Using the Dynamic Perturbation System to predict Fall Risk in the Elderly

1
Using the Dynamic Perturbation System to predict
Fall Risk in the Elderly
Advisor Sai Wei Yang Reporter Yi Ching Tsai

Date
20070611
2
Introduction

• Demography
• Fall risk factors
• The effects of the perturbation training
• Hypothesis
• Purpose

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Demography

• The elderly adults ?65 years old
• The elderly In Taiwan
• 1. from 1994 to 2005, 7.38 of population
  over
• 65 ys is increased to 9.74
• 2. 44.09 of the number of deaths
  in accidental
• falls are the elderly (?gt?)

?????? http//www.doh.gov.tw. 2005.
4
Risk factors add up to falls
Active Independent Aging A community guide for
falls prevention and active living Community
Health Research Unit, University of Ottawa and
Public Health and Long-Term Care Branch, City of
Ottawa
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Summary of internal and external
contributors to falls
Internal contributors (age-related
deteriorations) Reduced visual acuity, depth
perception, and peripheral vision / Vestibular
impairment Reduced ability to sense touch and
vibration / Reduced static and dynamic balance
Reduced walking speed / Poor mobility and gait
disorders Reduced strength of the lower
extremities / Reduced reaction time Acute
illness / Chronic disease / Cognitive impairment
/ Polypharmacy

FALLS
external contributors (environment) Inadequate
lighting brightness and placement of switches and
fixtures Lack of handrails on stairs inside and
outside of home / Cords and wires on floor Lack
of grab bars around toilet and bathtub / Lack of
nonslip strips on bathtub floor Toilet seat that
is too low / Polished or waxed floors / Furniture
that is too low or is not sturdy Throw rugs that
are not secured / Sidewalk cracks and ridges /
Ice and snow Prosthetic and cane or walker use
-Michael ER et al., 2003.
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Fall risk factors
Insufficiency Factors Functions of the factors
1. Muscle strength Maintain dynamic stability affects speed in early swing -Louis FD et al., 2004. -Michael EH et al., 2005. - Sandra MSFF et al., 2005. -Michael ER et al., 2003.
2. Mobility to complete the task Postural changes (voluntarily perturb the body to sway) - Sandra MSFF et al., 2005.
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Fall risk factors
Insufficiency Factors Functions of the factors
3. Balance control Maintain static and dynamic stability -Louis FD et al., 2004.
4. Range of motion Obstacle crossing -Louis FD et al., 2004.
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The Dynamic Perturbation
Mobility and Postural control

• 1Dynamic Balance System
• 2RS-Scan
• For Pressure change
• Pressure distribution
• 3EMG-MA300
• 4Camera
• 5 Berg Balance Scale

?Complete the task and maintain the stability
Muscle strength
-???, 2003.
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The effects of the perturbation training

• Functional approach based balance training
  programs may gain largest effects in fall
  prevention.
• -Duncan et al., 1993.
• There was a high correlation between falling
  index and COP maximum speed and distance.
• -???,2003.

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• Perturbation training provides the stimulus for
• reorganizing muscle responses lead to
  improved
• function.
• The training changed the knee stabilization
  strategy to dynamically stabilize knee in
  response to unexpected perturbations (increasing
  knee flexion angle) .
• -Terese LC et al., 2005.

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Relationship between Perturbation Training
Program and Falling
Motor Control Theory
Improve Functions
The Perturbation Training Program
Reduce Fall Risk Factors
Postural Control Theory
Motor Learning Theory
Fall
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Hypothesis

• Using the dynamic perturbation system may improve
  postural control and reduce the fall risk factors
  in the elderly

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Purpose

• To find the best perturbation models and set up a
  dynamic perturbation training system
• To provide a choice in training dynamic
• balance
• To reduced the number of deaths and
• injuries in accidental falls

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Methods

• Subjects
• The training program
• Evaluation

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Subjects

• age ?65 years old with no severe cognitive
• impairment, blindness and L/E dysfunction
• ?1 fall experience in nearly year
• ability to walk 10m without assistive device

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The training program
Stewart Platform
DOF Technology, Inc. Steward Platform
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P5-03 P5-06
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P10-03 P10-06
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Evaluation

• Frequency
• Group A Pre-training, Post-training and
• per 4 weeks after training
• Group B Pretest and after 4 weeks
• Questionnaires and Instruments
• - The record of falls
• - The continuous-scale physical functional
• performance test (CS-PFP)
• - Evaluation of Range of Motion Active and
  Passive

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Evaluation

• - The Functional reach test
• - The dynamic perturbation system with force
  plate
• - The EMG system MA300
• - The foot scan system RS scan
• - The 3D motion analysis system Vicon MX
• - The isokintic dynamometer system Biodex
  System

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Biodex Storeroom
10m
Table
Dressing room
Mobilization Table
Vicon
Door
V1
V2
V3
Table
C2
9.6m
5.1m
1.7m
when test
Force Plate Foot Scan
Stewart Platform
C1
V4
V8
Suspension on ceiling
V6
Table
Table
V7
When no test
V5
Stewart Platform
Scanner
Pedar
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References

• 1. ??????,??????,??http//www.doh.gov.tw.2005.
• 2. Luukinen H., Koski K., Hiltunen L., Kivelä
  S.-L., 1994. Incidence rate
• of falls in an aged population in Northern
  Finland. J Clin Epidemiol
• 47, 843850.
• 3. Michael ER., Nicole LR., Nobuo T., Mohammod
  MI., 2003. Methods
• to assess and improve the physical parameters
  associated with fall
• risk in older adults. Preven Med 36,
  255264.4.
• 4. Michael EH., Heng-Ju L., Li-Shan C., 2005.
  Increased muscular
• challenge in older adults during obstructed
  gait. Gait Posture 22,
• 356361.5.
• 5. Louis FD., Christina EK., 2004. The effects of
  walking speed on
• obstacle crossing in healthy young and
  healthy older adults. J
• Biomech 37, 889896.6.
• 6. Sandra MSFF., Silvana AW., Paulo HM., Marcos
  D., 2005. Age-
• related changes in human postural control of
  prolonged standing.
• Gait Posture 22, 322330.

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Thank you for your attention!
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8th International Symposium on Footwear
Biomechanics
June 27-29, 2007, Taipei, Taiwan http//FBS2007.ym
.edu.tw
Important Dates
Submission of abstract March 15,
2007 Notification of acceptance April 15,
2007 Early registration due May 15, 2007
Organizer
National Yang-Ming University The Footwear
Biomechanics Group, International Society of
Biomechanics (ISB)
FBS-8th Secretariat Institute of Biomedical
Engineering, National Yang-Ming University,
Taiwan Tel [phone] Fax
886-2-2821-0847 E-mail fbs2007_at_bme.ym.edu.tw