Lateral Stability and Falls in Aging

描述（由申请人提供）：本研究的长期目标是确定老年人姿势平衡功能障碍的神经机械（NM）损伤机制，并建立一个科学的治疗方案，以增强平衡功能和降低福尔斯的风险。当人体平衡受到挑战时，踏步反应是稳定身体和防止摔倒的有力手段。因此，保护性踏步是在日常生活活动中保持平衡的重要策略。我们认为，在区域内外侧（M-L）髋外展肌/内收肌（AB/AD）NM反应的老化限制损害横向平衡稳定性破坏保护性步进。因此，许多老年人可能特别容易受到横向不稳定和伤害性福尔斯。因此，我们的目标涉及实验，建模和干预的方法来理解这些关系。目的一是a）确定平衡扰动幅度水平，在该水平下，由于由运动动力学和运动学确定的髋关节AB/AD NM控制的限制，老年受试者过渡到更危险和更有问题的交叉保护性踏步模式;以及B）评估平衡扰动幅度和相关的步进和髋关节AB/AD NM反应测量区分具有低跌倒风险的受试者和具有高跌倒风险的受试者。目的二是开发和应用一个计算模型，预测M-L步进模式的平衡限制与区域髋关节AB/AD NM限制。目的三是评估可行性因素（依从性，耐受性，效益），以促进全面的治疗干预，以防止福尔斯。我们假设，相结合的诱导台阶训练和髋关节AB/AD肌肉强化的干预方法将证明更大的性能结果的改善和更少的前瞻性识别福尔斯比单独进行的程序。公共卫生相关性。这项研究与公共卫生的相关性在于其重点是了解原因和干预措施，以尽量减少与年龄相关的福尔斯的破坏性经济，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.