Walking adaptability for targeted fall-risk assessments

...taking steps towards a better identification of (future) fallers

Walking adaptability is defined as the ability to modify walking to meet behavioural task goals and  demands of the environment. Walking-related falls often occur due to trips, slips or misplaced steps,  suggesting that people have problems adapting walking. Walking adaptability therefore seems to be  related to fall risk and appears to be an important component of safe walking. 

The Interactive Walkway is an 8- or 10-meter walkway instrumented with an integrated multi-Kinect  v2 set-up for markerless registration of 3D full-body kinematics during walking. The Interactive  Walkway is equipped with a projector to augment the entire walkway with (gait-dependent) visual  context, such as obstacles, sudden-stop-and-start cues and stepping targets. Using the real-time  processed integrated Kinect data, obstacles can suddenly appear at the position one would step next,  demanding a step adjustment under time pressure demands. The so-elicited gait-environment interactions allow for assessing various walking-adaptability aspects (e.g., the ability to avoid  obstacles, suddenly stop or start, perform accurate goal-directed steps) in a safe manner. 

Prospective fallers experienced more fear of falling and more fear-of-falling-related activity  avoidance at baseline than non-fallers. In addition, prospective fallers walked slower and with  smaller steps, and had a poorer performance on clinical gait and balance tests. 

As anticipated, prospective fallers also performed worse on various walking-adaptability tasks. In  addition to fall history, obstacle-avoidance success rate and normalized walking speed during goal directed stepping were identified as predictor variables for falls and these fall-risk factors improved  the identification of fallers. It appears that subjects who performed worse on the obstacle-avoidance  task without substantially lowering their walking speed during goal-directed stepping are most at risk  of falling.

Identification of these task-specific fall-risk factors may lead to more targeted, personalised and,  possibly, more effective falls prevention programmes. If validated in larger samples in future studies  these measures hold promise as future entry tests for falls prevention programmes.

> From: Geerse et al., Gait Posture 70 (2019) 203-210 . All rights reserved to Elsevier B.V. Click here for the online summary.

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