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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Tong CY, Zhu RTL, Ling YT, Scheeren EM, Lam FMH, Fu H, Ma CZH. Muscular and Kinematic Responses to Unexpected Translational Balance Perturbation: A Pilot Study in Healthy Young Adults. Bioengineering (Basel) 2023; 10:831. [PMID: 37508858 PMCID: PMC10376184 DOI: 10.3390/bioengineering10070831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
Falls and fall-related injuries are significant public health problems in older adults. While balance-controlling strategies have been extensively researched, there is still a lack of understanding regarding how fast the lower-limb muscles contract and coordinate in response to a sudden loss of standing balance. Therefore, this pilot study aims to investigate the speed and timing patterns of multiple joint/muscles' activities among the different challenges in standing balance. Twelve healthy young subjects were recruited, and they received unexpected translational balance perturbations with randomized intensities and directions. Electromyographical (EMG) and mechanomyographical (MMG) signals of eight dominant-leg's muscles, dominant-leg's three-dimensional (3D) hip/knee/ankle joint angles, and 3D postural sways were concurrently collected. Two-way ANOVAs were used to examine the difference in timing and speed of the collected signals among muscles/joint motions and among perturbation intensities. This study has found that (1) agonist muscles resisting the induced postural sway tended to activate more rapidly than the antagonist muscles, and ankle muscles contributed the most with the fastest rate of response; (2) voluntary corrective lower-limb joint motions and postural sways could occur as early as the perturbation-induced passive ones; (3) muscles reacted more rapidly under a larger perturbation intensity, while the joint motions or postural sways did not. These findings expand the current knowledge on standing-balance-controlling mechanisms and may potentially provide more insights for developing future fall-prevention strategies in daily life.
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Affiliation(s)
- Cheuk Ying Tong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Ringo Tang-Long Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Centre for Developmental Neurobiology, King's College London, London SE1 1UL, UK
| | - Eduardo Mendonça Scheeren
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Brazil
| | - Freddy Man Hin Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
| | - Hong Fu
- Department of Mathematics and Information Technology, The Education University of Hong Kong, Hong Kong SAR 999077, China
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR 999077, China
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Wang S, Miranda F, Wang Y, Rasheed R, Bhatt T. Near-Fall Detection in Unexpected Slips during Over-Ground Locomotion with Body-Worn Sensors among Older Adults. SENSORS (BASEL, SWITZERLAND) 2022; 22:3334. [PMID: 35591025 PMCID: PMC9102890 DOI: 10.3390/s22093334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
Slip-induced falls are a growing health concern for older adults, and near-fall events are associated with an increased risk of falling. To detect older adults at a high risk of slip-related falls, this study aimed to develop models for near-fall event detection based on accelerometry data collected by body-fixed sensors. Thirty-four healthy older adults who experienced 24 laboratory-induced slips were included. The slip outcomes were first identified as loss of balance (LOB) and no LOB (NLOB), and then the kinematic measures were compared between these two outcomes. Next, all the slip trials were split into a training set (90%) and a test set (10%) at sample level. The training set was used to train both machine learning models (n = 2) and deep learning models (n = 2), and the test set was used to evaluate the performance of each model. Our results indicated that the deep learning models showed higher accuracy for both LOB (>64%) and NLOB (>90%) classifications than the machine learning models. Among all the models, the Inception model showed the highest classification accuracy (87.5%) and the largest area under the receiver operating characteristic curve (AUC), indicating that the model is an effective method for near-fall (LOB) detection. Our approach can be helpful in identifying individuals at the risk of slip-related falls before they experience an actual fall.
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Affiliation(s)
- Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
| | - Fabio Miranda
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA; (F.M.); (R.R.)
| | - Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
| | - Rahiya Rasheed
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA; (F.M.); (R.R.)
