Fall risk assessment in very old males and females living in nursing homes

Background:?Several studies identified muscle weakness, history of falls, gait deficit and balance deficit as the most common risk factors for falls.

Aims:?To determine risk factors of fall in older males and females living in nursing homes and to compare characteristics of fallers and non fallers.

Methods:?This is a cross-sectional study with a convenience sample of 40 nursing home elderly (13 males and 27 females), mean age 86.35, of which 17 (6 males and 11 females) fell at least once in the previous year and 23 (7 males and 16 females) had not fallen. Each participant filled a self-assessment questionnaire (general health questions and selected questions from the SF-36). An objective evaluation was performed with measurements of blood pressure and heartrate (supine and standing), lower extremity strength and power (dominate side only) by Biodex isokinetic dynamometry, dynamic postural stability by Biodex balance system (5?s trials at level 8) and gait assessment (6?min walk test at comfortable speed) by gait treadmill Biodex.

Results:?The fallen males decreased significantly knee flexion peak torque (p?=?0.08), ankle plantarflexion peak torque and average power (p?=?0.05), compared with the not fallen group. The fallen females decreased significantly knee extension peak torque and average power (p?<?0.05), walking speed (p?<?0.005) and cadence (p?<?0.01), compared with the not fallen group.

Conclusions:?This study shows that the fallen males had greater deficits of ankle plantar-flexion strength and power, while fallen females had greater deficits of knee extension strength and power and less walking speed.     

Compensatory advantages of toe walking

OBJECTIVES: The study's hypothesis is that toe walking requires less peak muscle strength distally about the ankle and knee compared with normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal muscle weakness. DESIGN: Motion analysis and force platform data were collected in able-bodied subjects during toe walking and normal walking. Sagittal plane joint torques reflecting muscle force requirements and joint powers reflecting nonisometric muscle contraction were compared between the two conditions using paired t tests, applying a Bonferroni correction for multiple comparisons. SETTING: A gait laboratory. SUBJECTS: Seventeen able-bodied adults, 9 of whom were ballet dancers. MAIN OUTCOME MEASURES: Peak hip, knee, and ankle joint torque and power variables during walking. RESULTS: Peak ankle plantarflexor torque and ankle power generation during terminal stance and preswing were reduced (p<.001), as compared with normal heel-toe walking. The normal ankle dorsiflexor torque at initial contact-and the knee extensor torque and knee power generation during loading response were all essentially absent during toe walking. Hip extensor torque and hip power generation during the loading response phase were greater for toe walking (p<.001). CONCLUSION: Toe walking may require less ankle plantarflexor, ankle dorsiflexor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal lower extremity weakness.     

Kinetic alterations independent of walking speed in elderly fallers

OBJECTIVES: To determine if joint kinetic gait alterations in fallers persist when they attempt to walk at a faster speed that is more comparable with nonfallers' comfortable walking speed. DESIGN: Retrospective, case-control study. Stereophotogrammetric and force platform data were collected. SETTING: A gait laboratory. PARTICIPANTS: Sixteen elderly subjects who had at least 2 falls in the last 6 months from an unclear cause and 23 elderly subjects with no history of repeated falls. MAIN OUTCOME MEASURES: Differences in all major peak joint kinetic (moment and power) values during the gait cycle between elderly nonfallers walking at comfortable speed and elderly fallers walking at (1) comfortable and (2) fast speed. RESULTS: Statistically significant differences present at both comfortable and fast walking speeds were present in 4 sagittal plane parameters. There was an increase in peak external hip flexion moment in stance, a reduction in peak hip extension moment, a reduction in knee flexion moment in preswing, and a reduction in knee power absorption in preswing. CONCLUSION: The presence and persistence of 4 specific alterations in sagittal plane joint kinetics at both comfortable and fast walking speeds imply specific intrinsic pattern differences and allow for new insights into the mechanics of gait in elderly people who fall. The presence of these alterations also suggests they may serve as potential identifiable markers to detect those who may be at risk for falls.     

