Koschate J, Stuckenschneider T, Zieschang T
Fakultät VI - Medizin und Gesundheitswissenschaften, Abteilung Geriatrie, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
Z Gerontol Geriatr. 2023 Oct;56(6):458-463. doi: 10.1007/s00391-023-02227-7. Epub 2023 Sep 1.
Most falls in older persons occur during walking and are often due to maladaptation in response to gait perturbations. Therefore, the assessment of reactive dynamic balance is highly relevant for determining the individual risk of falling and could enable an early initiation of interventions.
The methods available for perturbation of gait and for evaluating the corresponding reaction patterns are critically discussed in order to approach the assessment of reactive dynamic balance.
A diagnostic protocol for perturbation of gait on a treadmill was developed based on the literature. The application of the protocol to map reactive dynamic balance as comprehensively as possible is presented.
After the initial determination of the individually preferred gait speed over ~ 6 min, the participant's gait is disrupted with 9 different types of perturbations over a time period of ~ 4:30 min. The evaluation options include spatiotemporal parameters and their variability, the margin of stability and the Lyapunov exponent.
Dynamic reactive balance is a promising and specific parameter for quantifying the risk of falling in older persons. The comprehensive evaluation of the documented parameters is currently insufficient because there are no established methods or references. The development of a unified method for the sensitive determination of reactive dynamic balance is essential for its use in assessment of the risk of falling in the clinical context and for measuring the success of training.
老年人的大多数跌倒发生在行走过程中，通常是由于对步态扰动的适应不良所致。因此，反应性动态平衡的评估对于确定个体跌倒风险高度相关，并且能够使干预措施尽早启动。
对现有的步态扰动方法和评估相应反应模式的方法进行批判性讨论，以便接近反应性动态平衡的评估。
基于文献制定了一种在跑步机上进行步态扰动的诊断方案。介绍了该方案尽可能全面地映射反应性动态平衡的应用。
在初步确定个体在约6分钟内的首选步态速度后，在约4:30分钟的时间段内用9种不同类型的扰动干扰参与者的步态。评估选项包括时空参数及其变异性、稳定裕度和李雅普诺夫指数。
动态反应性平衡是量化老年人跌倒风险的一个有前景的特定参数。目前对记录参数的全面评估不足，因为没有既定的方法或参考标准。开发一种用于敏感确定反应性动态平衡的统一方法对于其在临床环境中用于评估跌倒风险和衡量训练效果至关重要。