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
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Xu JC, Silvano AP, Keller A, Krašna S, Thomson R, Klug C, Linder A. Identifying and Characterizing Types of Balance Recovery Strategies Among Females and Males to Prevent Injuries in Free-Standing Public Transport Passengers. Front Bioeng Biotechnol 2021; 9:670498. [PMID: 34291040 PMCID: PMC8287834 DOI: 10.3389/fbioe.2021.670498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
Free-standing passengers on public transport are subjected to perturbations during non-collision incidents caused by driver maneuvers, increasing the risk of injury. In the literature, the step strategy is described as a recovery strategy during severe perturbations. However, stepping strategies increase body displacement, ultimately subjecting passengers to higher risk of impacts and falls on public transport. This study investigates the influence of different recovery strategies on the outcome of balance recovery of free-standing public transport passengers, challenged in postural balance by the non-uniform vehicle dynamics. From high-speed video recordings, a qualitative investigation of the balance responses of volunteer participants in a laboratory experiment was provided. On a linearly moving platform, 24 healthy volunteers (11 females and 13 males) were subjected to perturbation profiles of different magnitude, shape and direction, mimicking the typical acceleration and deceleration behavior of a bus. A methodology categorizing the balancing reaction to an initial strategy and a recovery strategy, was used to qualitatively identify, characterize and, evaluate the different balance strategies. The effectiveness of different strategies was assessed with a grading criterion. Statistical analysis based on these ordinal data was provided. The results show that the current definition in the literature of the step strategy is too primitive to describe the different identified recovery strategies. In the volunteers with the most successful balancing outcome, a particularly effective balance recovery strategy not yet described in the literature was identified, labeled the fighting stance. High jerk perturbations seemed to induce faster and more successful balance recovery, mainly for those adopting the fighting stance, compared to the high acceleration and braking perturbation profiles. Compared to the pure step strategy, the characteristics of the fighting stance seem to increase the ability to withstand higher perturbations by increasing postural stability to limit body displacement.
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Affiliation(s)
- Jia-Cheng Xu
- Swedish National Road and Transport Research Institute, Linköping, Sweden
| | - Ary P Silvano
- Swedish National Road and Transport Research Institute, Linköping, Sweden
| | | | - Simon Krašna
- Faculty of Mechanical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Thomson
- Mechanics and Maritime Science, Chalmers University of Technology, Gothenburg, Sweden
| | - Corina Klug
- Vehicle Safety Institute, Graz University of Technology, Graz, Austria
| | - Astrid Linder
- Swedish National Road and Transport Research Institute, Linköping, Sweden.,Mechanics and Maritime Science, Chalmers University of Technology, Gothenburg, Sweden
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Okubo Y, Schoene D, Caetano MJD, Pliner EM, Osuka Y, Toson B, Lord SR. Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests. Ageing Res Rev 2021; 66:101238. [PMID: 33352293 DOI: 10.1016/j.arr.2020.101238] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
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Bohm S, Mandla-Liebsch M, Mersmann F, Arampatzis A. Exercise of Dynamic Stability in the Presence of Perturbations Elicit Fast Improvements of Simulated Fall Recovery and Strength in Older Adults: A Randomized Controlled Trial. Front Sports Act Living 2020; 2:52. [PMID: 33345043 PMCID: PMC7739602 DOI: 10.3389/fspor.2020.00052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022] Open
Abstract
Age-related impairments of reactive motor responses to postural threats and reduced muscular capacities of the legs are key factors for the higher risk of falling in older people. It has been evidenced that a training of dynamic stability in the presence of perturbations has the potential to improve these deficits. However, the time course of training effects during such interventions is poorly understood. The purpose of this parallel-group study was to investigate the temporal adaptation dynamics of the balance recovery performance and leg strength during a dynamic stability training. Forty-two healthy older adults (65–85 years) were randomly assigned to a training (n = 27, analyzed n = 18) or control group (n = 15, n = 14). The training was conducted in a group setting for 6 weeks (3×/week, 45 min). The exercises focused on the mechanism of stability control (i.e., modulation of the base of support and segment counter-rotations around the center of mass) during standing, stepping, and jumping on unstable surfaces with a high balance intensity. Before, after 3 and after 6 weeks, the maximum plantar flexion moment and the knee extension moment were assessed. The recovery performance was evaluated by a simulated forward fall (lean-and-release test) and the margin of stability concept. The margin of stability at release decreased significantly after 3 weeks of training (34%, effect size g = 0.79), which indicates fast improvements of balance recovery performance. The margin of stability further decreased after week 6 (53%, g = 1.21), yet the difference between weeks 3 and 6 was not significant. Furthermore, the training led to significant increases in the plantar flexion moment after weeks 3 (12%, g = 0.72) and 6 (13%, g = 0.75) with no significant difference between weeks. For the knee extension moment, a significant increase was found only after week 6 (11%, g = 1.07). The control group did not show any significant changes. This study provides evidence that a challenging training of dynamic stability in the presence of perturbations can improve balance recovery performance and leg strength of older adults already after a few weeks. Therefore, short-term training interventions using this paradigm may be an effective strategy for fall prevention in the elderly population, particularly when intervention time is limited.
