Skip to main content
Log in

Limb Collapse or Instability? Assessment on Cause of Falls

  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

What causes an older adult to fall? Could the same factor lead to a recurring fall? The purposes of this study sought to address these questions by developing a causal-based assessment method for detection of the initial biomechanical cause of fall, and investigating the causation of 97 falls (out of 195 community dwelling older adults who participated in this study) based on this method. The unrecoverable limb collapse, or unrecoverable instability, along with its point of no return was defined, and the assessment method was established. Both the novel and the second slips of 97 participants who experienced laboratory induced slip related falls were assessed. The results showed that these older adults had more limb collapse (59.8%) initiated falls than instability (40.2%; and 32.0% of which from anteroposterior instability while only 8.2% from mediolateral instability) initiated falls. Interestingly, the majority (86.4%) of those 22 repeated fallers fell twice because of the same cause. These findings shed light on the vulnerability and the causation of recurring falls, which is one of the most challenging healthcare issues that an active but aging population is facing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. Bhatt, T., J. D. Wening, and Y. C. Pai. Influence of gait speed on stability: recovery from anterior slips and compensatory stepping. Gait Posture 21:146–156, 2005.

    Article  CAS  PubMed  Google Scholar 

  2. Bhatt, T., J. D. Wening, and Y. C. Pai. Adaptive control of gait stability in reducing slip-related backward loss of balance. Exp. Brain Res. 170:61–73, 2006.

    Article  CAS  PubMed  Google Scholar 

  3. Blake, A. J., K. Morgan, M. J. Bendall, H. Dallosso, S. B. J. Ebrahim, T. H. D. Arie, P. H. Fentem, and E. J. Bassey. Falls by elderly people at home—prevalence and associated factors. Age Ageing 17:365–372, 1988.

    Article  CAS  PubMed  Google Scholar 

  4. Burr, D. B. Muscle strength, bone mass, and age-related bone loss. J. Bone Mineral Res. 12:1547–1551, 1997.

    Article  CAS  Google Scholar 

  5. Cham, R., and M. S. Redfern. Heel contact dynamics during slip events on level and inclined surfaces. Saf. Sci. 40:559–576, 2002.

    Article  Google Scholar 

  6. de Leva, P. Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J. Biomech. 29:1223–1230, 1996.

    Article  PubMed  Google Scholar 

  7. Donald, I. P., and C. J. Bulpitt. The prognosis of falls in elderly people living at home. Age Ageing 28:121–125, 1999.

    Article  CAS  PubMed  Google Scholar 

  8. Elbar, O., I. Tzedek, E. Vered, G. Shvarth, M. Friger, and I. Melzer. A water-based training program that includes perturbation exercises improves speed of voluntary stepping in older adults: a randomized controlled cross-over trial. Arch. Gerontol. Geriatr. 56:134–140, 2013.

    Article  PubMed  Google Scholar 

  9. El-Khoury, F., B. Cassou, M. A. Charles, and P. Dargent-Molina. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 347:f6234, 2013.

    PubMed  PubMed Central  Google Scholar 

  10. Glickman-Simon, R. Home-based tai chi chuan may reduce fall rate compared to lower extremity exercise training in older adults with history of falls. Explor. J. Sci. Healing 13:79–80, 2017.

    Google Scholar 

  11. Granacher, U., A. Gollhofer, T. Hortobagyi, R. W. Kressig, and T. Muehlbauer. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med. 43:627–641, 2013.

    Article  PubMed  Google Scholar 

  12. Holbrook T. L. and K. L. Grazier. The frequency of occurrence, impact, and cost of selected musculoskeletal conditions in the United States. Amer Academy of Orthopaedic, 1984.

  13. Horak, F. B. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 35:7–11, 2006.

    Article  Google Scholar 

  14. Hu, M. H., and M. H. Woollacott. Multisensory training of standing balance in older adults .1. Postural stability and one-leg stance balance. J. Gerontol. 49:52–61, 1994.

    Article  Google Scholar 

  15. Kannus, P., J. Parkkari, S. Koskinen, S. Niemi, M. Palvanen, M. Jarvinen, and I. Vuori. Fall-induced injuries and deaths among older adults. JAMA 281:1895–1899, 1999.

    Article  CAS  PubMed  Google Scholar 

  16. Moreland, J. D., J. A. Richardson, C. H. Goldsmith, and C. M. Clase. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J. Am. Geriatr. Soc. 52:1121–1129, 2004.

    Article  PubMed  Google Scholar 

  17. Norton, R., A. J. Campbell, T. LeeJoe, E. Robinson, and M. Butler. Circumstances of falls resulting in hip fractures among older people. J. Am. Geriatr. Soc. 45:1108–1112, 1997.

    Article  CAS  PubMed  Google Scholar 

  18. Nyberg, L., Y. Gustafson, D. Berggren, B. Brannstrom, and G. Bucht. Falls leading to femoral neck fractures in lucid older people. J. Am. Geriatr. Soc. 44:156–160, 1996.

