence of significant pain-related symptoms within the past month that had continued for at least 6 months. Social frailty was defined as positive responses to two of the following five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). Physical function was assessed using the Chair Stand and Timed Up and Go tests. A total of 55 participants (22.2%) met the criteria for social frailty. A total of 28 socially frail participants (50.9%) and 56 of the socially integrated participants (29.0%) reported chronic pain. The presence of chronic pain was significantly associated with social frailty after adjusting for age, sex and physical function measures (odds ratio 2.13, 95% confidence interval 1.01-4.48). Chronic pain was also significantly associated with three social frailty items: going out less frequently, rarely visiting friends and feeling unhelpful to friends or family. Chronic pain was independently associated with social frailty in community-dwelling older adults. Simple assessments of chronic pain and subsequent pain management interventions might be beneficial for older people with social frailty. Geriatr Gerontol Int 2019 19: 1153-1156.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2019
DOI: 10.1519/JPT.0000000000000181
Abstract: Falls among older people are a serious health issue. Remote detection of near falls may provide a new way to identify older people at high risk of falling. This could enable exercise and fall prevention programs to target the types of near falls experienced and the situations that cause near falls before fall-related injuries occur. The purpose of this systematic review was to summarize and critically examine the evidence regarding the detection of near falls (slips, trips, stumbles, missteps, incorrect weight transfer, or temporary loss of balance) using wearable devices. CINAHL, EMBASE, MEDLINE, Compendex, and Inspec were searched to obtain studies that used a wearable device to detect near falls in young and older people with or without a chronic disease and were published in English. Nine studies met the final inclusion criteria. Wearable sensors used included accelerometers, gyroscopes, and insole force inducers. The waist was the most common location to place a single device. Both high sensitivity (≥85.7%) and specificity (≥90.0%) were reported for near-fall detection during various clinical simulations and improved when multiple devices were worn. Several methodological issues that increased the risk of bias were revealed. Most studies analyzed a single or few near-fall types by younger adults in controlled laboratory environments and did not attempt to distinguish naturally occurring near falls from actual falls or other activities of daily living in older people. The use of a single lightweight sensor to distinguish between different types of near falls, actual falls, and activities of daily living is a promising low-cost technology and clinical tool for long-term continuous monitoring of older people and clinical populations at risk of falls. However, currently the evidence is limited because studies have largely involved simulated laboratory events in young adults. Future studies should focus on validating near-fall detection in larger cohorts and include data from (i) people at high risk of falling, (ii) activities of daily living, (iii) both near falls and actual falls, and (iv) naturally occurring near falls.
Publisher: Wiley
Date: 07-12-2017
DOI: 10.1111/GGI.13218
Publisher: Wiley
Date: 12-10-2023
DOI: 10.1111/GGI.14702
Publisher: BMJ
Date: 08-01-2017
DOI: 10.1136/BJSPORTS-2015-095452
Abstract: To examine the effects of stepping interventions on fall risk factors and fall incidence in older people. Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, CENTRAL) and reference lists of included articles from inception to March 2015. Randomised (RCT) or clinical controlled trials (CCT) of volitional and reactive stepping interventions that included older (minimum age 60) people providing data on falls or fall risk factors. Meta-analyses of seven RCTs (n=660) showed that the stepping interventions significantly reduced the rate of falls (rate ratio=0.48, 95% CI 0.36 to 0.65, p<0.0001, I The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. This clinically significant reduction may be due to improvements in reaction time, gait, balance and balance recovery but not in strength. Further high-quality studies aimed at maximising the effectiveness and feasibility of stepping interventions are required. CRD42015017357.