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Affiliation(s)
- Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Mandla-Liebsch
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Ochi A, Ohko H, Hayashi T, Osawa T, Sugiyama Y, Nakamura S, Ibuki S, Ichihashi N. Relationship Between Balance Recovery From a Forward Fall and Lower-Limb Rate of Torque Development. J Mot Behav 2019; 52:71-78. [PMID: 30915901 DOI: 10.1080/00222895.2019.1585743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors examined the relationship between the maximum recoverable lean angle via the tether-release method with early- or late-phase rate of torque development (RTD) and maximum torque of lower-limb muscle groups in 56 young healthy adults. Maximal isometric torque and RTD at the hip, knee, and ankle were recorded. The RTD at 50-ms intervals up to 250 ms from force onset was calculated. The results of a stepwise multiple regression analysis, early RTD for hip flexion, and knee flexion were chosen as predictive variables for the maximum recoverable lean angle. The present study suggests that some of the early RTD in the lower limb muscles, but not the maximum isometric torque, can predict the maximum recoverable lean angle.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Hiroshi Ohko
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, Toukai, Japan
| | - Tatsuya Osawa
- Faculty of Rehabilitation, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Yuto Sugiyama
- Faculty of Rehabilitation, Kakamigahara Rehabilitation Hospital, Kakamigahara, Japan
| | | | - Satoko Ibuki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis. SPORTS MEDICINE-OPEN 2018; 4:56. [PMID: 30547249 PMCID: PMC6292834 DOI: 10.1186/s40798-018-0170-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/09/2018] [Indexed: 01/07/2023]
Abstract
Background The risk of falling and associated injuries increases with age. Therefore, the prevention of falls is a key priority in geriatrics and is particularly based on physical exercising, aiming to improve the age-related decline in motor performance, which is crucial in response to postural threats. Although the benefits and specifications of effective exercise programs have been well documented in pre-post design studies, that is during the treatment, the definitive retention and transfer of these fall-related exercise benefits to the daily life fall risk during follow-up periods remains largely unclear. Accordingly, this meta-analysis investigates the efficacy of exercise interventions on the follow-up risk of falling. Methods A systematic database search was conducted. A study was considered eligible if it examined the number of falls (fall rate) and fallers (fall risk) of healthy older adults (≥ 65 years) during a follow-up period after participating in a randomized controlled physical exercise intervention. The pooled estimates of the fall rate and fall risk ratios were calculated using a random-effects meta-analysis. Furthermore, the methodological quality and the risk of bias were assessed. Results Twenty-six studies with 31 different intervention groups were included (4739 participants). The number of falls was significantly (p <0.001) reduced by 32% (rate ratio 0.68, 95% confidence interval 0.58 to 0.80) and the number of fallers by 22% (risk ratio 0.78, 95% confidence interval 0.68 to 0.89) following exercising when compared with controls. Interventions that applied posture-challenging exercises showed the highest effects. The methodological quality score was acceptable (73 ± 11%) and risk of bias low. Conclusions The present review and meta-analysis provide evidence that physical exercise interventions have the potential to significantly reduce fall rate and risk in healthy older adults. Posture-challenging exercises might be particularly considered when designing fall prevention interventions. Electronic supplementary material The online version of this article (10.1186/s40798-018-0170-z) contains supplementary material, which is available to authorized users.
