Lateral Stability and Falls in Aging

描述(申请人提供)：这项研究的长期目标是确定老年人姿势平衡功能障碍背后的神经机械性(NM)损害的机制，并建立一项具有科学基础的增强平衡功能和降低跌倒风险的治疗计划。当人体的平衡受到挑战时，踏步反应是稳定身体和防止摔倒的有力手段。因此，保护性步法是在日常生活活动中保持平衡的重要策略。我们认为，区域内侧(M-L)髋外展肌/内收肌(AB/AD)NM反应的年龄限制破坏了保护性台阶，从而损害了侧向平衡稳定性。因此，许多老年人可能特别容易受到侧向不稳定和损伤性跌倒的影响。因此，我们的目标包括了解这些关系的实验、建模和干预方法。目的一是确定由于运动动力学和运动学决定的髋关节AB/AD NM控制的局限性，老年受试者过渡到风险更高、问题更多的交叉保护性踏步模式的平衡扰动幅度水平；以及b)评估平衡扰动幅度以及相关的踏步和髋关节AB/AD NM反应测量是否区分低跌倒风险和高跌倒风险的受试者。第二个目的是开发和应用一个计算模型来预测M-L步态的平衡极限与区域髋关节AB/AD NM极限的关系。目标三是评估推进预防跌倒的全面治疗干预所必需的可行性因素(依从性、耐受性、益处)。我们假设，结合诱导台阶训练和髋关节AB/AD肌肉强化的干预方法将显示出比单独执行这两种方案中的任何一种方案在表现结果上更大的改善和更少的预期摔倒。与公共卫生相关。这项研究与公共卫生的相关性在于，它的重点在于了解原因和干预措施，以最大限度地减少与年龄相关的跌倒造成的破坏性经济、社会和个人后果。

DESCRIPTION (provided by applicant): The long term objectives of this research are to identify the mechanisms of neuromechanical (NM) impairments underlying postural balance dysfunction in older people, and to establish a scientifically grounded therapeutic program for enhancing balance function and reducing the risk of falls. When human balance is challenged, the stepping reaction is a powerful means of stabilizing the body and preventing falling. Protective stepping is therefore a vital strategy for maintaining balance during activities of daily life. We propose that aging limitations in regional medio-lateral (M-L) hip abductor/adductor (AB/AD) NM responses compromise lateral balance stability by disrupting protective stepping. Consequently, many older people may be particularly vulnerable to lateral instability and injurious falls. Accordingly, our aims involve experimental, modeling, and interventional approaches to understanding these relationships. Aim one is to a) identify the balance perturbation magnitude level at which older subjects transition to a riskier and more problematic crossover protective stepping pattern due to limitations in hip AB/AD NM control as determined by movement kinetics and kinematics; and to b) assess whether balance perturbation magnitude and associated stepping and hip AB/AD NM response measures discriminate between subjects with low fall risk and those with high fall risk. Aim two is to develop and apply a computational model that predicts the balance limits of M-L stepping patterns in relation to regional hip AB/AD NM limitations. Aim three is to assess feasibility factors (compliance, tolerance, benefits) necessary to advance a full-scale therapeutic intervention for preventing falls. We hypothesize that an intervention approach that combines induced step training and hip AB/AD muscle strengthening will demonstrate greater improvements in performance outcomes and fewer prospectively identified falls than either program performed alone. PUBLIC HEALTH RELEVANCE. The relevance of this research to public health lies in its focus on understanding the causes and interventions for minimizing the devastating economic, societal, and personal consequences of age-associated falls.