Publisher: Frontiers Media SA
Date: 20-08-2021
DOI: 10.3389/FSPOR.2021.702320
Abstract: Background: Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway. Method: Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip. Results: No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks ( P & 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT ( P & 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed ( P & 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip. Conclusions: This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.GAITPOST.2021.10.038
Abstract: People with Parkinson's disease (PD) have difficulties adapting their gait. While underlying neural mechanisms involving the prefrontal cortex (PFC) have been studied across various complex walking tasks, less is known about the premotor cortex (PMC) and supplementary motor area (SMA), key cortical regions for motor planning. This study compared frontal cortical regions activation patterns using functional near-infrared spectroscopy (fNIRS), between people with PD and healthy controls (HC) during gait adaptability tasks. Forty-nine people with PD (mean (SD) age: 69.5 (7.9) years) and 21 HC (69.0 (5.9) years) completed a simple walk and three randomly presented gait adaptability tasks: (i) stepping on targets, (ii) avoiding obstacles and (iii) negotiating both targets and obstacles. Cortical activity in the dorsolateral PFC (DLPFC), SMA and PMC were recorded using fNIRS. Step length, velocity and accuracy and cortical activity were contrasted between the groups and walking conditions. Compared with the HC, the PD group exhibited greater PMC activation and walked significantly slower and took shorter steps in all conditions. A statistically significant group by condition interaction indicated an increase in DLPFC cortical activation in the HC participants when undertaking the obstacle avoidance task compared with the simple walk but no increase in cortical activation in the PD group when undergoing this more challenging gait task. Our findings suggest people with PD have little or no DLPFC, SMA and PMC capacity beyond what they need for simple walking and in consequence need to slow their gait velocity to meet the demands of target stepping and obstacle avoidance tasks. Such behavioral and neural patterns appear consistent with concepts of compensatory over-activation and capacity limitation.
Publisher: Elsevier BV
Date: 05-2020
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2015
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 09-2012
Publisher: MDPI AG
Date: 02-06-2023
Abstract: (1) Background: This prospective study aimed to identify predictors of falls and fall-related fractures in community-dwelling older people with pain (2) Methods: Participants comprised 389 community-dwelling older people aged 70+ years who had musculoskeletal pain in the neck, back, hip, leg/knee and/or feet. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Falls were monitored with monthly falls calendars for 12 months. Logistic regression analyses were performed to identify predictors of falls and fall-related fractures during a 12-month follow-up (3) Results: Of the 389 participants, 175 (45.0%) and 20 (5.1%) reported falls and fall-related fractures during the 12-month follow-up, respectively. Greater postural sway on foam, more depressive symptoms and lower physical activity levels at baseline were associated with falls during the 12-month follow-up. Slower walking speed at baseline was associated with fall-related fractures during the 12-month follow-up. These associations remained significant after adjusting for age, sex, body mass index, comorbidities and medication use (4) Conclusions: This study suggests poor balance, low mood and a less active lifestyle are predictors of falls, and slower walking speed predicts fall-related fractures among community-dwelling older people with pain.
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2015
Publisher: Wiley
Date: 22-01-2015
DOI: 10.1111/GGI.12444
Publisher: Springer Science and Business Media LLC
Date: 2016
Publisher: Cold Spring Harbor Laboratory
Date: 04-06-2018
DOI: 10.1101/333989
Abstract: This study aimed to determine if repeated exposure to unpredictable trips and slips while walking can improve balance recovery responses when predictive gait alterations (e.g. slowing down) are minimised. Ten young adults walked on a 10-m walkway that induced slips and trips in fixed and random locations. Participants were exposed to a total of 12 slips, 12 trips and 6 non-perturbed walks in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) random leg and location. Kinematics during non-perturbed walks and previous and recovery steps were analysed. Throughout the three conditions, participants walked with similar gait speed, step length and cadence( p .05). Participants’ extrapolated centre of mass (XCoM) was anteriorly shifted immediately before slips at the fixed location ( p .01), but this predictive gait alteration did not transfer to random perturbation locations. Improved balance recovery from trips in the random location was indicated by increased margin of stability and step length during recovery steps ( p .05). Changes in balance recovery from slips in the random location was shown by reduced backward XCoM displacement and reduced slip speed during recovery steps ( p .05). Even in the absence of most predictive gait alterations, balance recovery responses to trips and slips were improved through exposure to repeated unpredictable perturbations. A common predictive gait alteration to lean forward immediately before a slip was not useful when the perturbation location was unpredictable. Training balance recovery with unpredictable perturbations may be beneficial to fall avoidance in everyday life.