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Hamed A, Bohm S, Mersmann F, Arampatzis A. Exercises of dynamic stability under unstable conditions increase muscle strength and balance ability in the elderly. Scand J Med Sci Sports 2018; 28:961-971. [DOI: 10.1111/sms.13019] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
Affiliation(s)
- A. Hamed
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
- Department of Biomechanics; Faculty of Physical Therapy; Cairo University; Cairo Egypt
| | - S. Bohm
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - F. Mersmann
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
| | - A. Arampatzis
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
- Berlin School of Movement Science; Berlin Germany
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Zhou J, Qin MZ, Liu Q, Liu JP. Investigation and analysis of osteoporosis, falls, and fragility fractures in elderly people in the Beijing area: a study on the bone health status of elderly people ≥ 80 years old with life self-care. Arch Osteoporos 2017; 12:108. [PMID: 29214357 DOI: 10.1007/s11657-017-0408-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Among ≥ 80 years old and under life self-care in the Beijing area, the prevalences of osteoporosis, falls, and fragility fracture were high; and these prevalences were even higher in women. The treatment rate of osteoporosis is very low. Therefore, comprehensive and standardized prevention and treatment should be promoted. PURPOSE The purpose of this study is to investigate prevalence of osteoporosis, falls, and fragility fractures in this population, and analyze related factors, in order to provide a basis for standardized prevention and treatment. METHODS From August 2015 to August 2016 in Beijing City, a total of 175 elderly individuals, who were ≥ 80 years old and had good self-care ability, were included into this study. The questionnaire, risk of falls, grip force, and walking speed were measured, and the Timed Up and Go test (TUG) and chair-rising test (CRT) were performed. RESULTS Compared to women, men have higher rates of smoking, drinking, drinking strong tea, longer outdoor activity time, as well as larger muscle strength and pace, and lower consumption of dairy products, fall risk assessment scale (FRA) score, 25OHD, administration rates of calcium and anti-osteoporosis drugs (P < 0.05, P < 0.01). Compared with men, women had higher bone turnover markers (P1NP, β-CTx, and OC) (P < 0.05, P < 0.01) and lower levels of sex hormones (E2, T) (P < 0.01). The overall prevalence of osteoporosis was 24.6%, and this was significantly higher in women than in men (52.5 vs. 9.6%, P < 0.01). Among these subjects, 62.9% had a history of fall after 80 years old, and this rate was higher in women than in men (77 vs. 55.3%, P < 0.01). The overall prevalence of fragility fractures was 25.1%, which was higher in women than in men (45.9 vs. 14.0%, P < 0.01). Risk factors included falls after age 80, high FRA score, and reduction in bone density of lumbar vertebrae 1-4, and odds ratio (OR) was 12.195, 1.339, and 0.076, respectively (P < 0.01). Anti-osteoporosis therapy was only performed on a small number of patients with fractures. CONCLUSION The prevalences of falls, prior fracture, and low BMD were high among ≥ 80 years old and under life self-care in the Beijing area. Therefore, a comprehensive approach to assessment and treatment should be promoted.
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Affiliation(s)
- Jian Zhou
- Department of Gerontology, Tongren Hospital of China Capital Medical University, No.1 of Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China.
