Judge J O, King M B, Whipple R, Clive J, Wolfson L I
Travelers Center on Aging, University of Connecticut Health Center, Farmington, USA.
J Gerontol A Biol Sci Med Sci. 1995 Sep;50(5):M263-70. doi: 10.1093/gerona/50a.5.m263.
Understanding the motor and sensory contributions to balance function in older persons is important in order to design effective interventions to prevent falls and loss of mobility. We tested the contributions of visual and proprioceptive input, muscle strength, and age to balance performance in 110 subjects free of clinical evidence of neurologic disease (mean age 80 years).
The EquiTest Sensory Organization Test was used to present sequential conditions that altered sensory input in a 2 (tactile/proprioceptive input) x 3 (visual input) design. Center of force and shear force data were recorded from the platform; the primary outcomes were loss of balance (LOB) and anterior-posterior center of force (COF) displacement as a proportion of foot length (COFD).
Subjects had 3.5 +/- 2.7 LOB during testing. Reduction of vision input increased the odds ratio of a LOB 5.7 fold (3.9, 8.4, 95% CI) in unstable surface conditions, but adaptation with repeated trials was substantial. The adjusted odds ratio of a LOB was 0.65 and 0.45 in the second and third trials, respectively, compared to the first. Muscle strength and age were independent predictors of LOB. Gait velocity, single stance balance, and reported difficulty with ambulation, mobility, and instrumental activities of daily living were also associated with LOB.
Performance on clinical tests of strength, balance, and gait was associated with performance on a challenging balance test which reduced sensory input and effectiveness of motor responses. Adaptation to challenging balance conditions was substantial in this group of older subjects, but was diminished in the oldest subjects.
了解运动和感觉对老年人平衡功能的影响，对于设计预防跌倒和行动能力丧失的有效干预措施至关重要。我们对110名无神经系统疾病临床证据的受试者（平均年龄80岁），测试了视觉和本体感觉输入、肌肉力量以及年龄对平衡能力的影响。
采用平衡测试仪感觉统合测试，以2（触觉/本体感觉输入）×3（视觉输入）设计呈现改变感觉输入的连续条件。从平台记录力中心和剪切力数据；主要结局指标为平衡丧失（LOB）以及前后力中心（COF）位移占足长的比例（COFD）。
受试者在测试期间平均有3.5±2.7次平衡丧失。在不稳定表面条件下，视觉输入减少使平衡丧失的比值比增加5.7倍（3.9, 8.4, 95%可信区间），但重复试验后的适应性显著。与第一次试验相比，第二次和第三次试验中平衡丧失的校正比值比分别为0.65和0.45。肌肉力量和年龄是平衡丧失的独立预测因素。步态速度、单腿站立平衡以及报告的行走、活动能力和日常生活工具性活动困难也与平衡丧失有关。
力量、平衡和步态的临床测试表现与一项具有挑战性的平衡测试表现相关，该测试减少了感觉输入和运动反应的有效性。在这组老年受试者中，对具有挑战性的平衡条件的适应性显著，但在年龄最大的受试者中有所减弱。
