Shelton Andrew D, Allen Jessica L, Mercer Vicki S, Crenshaw Jeremy R, Franz Jason R
Joint Department of Biomedical Engineering, University of North Carlina at Chapel Hill & North Carolina State University, Chapel Hill, NC, United States of America.
Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, United States of America.
PLoS One. 2024 Dec 12;19(12):e0315368. doi: 10.1371/journal.pone.0315368. eCollection 2024.
Rehabilitation to prevent falls should not only directly address intrinsic and extrinsic factors, but also the neuropsychology of falls to promote safe and independent mobility in our aging population. The purpose of this study was to determine the relation between falls self-efficacy and objective responses to a series of walking balance perturbations. 29 healthy younger adults and 28 older adults completed four experimental trials, including unperturbed walking and walking while responding to three perturbations: mediolateral optical flow, treadmill-induced slips, and lateral waist-pulls; and three self-reported questionnaires: Activity-specific Balance Confidence, Falls Efficacy Scale, and the Fear of Falling Questionnaire-Revised. We quantified stabilizing responses as a change in margin of stability from unperturbed walking. Older adults generally exhibited larger instability than younger adults in response to walking balance perturbations. Only the Fear of Falls Questionnaire-Revised showed an increase in perceived falls risk for older adults. We found no significant correlations for older adults between any balance perturbation response and questionnaires of self-perception. Given the disconnect between self-perceived falls risk and responses to walking balance perturbations, rehabilitation to prevent falls while maintaining mobility and independence will likely require personalized techniques that combine neuromuscular training with approaches for neurophysiological reeducation.
预防跌倒的康复治疗不仅应直接针对内在和外在因素，还应关注跌倒的神经心理学，以促进老年人群的安全和独立移动。本研究的目的是确定跌倒自我效能与对一系列行走平衡扰动的客观反应之间的关系。29名健康的年轻人和28名老年人完成了四项实验性试验，包括无扰动行走以及在应对三种扰动时行走：内外侧光流、跑步机诱发滑倒和侧向腰部牵拉；以及三份自我报告问卷：特定活动平衡信心量表、跌倒效能感量表和修订版跌倒恐惧问卷。我们将稳定反应量化为无扰动行走时稳定性边际的变化。在应对行走平衡扰动时，老年人通常比年轻人表现出更大的不稳定性。只有修订版跌倒恐惧问卷显示老年人感知到的跌倒风险增加。我们发现，对于老年人而言，任何平衡扰动反应与自我感知问卷之间均无显著相关性。鉴于自我感知的跌倒风险与对行走平衡扰动的反应之间存在脱节，在保持移动性和独立性的同时预防跌倒的康复治疗可能需要将神经肌肉训练与神经生理再教育方法相结合的个性化技术。