| | - Ming-Zhao Qin
- Department of Gerontology, Tongren Hospital of China Capital Medical University, No.1 of Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Qian Liu
- Department of Gerontology, Tongren Hospital of China Capital Medical University, No.1 of Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Jin-Ping Liu
- Department of Gerontology, Tongren Hospital of China Capital Medical University, No.1 of Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
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Graham DF, Carty CP, Lloyd DG, Barrett RS. Muscle contributions to the acceleration of the whole body centre of mass during recovery from forward loss of balance by stepping in young and older adults. PLoS One 2017; 12:e0185564. [PMID: 29069097 PMCID: PMC5656315 DOI: 10.1371/journal.pone.0185564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/14/2017] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to determine the muscular contributions to the acceleration of the whole body centre of mass (COM) of older compared to younger adults that were able to recover from forward loss of balance with a single step. Forward loss of balance was achieved by releasing participants (14 older adults and 6 younger adults) from a static whole-body forward lean angle of approximately 18 degrees. 10 older adults and 6 younger adults were able to recover with a single step and included in subsequent analysis. A scalable anatomical model consisting of 36 degrees-of-freedom was used to compute kinematics and joint moments from motion capture and force plate data. Forces for 92 muscle actuators were computed using Static Optimisation and Induced Acceleration Analysis was used to compute individual muscle contributions to the three-dimensional acceleration of the whole body COM. There were no significant differences between older and younger adults in step length, step time, 3D COM accelerations or muscle contributions to 3D COM accelerations. The stance and stepping leg Gastrocnemius and Soleus muscles were primarily responsible for the vertical acceleration experienced by the COM. The Gastrocnemius and Soleus from the stance side leg together with bilateral Hamstrings accelerated the COM forwards throughout balance recovery while the Vasti and Soleus of the stepping side leg provided the majority of braking accelerations following foot contact. The Hip Abductor muscles provided the greatest contribution to medial-lateral accelerations of the COM. Deficits in the neuromuscular control of the Gastrocnemius, Soleus, Vasti and Hip Abductors in particular could adversely influence balance recovery and may be important targets in interventions to improve balance recovery performance.
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Affiliation(s)
- David F. Graham
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Christopher P. Carty
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - David G. Lloyd
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- * E-mail:
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12
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Petró B, Papachatzopoulou A, Kiss RM. Devices and tasks involved in the objective assessment of standing dynamic balancing - A systematic literature review. PLoS One 2017; 12:e0185188. [PMID: 28934308 PMCID: PMC5608356 DOI: 10.1371/journal.pone.0185188] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Static balancing assessment is often complemented with dynamic balancing tasks. Numerous dynamic balancing assessment methods have been developed in recent decades with their corresponding balancing devices and tasks. OBJECTIVE The aim of this systematic literature review is to identify and categorize existing objective methods of standing dynamic balancing ability assessment with an emphasis on the balancing devices and tasks being used. DATA SOURCES Three major scientific literature databases (Science Direct, Web of Science, PLoS ONE) and additional sources were used. STUDY SELECTION Studies had to use a dynamic balancing device and a task described in detail. Evaluation had to be based on objectively measureable parameters. Functional tests without instrumentation evaluated exclusively by a clinician were excluded. A total of 63 articles were included. DATA EXTRACTION The data extracted during full-text assessment were: author and date; the balancing device with the balancing task and the measured parameters; the health conditions, size, age and sex of participant groups; and follow-up measurements. DATA SYNTHESIS A variety of dynamic balancing assessment devices were identified and categorized as 1) Solid ground, 2) Balance board, 3) Rotating platform, 4) Horizontal translational platform, 5) Treadmill, 6) Computerized Dynamic Posturography, and 7) Other devices. The group discrimination ability of the methods was explored and the conclusions of the studies were briefly summarized. LIMITATIONS Due to the wide scope of this search, it provides an overview of balancing devices and do not represent the state-of-the-art of any single method. CONCLUSIONS The identified dynamic balancing assessment methods are offered as a catalogue of candidate methods to complement static assessments used in studies involving postural control.
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Affiliation(s)
- Bálint Petró
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | | | - Rita M Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
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Patikas DA, Mersmann F, Bohm S, Schroll A, Marzilger R, Arampatzis A. Soleus H-reflex modulation during balance recovery after forward falling. Muscle Nerve 2016; 54:952-958. [PMID: 27065438 DOI: 10.1002/mus.25142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Our purpose was to examine the Hoffmann reflex (H-reflex) during balance recovery after a simulated forward fall from 2 different inclination angles. METHODS The soleus H-reflex of 15 healthy adults was measured in 2 different leaning positions (exerting a horizontal force at 15% and 30% of body weight, respectively), with no release (Int0) and at 2 different intervals (Int1, Int2) after the release (∼45 and ∼65 ms, respectively). RESULTS During Int2, the H-reflex, which was evoked before the onset of the soleus electromyography, was significantly higher than the H-reflex induced 20 ms earlier (Int1). No significant difference was observed between Int0 and Int1 and between the 2 leaning positions. CONCLUSIONS These findings indicate that Ia afferent input is facilitated before muscle activation during forward falling. This could be important for the timely activation and increased rate of force development required during this task. Muscle Nerve 54: 952-958, 2016.
