Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The main aim of this study is to unravel the biomechanics of postural balance reactions during head-motion perturbed standing and walking in older adults who fall, while integrating the influence of frailty, sensory functioning and cognitive processing.
Older adults above 65 years old experience falls at a rate of 20-40% annually, with women being more affected than men. Unintentional falls are the second leading cause of accidental injury death and a major contributor to disability levels worldwide. Falls pose an even bigger burden on society in the future due to the increasing number of older adults and the higher prevalence of falls as people age. Gait and balance instability are major risk and causative factors for falls in older adults. As people age, their stability decreases. This is evident in the careful way that older adults walk. To prevent and predict falls, it is essential to understand how humans maintain their stability during locomotor activities.
Balance disruptions are typically not caused by walking itself, but rather by internal or external disturbances or the performance of multiple tasks simultaneously. In daily life, people often face complex situations that require high levels of sensory input and cognitive processing. This can be especially challenging when also trying to maintain a safe walking pattern, such as when checking the environment before crossing the street. This task requires coordinated movement of both the head and eyes to track moving objects. Gaze control requires accurate cognitive processing, including multisensory integration, attention, executive functioning, and motor responses to coordinate eye and head movements.
Older adults use different strategies than younger adults to control head movement for stabilizing their head during walking. Therefore, changes in head position may affect gait stability differently in older adults. Ageing can cause frailty, decline in sensorimotor and cognitive abilities, and a reduced capacity to adjust gait to changing environments. These changes may increase the risk of falls in older adults. However, research on these issues is currently insufficient.
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fallers | Community dwelling older adults with an age above 65 years. A participant is categorized as faller in case of a history of ≥2 falls in the previous 12 months and with identified high fall risk on the TUG (i.e., completion time ≥13.5 seconds). A fall is defined as an event that results in a person coming to rest inadvertently on the ground/floor/other lower level (WHO, 2021). Asyncopal fall, identified through the report of a loss of consciousness during the fall, has a different etiology and therefore will not be counted as a fall (Ang et al., 2020). |
| |
| Non-Fallers | Community dwelling older adults with an age above 65 years. A participant is included as non-faller in case of a history of 0 falls in the previous 12 months and without an identified fall risk on the TUG test (i.e., completion time ≤13.5 seconds). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cognition | Diagnostic Test |
|
| Measure | Description | Time Frame |
|---|---|---|
| Spatio-temporal parameters of gait | step length and width (cm) | baseline |
| Foot placement estimator | measure which estimates where the foot should be placed for stable gait | baseline |
| Onset latency | latency in msec between onset of movements and activation recorded by surface EMG of bilateral m. Erector Spinae (trunk stabilization), m. Gluteus medius (hip strategy), m. Tibialis anterior and m. Soleus (ankle strategy) | baseline |
| Peak amplitude | peak amplitude in microvolts of the surface EMG of bilateral m. Erector Spinae (trunk stabilization), m. Gluteus medius (hip strategy), m. Tibialis anterior and m. Soleus (ankle strategy) | baseline |
| Fixation duration | Duration of fixation of the eyes on target, measured by the Hololens 2 | baseline |
| Gain | Accuracy of the fixation of the eyes on target as measured by the Hololens 2 | baseline |
| Latency | Latency in msec between the movement of the target and the movement of the eyes and the head when following the target as measured by the Hololens 2. | baseline |
| Fall characteristics |
| Measure | Description | Time Frame |
|---|---|---|
| Multisensory integration | reaction times in visual/sensory vs. visuo-sensory conditions (ratio, in %) measured with CatchU app | baseline |
| Digit symbol substitution test | number of correct symbol-digit pairs completed |
| Measure | Description | Time Frame |
|---|---|---|
| Age | age in years | Screening before inclusion |
| Gender | male, female or other | Screening before inclusion |
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Community dwelling older adults with an age of 65 years or above
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ann Hallemans, PhD | Contact | 032652912 | ann.hallemans@uantwerpen.be | |
| Eugénie Lambrecht, MSc, PT | Contact | eugenie.lambrecht@uantwerpen.be |
| Name | Affiliation | Role |
|---|---|---|
| Ann Hallemans | Universiteit Antwerpen | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Antwerp | Recruiting | Antwerp | 2160 | Belgium |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D012677 | Sensation |
| D008403 | Mass Screening |
| ID | Term |
|---|---|
| D009424 | Nervous System Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
Not provided
Not provided
Not provided
Not provided
Not provided
|
| Sensory function | Diagnostic Test |
|
|
| Frailty | Diagnostic Test | Frailty will be assessed using the Fried criteria, comprising 5 categories (each accounting for 1 point if scored positive): Unintentional weight loss (interview), weakness (grip strength with hand-held dynamometer), poor endurance and energy (two statements of the CES-D Depression Scale), slowness (walking speed over 15ft through gait analysis) and low physical activity level (Minnesota Leisure Time Activity questionnaire)(Fried et al., 2001). |
|
| Biomechanical movement analysis | Other | Markers will be placed on the predefined anatomical locations and surface electrodes for electromyography will be applied at the predefined muscle locations following the SENIAM-guidelines. The Microsoft HoloLens 2 is fixated on the participant's head which will, on one hand, provide the cue to the participant for the head movement and on the other hand track eye and head movements. A safety harness is attached to the body and the ceiling of the lab. At the start of the trial, the subject will see a projection by the HoloLens 2 on the real environment moving to the left; right; upward; downward (cue in randomized order) which the participant is ought to follow with eyes and head. First while standing still and second while walking the 10-meter overground walkway at a self-preferred walking speed. |
|
| Screening | Other | The researcher will visit the possible participants (at their home, community centre, etc.) and after written consent on screening procedure is provided, the tests for eligibility will be performed.
|
|
| Follow up | Other | Participants are followed up for 12 months. They fill in a fall diary and telephone reminders will be performed monthly to encourage participants to complete and return their diaries. |
|
Fall diaries provide information on occurrence and number of falls, activity preceding a fall, cause of fall, obtained injuries and potential care that was received. |
| monthly during 12 months of follow-up |
| baseline |
| Trail making test | Time to complete part A vs. B (ratio in seconds) | baseline |
| Go/No Go test | Accuracy (number of correct responses) | baseline |
| Head Repositioning Accuracy | joint position error in degrees | baseline |
| Fly test | directional accuracy (in %) of movement | baseline |
| Fly test | Amplitude (in mm) of movement | baseline |
| vHIT | VOR-gain and VOR-gain asymmetry in % | baseline |
| fHIT | statfHIT (Static visual acuity): logMAR-score and dynfHIT (Dynamic visual acuity): % correct responses | baseline |
| Frailty | Fried criteria: Frailty level (categorical): non-frail (0/5), pre-frail( 1-2/5) or frail (≥3/5) | baseline |
| Medical history | presence or absence of diagnosed vestibulopathy, orthostatic hypotension, peripheral neuropathy, limb amputation, neurological/ or neuromuscular disorders affecting balance, neck disorders affecting sensorimotor control, blindness, deafness and if a full-time walking aid is indispensable | Screening before inclusion |
| Fall history | number of falls in last 12 months | Screening before inclusion |
| D006306 | Health Surveys |
| D011795 | Surveys and Questionnaires |
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D003954 | Diagnostic Services |
| D011314 | Preventive Health Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
| D015980 | Public Health Practice |