Dunsky Ayelet
School of Human Movement and Sport Sciences, The Academic College at Wingate, Wingate Institute, Netanya, Israel.
Front Aging Neurosci. 2019 Nov 15;11:318. doi: 10.3389/fnagi.2019.00318. eCollection 2019.
The ability to control balance during activities of daily living (ADL) is impaired in older adults as a result of deterioration in the sensory systems (i.e., vestibular, visual, somatosensory), the cognitive system (central nervous system), and the musculoskeletal system. Consequently, many older adults face a risk of falling during their ADL. In most cases, falls and related injuries impair the quality of life and result in physical limitations, anxiety, loss of confidence, and fear of falling. Among a variety of fall prevention interventions, adapted physical activity programs have been suggested for improving balance control during ADL. These programs challenge the sensory, cognitive, and musculoskeletal systems while addressing balance constraints such as orientation in space, changes in direction, and the speed or height of the center of mass during static and dynamic situations resembling ADL. The above-mentioned elements can be dealt with through a combination of balance and coordination exercises that challenge the postural control systems in multiple dimensions-including vertical and horizontal changes of the center of mass, standing on unstable surfaces with a reduced base of support, and changing body directions. Consequently, such exercises require environmental information-processing. The combination of dual-task, function-oriented challenges while controlling balance stimulates the sensory and neuromuscular control mechanisms. Among older adults, these programs have been found to improve static and dynamic stability, as well as a number of aspects in the quality of life. Recently, they have also been found to improve cognitive functions such as memory and spatial cognition.
由于感觉系统(即前庭、视觉、躯体感觉)、认知系统(中枢神经系统)和肌肉骨骼系统的衰退,老年人在日常生活活动(ADL)中控制平衡的能力会受到损害。因此,许多老年人在日常生活活动中面临跌倒风险。在大多数情况下,跌倒及相关损伤会损害生活质量,并导致身体受限、焦虑、信心丧失和跌倒恐惧。在各种预防跌倒干预措施中,已建议采用适应性身体活动计划来改善日常生活活动中的平衡控制。这些计划在应对平衡限制因素(如空间定向、方向变化以及在类似于日常生活活动的静态和动态情况下质心的速度或高度)的同时,对感觉、认知和肌肉骨骼系统提出挑战。上述因素可以通过平衡和协调练习的组合来处理,这些练习从多个维度挑战姿势控制系统,包括质心的垂直和水平变化、在支撑面减小的不稳定表面上站立以及改变身体方向。因此,此类练习需要环境信息处理。在控制平衡的同时进行双任务、功能导向挑战的组合会刺激感觉和神经肌肉控制机制。在老年人中,已发现这些计划可改善静态和动态稳定性以及生活质量的多个方面。最近,还发现它们可改善认知功能,如记忆和空间认知。