Gait characteristics of elderly people with a history of falls: a dynamic approach

BACKGROUND AND PURPOSE: This study investigated changes in the kinematics of elderly people who experienced at least one fall 6 months prior to data collection. The authors hypothesized that, in order to decrease variability of walking, people with a history of falls would show different kinematic adaptations of their walking patterns compared with elderly people with no history of falls. SUBJECTS AND METHODS: Twenty-one elderly people who had fallen within the previous 6 months ("fallers"; mean age=72.1 years, SD=4.9) and 27 elderly people with no history of falls ("nonfallers"; mean age=73.8 years, SD=6.4) walked at their preferred stride frequency (STF) as treadmill speed was gradually increased (from 0.18 m/s to 1.52 m/s) and then decreased in steps of 0.2 m/s. Gait parameter measurements were recorded, and statistical analysis was applied using walking speed and STF as independent variables. RESULTS: Fifty-seven percent of the fallers were unable to walk at the fastest speed, whereas all nonfallers walked comfortably at all walking speeds. Although the fallers showed significantly greater STF, smaller stride lengths, smaller center-of-mass lateral sway, and smaller ankle plantar flexion and hip extension during push-off, they showed increased variability of kinematic measures in their coordination of walking compared with the nonfallers. DISCUSSION AND CONCLUSION: Although the fallers' adaptations were expected to reduce variability in the coordination of walking, they showed less stable gait patterns (ie, greater variability) compared with the nonfallers. Increased variability of walking patterns may be an important gait risk factor in elderly people with a history of falls.     

Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Huisinga JM, Filipi ML, Schmid KK, Stergiou N. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Objective

To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics.

Design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Subjects with MS (n=32) and age- and sex-matched controls (n=30).

Interventions

None.

Main Outcome Measures

Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure.

Results

FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables.

Conclusions

Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.     

Effects of Robotic Exoskeleton-Aided Gait Training in the Strength,Body Balance,and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study

ObjectiveTo assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up.DesignSingle-group longitudinal preliminary study.SettingIndividuals with multiple sclerosis (MS) at a hospital neurology ward.ParticipantsParticipants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5.InterventionsExoskeleton-assisted walk training.Main Outcome MeasuresPrimary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3).ResultsAt the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant.ConclusionsIndividuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.     

Association between energy cost of walking,muscle activation,and biomechanical parameters in older female fallers and non-fallers

Objective

To determine the nervous activation, muscle strength, and biomechanical parameters that influence the cost of walking in older fallers and non-fallers.

Methods

Maximal voluntary isokinetic torque was measured for the hip, knee and ankle of older women. Oxygen consumption was measured at rest and during 8 min of walking at self-selected speed. An additional minute of walking was performed to collect kinematic variables and the electromyographic signal of trunk, hip, knee, and ankle muscles, which was analyzed by the linear envelope. Cost of walking was calculated by subtracting resting body mass-normalized oxygen consumption from walking body mass-normalized oxygen consumption. Stride time and length, and ankle and hip range of motion were calculated from kinematic data.

Findings

Older adult fallers had 28% lower knee extensor strength (p = 0.02), 47% lower internal oblique activation at heel contact (p = 0.03), and higher coactivation between tibialis anterior and gastrocnemius lateralis in each of the gait phases (p < 0.05). For fallers, a higher activation of gluteus maximus was associated with a higher cost of walking (r = 0.55, p < 0.05 and r = 0.71, p < 0.01, before and after heel contact, respectively). For non-fallers, an association between cost of walking and age (r = 0.60, p = 0.01) and cost of walking and thigh muscle coactivation (r = 0.53, p = 0.01) existed.

Interpretation

This study demonstrated that there may be links between lower-extremity muscle weakness, muscle activation patterns, altered gait, and increased cost of walking in older fallers.     

Rate of isometric knee extension strength development and walking speed after stroke

The relationship between lower-limb weakness and walking speed after stroke is not clear. This may be related to the measurement used to quantify weakness, typically peak strength. This study examined the relationship between two measures of isometric knee extension strength, i.e., peak torque and the rate of torque development and walking speed in adults with stroke. This study had 83 stroke survivors who participated. For the affected lower limb, rate and peak torque explained 12% of the variance in gait speed. Removing rate from the model significantly reduced the explained variance; in contrast, removing peak torque did not reduce the variance. For the less affected lower limb, rate tended to be more predictive of gait speed than peak torque. Diminished ability to rapidly generate knee extension torque contributes more to decreased walking speed after stroke than does maximal strength. Of note, 88% of the variance in gait speed is not explained by rate and peak isometric knee extension strength. Further studies are needed to determine if rehabilitation poststroke can increase the rate of knee strength development and if it results in faster walking speeds.     

Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke

Background

Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking.