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2014
Publisher: SERDI
Date: 2017
DOI: 10.14283/JFA.2017.38
Publisher: Public Library of Science (PLoS)
Date: 18-09-2018
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.ARCHGER.2014.10.008
Abstract: The purpose of this longitudinal study was to examine the association between habitual walking and multiple or injurious falls (falls) among community-dwelling older adults, by considering the relative risk of falling. A cohort of Japanese community-dwelling older adults (n=535) aged 60-91 years (73.1±6.6 year, 157 men and 378 women) who underwent community-based health check-ups from 2008 to 2012 were followed until 2013. Incidence rate of falls between walkers and non-walkers was compared separately by the number of risk factors (Groups R0, R1, R2, R3 and R4+). The Cox proportional hazard model was used to assess the association between habitual walking and falls separately by lower- (R<2) and higher- (R≥2) risk groups. In Groups R0 and R1, the incidence of falls was lower in walkers than non-walkers however, in Groups R2, R3, and R4+, the incidence of falls was higher in walkers. The Cox proportional hazard model showed that habitual walking was not significantly associated with falls (hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.48-1.62) among the lower risk group but that it was significantly associated with increased falls (HR: 1.89, 95% CI: 1.04-3.43) among the higher risk group. The significant interaction between habitual walking and higher risk of falling was found (P<0.05). When in iduals have two or more risk factors for falling, caution is needed when recommending walking because walking can actually increase their risk of experiencing multiple or injurious falls.
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4592526
Publisher: Japan Society of Mechanical Engineers
Date: 2018
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.CLINBIOMECH.2019.05.016
Abstract: Exposure to unpredictable trips and slips can improve balance recovery responses but it was not known if older adults can tolerate such high intensity training. The study aim was to determine if reactive balance in both young and older adults could be trained in a single day through exposure to slip and trip hazards hidden in unpredictable walkway locations. Ten young (20-40 yr) and ten older adults (65 + yr) completed 32 trials on a 10-meter trip and slip walkway 14 slip trials, 14 trip trials and 4 no-perturbation trials presented in a pseudo-random order. Participant usual gait speed was regulated using a metronome and stepping tiles at fixed distances. Gait kinematics (Vicon motion capture), falls (> 30% body weight into the harness), anxiety and confidence to avoid falling were assessed. Margin of stability for balance recovery after slips substantially improved at training completion for older adults (effect size = 1.13, P = 0.019). Falls from slips also decreased: 44.4% to 0% in the young adults and 28.6% to 14.3% in the older adults. Although confidence to avoid falling did not change, anxiety increased during training with one young and three older participants withdrawing during training. The findings indicate exposure to unpredictable perturbations improves reactive balance in young and older adults. However, improvements of balance recovery from trips were not significant. Elevated anxiety levels and a high dropout rate suggest the need for more in idualised training over multiple days.
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2011
Publisher: Springer Science and Business Media LLC
Date: 24-07-2019
Publisher: Oxford University Press (OUP)
Date: 16-05-2020
Abstract: pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. 12-month prospective cohort study. community. 242 community-dwelling older adults aged 70+ years. participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-07-2021
DOI: 10.1519/JPT.0000000000000312
Abstract: Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips. Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls. Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls. Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
Publisher: Wiley
Date: 23-04-2021
DOI: 10.1111/GGI.14172
Abstract: The aim of this prospective cohort study was to identify the predictors of the development and persistence of musculoskeletal pain (MSKP) in older people. Participants comprised 431 community‐dwelling older people aged 70+ years. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Participants were asked about the presence of MSKP in the neck/back, hip, knee/leg and/or feet at baseline and two‐year follow‐up. Logistic regression analyses were performed to identify predictors of the development and persistence of MSKP at two‐year follow‐up. Of 179 participants who reported no MSKP at baseline, 84 (46.9%) reported MSKP at two‐year follow‐up, which was associated with a higher body mass index (odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02–1.18), more reported depressive symptoms (OR 1.30, 95% CI 1.05–1.61) and lower physical activity levels (OR 0.92, 95% CI 0.84–1.00) at baseline. Of 252 participants who reported MSKP at baseline, 202 (80.2%) reported MSKP at follow‐up, which was associated with a slower 6‐m walking time (OR 1.27, 95% CI 1.08–1.49) and more reported depressive symptoms (OR 1.39, 95% CI 1.09–1.78). These associations remained significant after adjusting for age, sex, comorbidities and medication use. This study suggests that higher body mass index, more depressive symptoms and less physical activity are predictors of developing MSKP, whereas slow gait speed and depressive symptoms are predictors of the persistence of MSKP among older people. The results highlight the importance of weight control, strategies to improve mental wellbeing and an active lifestyle for pain management among older people. Geriatr Gerontol Int 2021 21: 519–524 .