    Article  CAS  PubMed  Google Scholar 

  19. Pai, Y. C., and T. S. Bhatt. Repeated-slip training: an emerging paradigm for prevention of slip-related falls among older adults. Phys. Ther. 87:1478–1491, 2007.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pai, Y. C., T. Bhatt, E. Wang, D. Espy, and M. J. Pavol. Inoculation against falls: rapid adaptation by young and older adults to slips during daily activities. Arch. Phys. Med. Rehabilit. 91:452–459, 2010.

    Article  Google Scholar 

  21. Pai, Y. C., T. Bhatt, F. Yang, and E. Wang. Perturbation training can reduce community-dwelling older adults’ annual fall risk: a randomized controlled trial. J. Gerontol. A 69:1586–1594, 2014.

    Article  Google Scholar 

  22. Pai, Y. C., and J. Patton. Center of mass velocity-position predictions for balance control. J. Biomech. 30:347–354, 1997.

    Article  CAS  PubMed  Google Scholar 

  23. Pai, Y. C., J. D. Wening, E. F. Runtz, K. Iqbal, and M. J. Pavol. Role of feedforward control of movement stability in reducing slip-related balance loss and falls among older adults. J. Neurophysiol. 90:755–762, 2003.

    Article  PubMed  Google Scholar 

  24. Pai, Y. C., F. Yang, T. Bhatt, and E. Wang. Learning from laboratory-induced falling: long-term motor retention among older adults. Age 36:1367–1376, 2014.

    Article  Google Scholar 

  25. Parijat, P., and T. E. Lockhart. Effects of moveable platform training in preventing slip-induced falls in older adults. Ann. Biomed. Eng. 40:1111–1121, 2012.

    Article  PubMed  Google Scholar 

  26. Pavol, M. J., and Y. C. Pai. Deficient limb support is a major contributor to age differences in falling. J. Biomech. 40:1318–1325, 2007.

    Article  PubMed  Google Scholar 

  27. Pearson, K. G. Generating the walking gait: role of sensory feedback. Brain Mech. Integr. Posture Mov. 143:123–129, 2004.

    Article  Google Scholar 

  28. Rispens, S. M., K. S. van Schooten, M. Pijnappels, A. Daffertshofer, P. J. Beek, and J. H. van Dieen. Identification of fall risk predictors in daily life measurements: gait characteristics’ reliability and association with self-reported fall history. Neurorehabilit. Neural Repair 29:54–61, 2015.

    Article  Google Scholar 

  29. Rogers, M. W., and M. L. Mille. Lateral stability and falls in older people. Exerc. Sport Sci. Rev. 31:182–187, 2003.

    Article  PubMed  Google Scholar 

  30. Rubenstein, L. Z., and K. R. Josephson. Falls and their prevention in elderly people: what does the evidence show? Med. Clin. N. Am. 90:807, 2006.

    Article  PubMed  Google Scholar 

  31. Stevens, J. A., and E. D. Sogolow. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj. Prev. 11:115–119, 2005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Trombetti, A., M. Hars, F. R. Herrmann, R. W. Kressig, S. Ferrari, and R. Rizzoli. Effect of music-based multitask training on gait, balance, and fall risk in elderly people a randomized controlled trial. Arch. Intern. Med. 171:525–533, 2011.

    Article  PubMed  Google Scholar 

  33. Tromp, A. M., S. M. F. Pluijm, J. H. Smit, D. J. H. Deeg, L. M. Bouter, and P. Lips. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J. Clin. Epidemiol. 54:837–844, 2001.

    Article  CAS  PubMed  Google Scholar 

  34. Wang, S., X. Liu, A. Lee, and Y.-C. Pai. Can recovery foot placement affect older adults’ slip-fall severity? Ann. Biomed. Eng. 45:1941–1948, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Wolf, S. L., R. W. Sattin, M. Kutner, M. O’Grady, A. I. Greenspan, and R. J. Gregor. Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J. Am. Geriatr. Soc. 51:1693–1701, 2003.

    Article  PubMed  Google Scholar 

  36. Yang, F., F. C. Anderson, and Y. C. Pai. Predicted threshold against backward balance loss following a slip in gait. J. Biomech. 41:1823–1831, 2008.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yang, F., T. Bhatt, and Y. C. Pai. Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities. J. Biomech. 42:1903–1908, 2009.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Yang, F., T. Bhatt, and Y. C. Pai. Limits of recovery against slip-induced falls while walking. J. Biomech. 44:2607–2613, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yang, F., D. Espy, and Y. C. Pai. Feasible stability region in the frontal plane during human gait. Ann. Biomed. Eng. 37:2606–2614, 2009.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Yang, F., and Y. C. Pai. Automatic recognition of falls in gait-slip training: harness load cell based criteria. J. Biomech. 44:2243–2249, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This work was supported by National Institute on Aging (NIH R01-AG029616 and NIH R01-AG044364). We thank Ms. Yiru Wang for helpful edits of an earlier version and Dr. Edward Wang for assistant on statistical analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yi-Chung Pai.

Additional information

Associate Editor Thurmon E. Lockhart oversaw the review of this article.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, S., Liu, X. & Pai, YC. Limb Collapse or Instability? Assessment on Cause of Falls. Ann Biomed Eng 47, 767–777 (2019). https://doi.org/10.1007/s10439-018-02195-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-018-02195-9

Keywords

Navigation