Methods

Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household < 0.4 m/s, Limited Community 0.4–0.8 m/s, Community > 0.8 m/s).

Findings

While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P < .05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction.

Interpretation

These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.     

Changes in muscle group work associated with changes in gait speed of persons with stroke

BACKGROUND: Knowledge of associations between changes in muscle work with changes in gait speed could assist gait training in persons with stroke. The purpose of the study was to determine changes in the work of major muscle groups during gait that were associated with increases in walking speed of persons with stroke following training. METHODS: The gait of 28 subjects (14 males, 14 females) with mean age of 64.2 (SD 11.7) years, at 4.8 (SD 6.9) years post stroke was studied using two-dimensional motion analysis before and after a strength training program. Outcome variables were changes in gait speed and changes in work associated with the hip flexors and extensors, knee flexors and extensors and ankle plantar flexors bilaterally. A stepwise linear regression analysis determined best positive work predictors of changes in gait speed. FINDINGS: Hip extension work in early stance and ankle plantarflexion work in late stance of the affected side accounted for 74.9% of the variance in change of gait speed; a second model showed that hip extension work in early stance of the affected and less-affected sides accounted for 74.3%, a similar amount of variance. INTERPRETATION: This work is the first to explore the changes in muscle work during gait that are associated with speed increases in persons with stroke. Augmenting hip extensor work in early stance on both sides, as well as ankle plantarflexion thrust on the affected side may be particularly beneficial in increasing the speed of walking of persons with stroke.     

Identification of kinetic differences between fallers and nonfallers in the elderly.

Falls are a major cause of decreased mobility and disability in the elderly. Multiple factors are believed to contribute to falling. Among these, gait abnormalities have drawn attention as a possible risk factor. Although previous studies have revealed few differences in gait parameters compared with similar aged controls, it was hypothesized that because of intrinsic differences in balance and motor control, we would observe differences in joint kinetics. In this study, 15 subjects (mean age, 77 +/- 9 yr), who had at least 2 mo of repeated falls from an unclear cause, were evaluated in a gait laboratory and were compared with a control group of 15 subjects (mean age, 75 +/- 5 yr) with no history of falls. Analysis of data demonstrated a significantly greater peak torque in the falls group for the following: hip flexion, hip adduction, knee extension, knee varum, ankle dorsiflexion, and ankle eversion (P < 0.003 in each comparison). Also, ankle plantarflexion torque was significantly decreased in the falls group (P = 0.001). Joint powers showed different absorption at the knee and ankle in the falls group. The discovery of these kinetic differences may provide further insight into the mechanism of falls in the elderly and, more importantly, lead to identifiable markers to detect those who may be susceptible to falls.     

Joint kinetics during Tai Chi gait and normal walking gait in young and elderly Tai Chi Chuan practitioners

BACKGROUND: Tai Chi Chuan is becoming a popular exercise among elders. This study measured the inter-segmental forces and moments at the lower extremity joints during a Tai Chi gait as compared to those during normal walking gait, in both apparently healthy young and elderly Tai Chi Chuan practitioners. METHODS: Three-dimensional inter-segmental joint reaction force and moment were computed using the Inverse Dynamic Approach based on the kinematics and ground reaction force measurements in a laboratory setting in six young (two females, mean age 28; SD 6 years) and six elderly (five females, mean age 72; SD 8 years) subjects who had previous training of Yang style Tai Chi Chuan. FINDINGS: The results showed significant gait differences in both age groups, with significantly smaller peak compressive forces, larger peak shear forces in the ankle, knee and hip joints, and larger peak moments in the knee and hip joints during Tai Chi gait as compared to normal gait. Moreover, the peak shear force was oriented more in the medial-lateral direction at the ankle and knee joints, and the peak moment was in the frontal plane at the knee and hip joints. The results also showed significant age differences, with significantly smaller peak shear forces in all three joints in the elderly group than in the young group during Tai Chi gait. INTERPRETATION: Tai Chi gait has an increased shear force and frontal plane torque at lower extremity joints than normal gait. The shear force at all three lower extremity joints during Tai Chi gait is lower in the elderly subjects than young subjects. This data suggest that, in Tai Chi Chuan training, elderly people with degenerative joint diseases in the lower extremity should use caution when practicing Tai Chi Chuan.     

