FALL BIOMECHANICS AND HIP FRACTURE RISK

描述：（申请中的逐字记录）福尔斯和跌倒相关 伤害是最严重的，常见的昂贵的医疗问题所面临的 老人在美国，每年大约有3000万福尔斯摔倒， 第二，在1000万名跌倒者中。此外，在大约30万髋关节中， 每年发生的骨折中，超过90%与福尔斯有关。我们有 先前表明，福尔斯向侧面跌倒并撞击臀部 髋部骨折的风险增加了20倍以上（与 与骨密度降低相关的风险增加3倍）。因此，在本发明中， 当筛选干预措施和骨折预防计划时， （药剂、转子垫或运动），它的成本要少得多 从公共卫生的角度来看， 每年将有1000万老年人摔倒（现在可以使用 相对简单的实地测试），而不是专注于50万至60万 老年受试者将跌倒一侧（对于这一点， 测试尚未完成）。本次竞争性续约申请的目的 都集中在这个目标上。在上一个资助期内，我们完成了 目标1的目标：侧福尔斯的动力学，证明缓慢的步态速度和 滑倒或昏厥的姿势紊乱与福尔斯跌倒有关， 侧面和臀部的冲击。我们还开发了第一款 多段，全身模型下降，并表明这是一个 这是一个研究向侧面倒下的生物动力学的有力工具。为我们 上一个目标2：侧面跌倒风险指数，我们完成了开发和 改进阶段的建议指数，表明，一个线性 串联步态、髋关节外展力量、步速不对称组合 从快步测试，和摇摆变量，而站在一个 半串联位置可用于区分老年受试者， 从其他方向倒下的人中倒向一边。根据我们的新 拟议目标1：验证侧面跌倒风险指数（SFRI），我们将确定 我们在上一次融资期间开发的侧摔风险指数 可以前瞻性地使用周期来识别将下降到 一旁作为我们以前关于侧面福尔斯动力学工作的扩展， 在目标2：步态变异性作为侧倒福尔斯的预测因子下，我们将分析 老年跌倒者在仪器上行走时的地面压力时程 mat.将现代信号分析理论应用于地压时间 历史利用混沌理论和分形分析， 心血管和神经肌肉病理学的特征是 心率和步态的规律性，分别，我们将确定是否步态 从地面压力时间历程确定的参数可用于 识别身体虚弱的老年受试者跌倒在一侧。

DESCRIPTION: (Verbatim from the application) Falls and fall-related injuries are the most serious, common costly medical problems facing the elderly. In the US each year there are about 30 millions falls, or about 1 per second, among 10 million fallers. In addition, of the approximately 300,000 hip fractures that occur each year, over 90% are associated with falls. We have shown previously that falls to the side with impact on the hip are associated with more than 20-fold increase in the risk of hip fractures (compared to a 3-fold increase in risk associated with reduced bone density). Thus, when screening for interventions and fracture prevention programs (pharmaceutical agents, trochanter padding or exercise), it is far less cost effective and efficient from a public health perspective to attempt to identify the 10 million elderly who will fall each year (which can now be done using relatively simple field tests) than it is to focus on the 500,000 to 600,000 elderly subjects who will fall to the side (for which comparable validated tests are not yet available). The aims of this competitive renewal application are focused on this goal. During the previous funding period, we completed the goals of Aim 1: Dynamics of Side Falls, demonstrating that slow gait speed and the postural disturbances of slipping or fainting are associated with falls to the side and impact on the hip. We have also developed the first available multi‑segment, whole body model for falling and showed it to be a powerful tool for studying the biodynamics of falling to the side. For our previous Aim 2: Side Fall Risk Index, we completed both the development and refinement phases of the proposed index, demonstrating that a linear combination of tandem gait, hip abduction strength, step velocity asymmetry from the quick-step test, and sway variables while standing in a semi-tandem position could be used to distinguish elderly subjects who fell to the side from those who fell in all other directions. Under our new proposed Aim 1: Validation of Side Fall Risk Index (SFRI), we will determine whether the Side Fall Risk Index we have developed during the previous funding period can be used prospectively to identify elderly subjects who will fall to the side. As an extension of our previous work on the dynamics of side falls, under Aim 2: Gait Variability as a Predictor of Side Falls we will analyze the ground pressure time histories of elderly fallers ambulating on an instrumented mat. We will apply modern signal analysis theory to the ground pressure time histories. Using chaos theory and fractal analysis and noting that cardiovascular and neuromuscular pathologies are characterized by increased regularity of heartbeat and gait, respectively, we will determine if gait parameters determined from ground pressure time histories can be used to identify frail elderly subjects who fall to the side.