Marques Nise Ribeiro, Camilo Giovanna Ferreira, de Martini Lopes Dos Santos Ana Paula, Cardoso Bruna Carvalho, Navega Marcelo Tavella, de Abreu Daniela Cristina Carvalho
Center of Health Sciences, Sacred Heart University, USC, Bauru, Brazil; Department of Health Sciences, University of São Paulo (USP), School of Medicine, Ribeirão Preto, SP, Brazil.
Department of Physiotherapy and Occupational Therapy, University of São Paulo State, UNESP, Marília, Brazil.
Clin Biomech (Bristol). 2019 May;65:123-127. doi: 10.1016/j.clinbiomech.2019.04.011. Epub 2019 Apr 18.
Cognitive impairments reduce adaptive responses and may increase the risk of falls.
To compare gait kinematics in older adults with cognitive impairments living in long term institutions and to identify the ability of gait kinematics to predict falls in older adults with cognitive impairments living in long term institutions.
Data of 23 older adults with cognitive impairments living in long term institutions were considered for this study. Fifty gait cycles were recorded during walking at a self-selected pace using footswitches sensors. The variables considered for the analysis were: speed; stride length; stance, swing and stride time; and the variability of these parameters. Fall status was recorded for a 6 month-period.
MANOVA found group effect (p = 0.025) for gait kinematics comparisons. Variability of stance (p = 0.01) and swing (p = 0.012) and stride time (p < 0.001) were higher in older fallers. Speed of older fallers was 31.8% slower than those of the non-fallers (p < 0.001). The kinematic variables that were able to predict falls were: stride time variability (p < 0.001), threshold of 0.4 s, sensitivity of 50% and specificity of 100%; and gait speed (p < 0.001), threshold of 0.65 m·s, sensibility and specificity of 50%.
Older adults living in an assisted living facility with a history of falls demonstrate increased kinematic variability while walking. However, the ability of gait kinematic parameters to predict falls was found to be weak. The results suggested that gait kinematic parameters are weak predictors of falls in older adults with cognitive impairments living in long term institutions.
认知障碍会降低适应性反应，并可能增加跌倒风险。
比较长期居住机构中患有认知障碍的老年人的步态运动学，并确定步态运动学预测长期居住机构中患有认知障碍的老年人跌倒的能力。
本研究纳入了23名长期居住机构中患有认知障碍的老年人的数据。使用脚踏开关传感器以自选速度行走时记录50个步态周期。分析所考虑的变量包括：速度；步幅；站立、摆动和步幅时间；以及这些参数的变异性。记录6个月期间的跌倒状态。
多变量方差分析发现，在步态运动学比较中存在组效应（p = 0.025）。跌倒的老年人在站立（p = 0.01）、摆动（p = 0.012）和步幅时间（p < 0.001）方面的变异性更高。跌倒的老年人的速度比未跌倒者慢31.8%（p < 0.001）。能够预测跌倒的运动学变量为：步幅时间变异性（p < 0.001），阈值为0.4秒，敏感度为50%，特异度为100%；以及步态速度（p < 0.001），阈值为0.65米/秒，敏感度和特异度为50%。
居住在辅助生活设施中有跌倒史的老年人在行走时表现出运动学变异性增加。然而，发现步态运动学参数预测跌倒的能力较弱。结果表明，步态运动学参数对长期居住机构中患有认知障碍的老年人跌倒的预测能力较弱。