Functional capacity, muscle strength and falls in women with fibromyalgia

Background

Patients with fibromyalgia have difficulty with activities of daily living, they exhibit reduced muscle strength and high incidence of reported falls. The objective of this study was to evaluate the functional performance and lower limb muscle strength in women with fibromyalgia and determine the relationship between muscle strength and falls.

Methods

Sixteen females with fibromyalgia and 16 healthy women participated in the study. Pain intensity, fibromyalgia impact on quality of life, physical activity level and fall prevalence were assessed. The peak torque and the rate of torque development were determined in maximal voluntary isometric contraction (hip, knee and ankle joints) using a load cell. The 30 s chair stand, 8 ft up and go, sit and reach, and functional reach tests were used to characterize functional performance.

Findings

Women with fibromyalgia showed deficits in lower limb muscle strength, balance and agility and exhibited decreased knee extension peak torque and rate of torque development. In addition, they showed lower hip adduction and extension peak torque in comparison to the control group (P > 0.05). Hip extension rate of torque development, duration of fibromyalgia symptoms, overall pain, knee pain, and fibromyalgia impact were strong predictors of the number of falls in patients with fibromyalgia (R2 = 0.86; P < 0.05), when considered collectively.

Interpretation

Women with fibromyalgia showed reduced functional performance and lower limb muscle strength, mostly explained by pain. There was a high prevalence of falls in this population, as explained by hip extensors rate of torque development, duration of fibromyalgia symptoms and pain.     

The ability of gait kinematic parameters to predict falls in older adults with cognitive impairments living in long term institutions

BackgroundCognitive impairments reduce adaptive responses and may increase the risk of falls.ObjectivesTo compare gait kinematics in older adults with cognitive impairments living in long term institutions and to identify the ability of gait kinematics to predict falls in older adults with cognitive impairments living in long term institutions.MethodsData of 23 older adults with cognitive impairments living in long term institutions were considered for this study. Fifty gait cycles were recorded during walking at a self-selected pace using footswitches sensors. The variables considered for the analysis were: speed; stride length; stance, swing and stride time; and the variability of these parameters. Fall status was recorded for a 6 month-period.FindingsMANOVA found group effect (p = 0.025) for gait kinematics comparisons. Variability of stance (p = 0.01) and swing (p = 0.012) and stride time (p < 0.001) were higher in older fallers. Speed of older fallers was 31.8% slower than those of the non-fallers (p < 0.001). The kinematic variables that were able to predict falls were: stride time variability (p < 0.001), threshold of 0.4 s, sensitivity of 50% and specificity of 100%; and gait speed (p < 0.001), threshold of 0.65 m·s⁻¹, sensibility and specificity of 50%.InterpretationOlder adults living in an assisted living facility with a history of falls demonstrate increased kinematic variability while walking. However, the ability of gait kinematic parameters to predict falls was found to be weak. The results suggested that gait kinematic parameters are weak predictors of falls in older adults with cognitive impairments living in long term institutions.     

Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers

OBJECTIVES: To describe the frequency and circumstances of falls among a community sample of people with stroke and to compare characteristics of fallers and nonfallers. DESIGN: Cross-sectional, observational study. SETTING: Community. PARTICIPANTS: Forty-one community-dwelling people with stroke (26 men, 15 women; mean age, 69.7 +/- 11.6y), of which 23 had right-hemisphere infarction, 16 left-hemisphere infarction, and 2 had a brainstem lesion. Time since onset of stroke ranged from 3 to 288 months (mean, 50mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Standardized tests were used to measure mobility, upper limb function, activities of daily living (ADL ability), and mood. Information about fall events was collected by using a questionnaire. RESULTS: Twenty-one participants (50%) were classed as fallers, of whom 10 had fallen repeatedly. No significant differences were found between fallers and nonfallers on any of the measures used. However, those who had 2 or more falls (n = 10) had significantly reduced arm function (P = .018) and ADL ability (P = .010), compared with those who had not fallen or experienced near falls (n = 5). Loss of balance, misjudgment, and foot dragging during walking, turning, and sit to stand were reported by fallers as the suspected causes and activities leading to falls. CONCLUSIONS: The high risk of falling among people with stroke was evident in this community-based sample. Repeat fallers had greater mobility deficits and significantly reduced arm function and ADL ability than those who did not report any instability.     