Publisher: Wiley
Date: 09-03-2022
DOI: 10.1111/GGI.14370
Abstract: Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) s led from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall‐risk‐increasing medication use, self‐rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall‐risk‐increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022 22: 338–343 .
Publisher: Elsevier BV
Date: 12-2020
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2013
Publisher: Wiley
Date: 20-01-2013
DOI: 10.1111/GGI.12029
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.GAITPOST.2017.02.014
Abstract: Although step training improves the ability of quick stepping, some home-based step training systems train limited stepping directions and may cause harm by reducing stepping performance in untrained directions. This study examines the possible transfer effects of step training on stepping performance in untrained directions in older people. Fifty four older adults were randomized into: forward step training (FT) lateral plus forward step training (FLT) or no training (NT) groups. FT and FLT participants undertook a 15-min training session involving 200 step repetitions. Prior to and post training, choice stepping reaction time and stepping kinematics in untrained, diagonal and lateral directions were assessed. Significant interactions of group and time (pre ost-assessment) were evident for the first step after training indicating negative (delayed response time) and positive (faster peak stepping speed) transfer effects in the diagonal direction in the FT group. However, when the second to the fifth steps after training were included in the analysis, there were no significant interactions of group and time for measures in the diagonal stepping direction. Step training only in the forward direction improved stepping speed but may acutely slow response times in the untrained diagonal direction. However, this acute effect appears to dissipate after a few repeated step trials. Step training in both forward and lateral directions appears to induce no negative transfer effects in diagonal stepping. These findings suggest home-based step training systems present low risk of harm through negative transfer effects in untrained stepping directions. ANZCTR 369066.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.CLINBIOMECH.2021.105511
Abstract: To examine reactive balance responses to a trip and slip during gait in people with multiple sclerosis (MS). This cross-sectional laboratory study involved 29 participants with MS (50.6 ± 13.4 years) and 29 gender-and-aged-matched healthy controls (50.9 ± 19.2 years). Falls following an induced trip and slip along a 10 m walkway, approach (e.g. gait speed, step length, foot contact angle) and recovery strategies (e.g. response time, extrapolated centre of mass position, margin of stability) were compared between the two groups. The rate of falls was significantly higher in the participants with MS relative to healthy controls (rate ratio=2.82, 95% confidence interval [CI]=1.42, 5.61). Participants with MS also experienced more trip falls (odds ratio [OR]=3.90, 95% CI=1.16, 13.08) and more slip falls (OR=6.27, 95% CI=1.95, 20.22) than the heathy controls. Participants with MS had significantly slower gait speed, step length, cadence, and foot contact angle during approach (P < 0.05). Following slips, participants with MS had significantly greater stance limb knee flexion (P < 0.05), suggesting inadequate lower limb support to recover balance post-slip. Following trips, participants with MS had significantly delayed response initiation, lower toe clearance, shorter step length, and greater trunk sway (P < 0.05). Fewer participants with MS showed a hopping response to clear the obstacle (P < 0.05). Multiple sclerosis impairs reactive balance responses to a trip and slip associated with reduced lower limb function and delayed postural responses. Neurorehabilitation targeting reactive balance may facilitate fall prevention in people with multiple sclerosis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: The Japanese Society of Physical Fitness and Sports Medicine
Date: 2014
Publisher: Wiley
Date: 12-03-2014
DOI: 10.1111/GGI.12268
Publisher: MDPI AG
Date: 09-07-2020
Abstract: (1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength 26.0 kg for men and 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index 7.0 kg/m2 for men and 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors.
No related grants have been discovered for Yoshiro Okubo.