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Affiliation(s)
- Dimitrios A Patikas
- Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Ag. Ioannis, 62110, Serres, Greece.
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Marzilger
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Hip joint contact loads in older adults during recovery from forward loss of balance by stepping. J Biomech 2016; 49:2619-2624. [DOI: 10.1016/j.jbiomech.2016.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
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15
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Levinger P, Downie C, Nagano H, Petersen A, Hayes A, Sanders KM, Cicuttini F, Begg R. Stepping strategy used to recover balance during an induced fall is associated with impaired function and strength in people with knee osteoarthritis. Int J Rheum Dis 2016; 21:1763-1771. [DOI: 10.1111/1756-185x.12891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pazit Levinger
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
| | - Calum Downie
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
| | - Hanatsu Nagano
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
| | - Aaron Petersen
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
| | - Alan Hayes
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
| | - Kerrie M. Sanders
- Institute for Health & Ageing; Australian Catholic University; Melbourne Victoria Australia
| | - Flavia Cicuttini
- Faculty of Medicine, Nursing & Health Sciences; Monash University; Melbourne Victoria Australia
| | - Rezaul Begg
- Institute of Sport, Exercise and Active Living (ISEAL); Victoria University; Melbourne Victoria Australia
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Gray VL, Pollock CL, Wakeling JM, Ivanova TD, Garland SJ. Patterns of muscle coordination during stepping responses post-stroke. J Electromyogr Kinesiol 2015; 25:959-65. [PMID: 26475243 DOI: 10.1016/j.jelekin.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/28/2015] [Accepted: 09/08/2015] [Indexed: 11/25/2022] Open
Abstract
This study compared self-induced stepping reactions of seventeen participants after stroke and seventeen controls. Surface electromyographic (EMG) signals were recorded bilaterally from the soleus (SOL), tibialis anterior (TA), biceps femoris (BF) and rectus femoris (RF) muscles. Principal component analysis (PCA) was used to reduce the data into muscle activation patterns and examine group differences (paretic, non-paretic, control leg). The first principal component (PC1) explained 46.7% of the EMG signal of the stepping leg. Two PCs revealed distinct activation features for the stepping paretic leg: earlier TA onset at step initiation and earlier BF and SOL onset at mid-step. For the stance leg, PC1 explained 44.4% of the EMG signal and significant differences were found in the non-paretic leg compared to paretic (p < 0.001) and control (p < 0.001). In PC1, at step onset the BF and SOL EMG and the RF and TA EMG were increased over the latter half of the step. No PC loadings were distinct for the paretic leg during stance, however differences were found in the non-paretic leg: earlier TA burst and increased BF and SOL EMG at step initiation. The results suggest impairments in the paretic leg when stepping and compensatory strategies in the non-paretic stance leg.
