Developing and Establishing Biomechanical Variables as Risk Biomarkers for Preventable Gait-Related Falls and Assessment of Intervention Effectiveness

Mark D Grabiner, K R Kaufman, Mark D Grabiner, K R Kaufman

Abstract

The purpose of this review is to position the emerging clinical promise of validating and implementing biomechanical biomarkers of falls in fall prevention interventions. The review is framed in the desirability of blunting the effects of the rapidly growing population of older adults with regard to the number of falls, their related injuries, and health care costs. We propose that biomechanical risk biomarkers may be derived from systematic study of the responses to treadmill-delivered perturbations to both identify individuals with a risk of specific types of falls, such as trips and slips as well as quantifying the effectiveness of interventions designed to reduce that risk. The review follows the evidence derived using a specific public health approach and the published biomedical literature that supports trunk kinematics as a biomarker as having met many of the criteria for a biomarker for trip-specific falls. Whereas, the efficacy of perturbation training to reduce slip-related falls by older adults appears to have been confirmed, its effectiveness presently remains an open and important question. There is a dearth of data related to the efficacy and effectiveness of perturbation training to reduce falls to the side falls by older adults. At present, efforts to characterize the extent to which perturbation training can reduce falls and translate the approaches to the clinic represents an important research opportunity.

Keywords: injury; intervention; perturbation training; prevention; risk factors.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Grabiner and Kaufman.

Figures

Figure 1
Figure 1
The total encircled area represents all-cause falls by all older adults. The white area represents all-cause falls by independent community dwelling older adults, who represent 95% of older adults in the United States (Administration on Aging, , http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf). The dotted area represents all-cause falls by older adults living in assisted living facilities. Direction-specific gait-related falls are a subset of all-cause falls. Slips and trips, direction-specific falls, that occur both in and outside the home, may generally account for about 50% gait-related falls by independent community-dwelling older adults (Berg et al., ; Crenshaw et al., 2017). A substantial number of falls by independent community-dwelling older adults are laterally-directed (Crenshaw et al., 2017). Because laterally-directed falls may have recovery solutions that involve stepping responses, the percentage of preventable direction-specific gait-related falls is increased. Of these gait-related falls, some proportion leads to injury, both minor and serious, the latter of which can be life-threatening. Of these direction-specific gait-related falls by independent community-dwelling older adults, some are demonstrably preventable through various clinical interventions. The hatched area at the intersection of injurious falls, direction-specific gait-related falls. and preventable, direction-specific gait-related falls represents out target for perturbation-based intervention.

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