Mechanisms leading to a fall from an induced trip in healthy older adults
Mechanisms leading to a fall from an induced trip in healthy older adults
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DOI：
10.1093/gerona/56.7.m428
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发表时间：
2001-07-01
影响因子：
5.1
通讯作者：
Grabiner, MD
中科院分区：
文献类型：
--
作者：
Pavol, MJ;Owings, TM;Grabiner, MD
背景绊倒是老年人福尔斯跌倒的主要原因。经常导致严重的伤害。虽然从旅行中恢复的要求是很好的特点，老年人旅行实际上导致福尔斯的机制尚不清楚。本研究旨在确定这样的机制。79名健康的、居住在社区的、安全带式的老年人（50名女性）在步态中使用隐蔽的。机械障碍描述恢复尝试的运动学和动力学变量进行了比较，那些谁跌倒，谁恢复。根据所采用的恢复策略（降低与升高）和“下降”的时间（步骤中与步骤后）对受试者进行分析。确定了三种明显的跌倒机制。对于降低策略，在步福尔斯与更快的行走速度（每秒91% +/- 8% vs 68% +/- 11%身高[bh]; p <0.001）和延迟的支撑肢体负荷（267 +/- 49毫秒vs 160 +/- 39毫秒; p <0.001）相关。台阶后福尔斯跌倒与绊倒时头臂躯干质心更靠前相关（6.2 +/- 1.3度vs 0.2 +/- 4.4度; p <0.01），随后是过度的腰部屈曲和恢复肢体屈曲。抬高策略跌倒与更快的步行速度相关（93% vs 68% +/-11%bh/s：p <0.001），随后是过度的腰椎屈曲。快速行走可能是健康老年人旅行后跌倒的最大原因。身体前部的质量携带，伴随着背部和膝盖伸肌无力，也可能导致旅行后的福尔斯跌倒。踏步反应不足并不导致福尔斯跌倒。
Background. Tripping is a leading cause of falls in older adults. often resulting in serious injury. Although the requirements for recovery from a trip are well characterized, the mechanisms whereby trips by older adults actually result in falls are not known. This study sought to identify such mechanisms.Methods. Trips were induced during gait in 79 healthy, community-dwelling, safety-harnessed, older adults (50 women) using a concealed. mechanical obstacle. Kinematic and kinetic variables describing the recovery attempts were compared between those who fell and those who recovered. Subjects were analyzed according to the recovery strategy employed (lowering vs elevating) and the time of the "fall" (during step vs after step).Results. Three apparent mechanisms of falling were identified. For a lowering strategy, during-step falls were associated with a faster walking speed at the time of the trip (91% +/- 8% vs 68% +/- 11% body height [bh] per second; p < .001) and delayed support limb loading (267 +/- 49 milliseconds vs 160 +/- 39 milliseconds; p < .001). After-step falls were associated with a more anterior head-arms-torso center of mass at the time of the trip (6.2 +/- 1.3 degrees vs 0.2 +/- 4.4 degrees; p < .01), followed by excessive lumbar flexion and buckling of the recovery limb. The elevating strategy fall was associated with a faster walking speed (93% vs 68% +/- 11% bh per second: p < .001) followed by excessive lumbar flexion.Conclusions. Walking quickly may be the greatest cause of falling following a trip in healthy older adults. An anterior body mass carriage, accompanied by back and knee extensor weakness, may also lead to falls following a trip. Deficient stepping responses did not contribute to the falls.