不同速度下膝关节等速肌力和自然步速下步态的时空参数比较

背景：当前研究肥胖对儿童的影响多限于代谢生理问题,对于骨骼肌肉及运动能力研究较少。 目的：比较肥胖儿童与正常儿童膝关节的等速肌力,从肌力方面分析肥胖儿童运动能力下降的原因。 方法：招募56名儿童,其中28名肥胖儿童,28名正常儿童。采用CON-TREX等速测试仪测量下肢肌力,采用VICON系统采集运动数据,采用SPSS 19.0统计软件对所有实验数据进行统计学处理。 结果与结论：在同一速度下,肥胖儿童的膝关节伸屈绝对峰力矩和平均功率大于正常儿童（P0.05）。在同一速度下,两组儿童的伸肌群力矩和功率均大于屈肌群（P〈0.05）,同时肥胖组儿童在较高速度[120（°）/s]下伸屈肌群绝对峰力矩和绝对平均功率与相对峰力矩和相对平均功率差异均有显著性意义（P〈0.05）。两组儿童均表现屈肌在较高速度下力矩大,伸肌在较低速度下力矩大。正常儿童的步频步速快于肥胖儿童,单步时间和步宽显著小于肥胖儿童（P〈0.05）。结果显示肥胖儿童绝对肌力大于正常儿童,但相对肌力等于甚至小于正常儿童,同时肥胖儿童步速较慢,步频较低,这可能解释为由于下肢肌力较弱,导致运动能力不足。     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

Reduced hip extension during walking: healthy elderly and fallers versus young adults

OBJECTIVES: To test the hypothesis that reduced hip extension range during walking, representing a limiting impairment of hip tightness, is a consistent dynamic finding that (1) occurs with increased age and (2) is exaggerated in elderly people who fall. DESIGN: Using a 3-dimensional optoelectronic motion analysis system, we compared full sagittal plane kinematic (lower extremity joint motion, pelvic motion) data during walking between elderly and young adults and between elderly fallers and nonfallers. Comparisons were also performed between comfortable and fast walking speeds within each elderly group. SETTING: A gait laboratory. PARTICIPANTS: Twenty-three healthy elderly subjects, 16 elderly fallers (otherwise healthy elderly subjects with a history of recurrent falls), and 30 healthy young adult subjects. MAIN OUTCOME MEASURES: All major peak joint angle and pelvic position values. RESULTS: Peak hip extension was the only leg joint parameter measured during walking that was both significantly lower in elderly nonfallers and fallers than in young adult subjects and was even lower in elderly fallers compared with nonfallers (all p <.05). Peak hip extension +/- standard deviation during comfortable walking speed averaged 20.4 degrees +/- 4.0 degrees for young adults, 14.3 degrees +/- 4.4 degrees for elderly nonfallers, and 11.1 degrees +/- 4.8 degrees for elderly fallers. Peak hip extension did not significantly improve when elderly subjects walked fast. CONCLUSION: An isolated and consistent reduction in hip extension during walking in the elderly, which is exaggerated in fallers, implies the presence of functionally significant hip tightness, which may limit walking performance. Overcoming hip tightness with specific stretching exercises is worthy of investigation as a simple intervention to improve walking performance and to prevent falls in the elderly.     

The impact of hearing loss on three-dimensional lower limb joint torques during walking in prepubertal boys

IntroductionIn children, the impact of hearing loss on biomechanical gait parameters is not well understood. Thus, the objectives of this study were to examine three-dimensional lower limb joint torques in deaf compared to age-matched healthy (hearing) children while walking at preferred gait speed.MethodsThirty prepubertal boys aged 8–14 were enrolled in this study and divided into a group with hearing loss (deaf group) and an age-matched healthy control. Three-dimensional joint torques were analyzed during barefoot walking at preferred speed using Kistler force plates and a Vicon motion capture system.ResultsFindings revealed that boys with hearing loss showed lower joint torques in ankle evertors, knee flexors, abductors and internal rotators as well as in hip internal rotators in both, the dominant and non-dominant lower limbs (all p < 0.05; d = 1.23–7.00; 14–79%). Further, in the dominant limb, larger peak ankle dorsiflexor (p < 0.001; d = 1.83; 129%), knee adductor (p < 0.001; d = 3.20; 800%), and hip adductor torques (p < 0.001; d = 2.62; 350%) were found in deaf participants compared with controls.ConclusionThe observed altered lower limb torques during walking are indicative of unstable gait in children with hearing loss. More research is needed to elucidate whether physical training (e.g., balance and/or gait training) has the potential to improve walking performance in this patient group.