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Affiliation(s)
- V L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD 21201, USA
| | - C L Pollock
- Dept Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - J M Wakeling
- Dept Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - T D Ivanova
- Dept Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - S J Garland
- Dept Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Effect of balance exercise in combination with whole-body vibration on muscle activity of the stepping limb during a forward fall in older women: A randomized controlled pilot study. Arch Gerontol Geriatr 2015; 60:244-51. [DOI: 10.1016/j.archger.2014.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/20/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
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18
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Carty CP, Cronin NJ, Nicholson D, Lichtwark GA, Mills PM, Kerr G, Cresswell AG, Barrett RS. Reactive stepping behaviour in response to forward loss of balance predicts future falls in community-dwelling older adults. Age Ageing 2015; 44:109-15. [PMID: 24918170 DOI: 10.1093/ageing/afu054] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND a fall occurs when an individual experiences a loss of balance from which they are unable to recover. Assessment of balance recovery ability in older adults may therefore help to identify individuals at risk of falls. The purpose of this 12-month prospective study was to assess whether the ability to recover from a forward loss of balance with a single step across a range of lean magnitudes was predictive of falls. METHODS two hundred and one community-dwelling older adults, aged 65-90 years, underwent baseline testing of sensori-motor function and balance recovery ability followed by 12-month prospective falls evaluation. Balance recovery ability was defined by whether participants required either single or multiple steps to recover from forward loss of balance from three lean magnitudes, as well as the maximum lean magnitude participants could recover from with a single step. RESULTS forty-four (22%) participants experienced one or more falls during the follow-up period. Maximal recoverable lean magnitude and use of multiple steps to recover at the 15% body weight (BW) and 25%BW lean magnitudes significantly predicted a future fall (odds ratios 1.08-1.26). The Physiological Profile Assessment, an established tool that assesses variety of sensori-motor aspects of falls risk, was also predictive of falls (Odds ratios 1.22 and 1.27, respectively), whereas age, sex, postural sway and timed up and go were not predictive. CONCLUSION reactive stepping behaviour in response to forward loss of balance and physiological profile assessment are independent predictors of a future fall in community-dwelling older adults. Exercise interventions designed to improve reactive stepping behaviour may protect against future falls.
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Affiliation(s)
- Christopher P Carty
- Centre for Musculoskeletal Research, Griffith Health Institute and School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Neil J Cronin
- Neuromuscular Research Centre, Department of Biology of Physical Activity, University of Jyväskylä, Jyväskylä, Finland
| | - Deanne Nicholson
- Centre for Musculoskeletal Research, Griffith Health Institute and School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Glen A Lichtwark
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Peter M Mills
- Centre for Musculoskeletal Research, Griffith Health Institute and School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Graham Kerr
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Andrew G Cresswell
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Rod S Barrett
- Centre for Musculoskeletal Research, Griffith Health Institute and School of Allied Health Sciences, Griffith University, Gold Coast, Australia
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Ochi A, Yokoyama S, Abe T, Yamada K, Tateuchi H, Ichihashi N. Differences in muscle activation patterns during step recovery in elderly women with and without a history of falls. Aging Clin Exp Res 2014; 26:213-20. [PMID: 24104446 DOI: 10.1007/s40520-013-0152-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/27/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS This study aimed at comparing the patterns of muscle activation used in stepping to regain balance during a forward fall between subjects with and without a history of falling and at identifying the causes of functional deficits in recovery stepping. METHODS Elderly women with and without a history of falling (fallers: n = 12, mean age ± SD = 82.8 ± 4.5 years; non-fallers: n = 17, age = 81.4 ± 3.4 years) participated in the study. The subjects were suspended in a forward-leaning position by a lean-control cable with a load of 15 % of body weight and instructed to regain standing balance upon release by taking a single step forward. Electromyography (EMG) data were obtained from five lower extremity muscles on the stepping side, and the muscle activation patterns were compared between fallers and non-fallers. RESULTS Fallers had a shorter step length and slower step velocity than non-fallers. The EMG time-to-peak for the gastrocnemius muscle, which provides push-off prior to foot lift-off, was slower for fallers than for non-fallers, whereas the EMG onset times of the biceps femoris and gastrocnemius muscles were similar between the groups. The fallers exhibited significantly delayed muscle deactivation of the upper leg and increased co-contraction between the rectus femoris and biceps femoris during the stepping phase than did the non-fallers. CONCLUSIONS These findings suggest that the muscle activation pattern during the regain balance may reflect an inability to step forward rapidly in elderly women with a history of falls.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai, Aichi, 476-8588, Japan,
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Graham DF, Carty CP, Lloyd DG, Lichtwark GA, Barrett RS. Muscle contributions to recovery from forward loss of balance by stepping. J Biomech 2014; 47:667-74. [DOI: 10.1016/j.jbiomech.2013.11.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/18/2013] [Accepted: 11/25/2013] [Indexed: 11/30/2022]
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