fall risk presentation
DESCRIPTION
My DPT group research study.TRANSCRIPT
![Page 1: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/1.jpg)
Increased Fall Risk is Associated with Elevated Ankle Co-contraction in Older Adults
Ryan Appell, Michael McKay, Hannah Nawaz, Joanna Roth, Robert Sigler, Jacqueline Third, Mark Walker, Erika Nelson-Wong
![Page 2: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/2.jpg)
Background
•Increased co-contraction in older adults (Hortobogyi et al. 2009; Chu et al. 2009; Cenciarini et al. 2009; Benjuya et al. 2004)
• Increased co-contraction associated with history of falls (Ho and Bendrups 2002)
•Co-contraction is not predictive of postural sway (Reynolds 2010)
•Does co-contraction during static balance tasks predict fall risk?
![Page 3: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/3.jpg)
Purpose
•To determine if co-contraction of the anterior and posterior ankle musculature during static balance challenges is associated with fall risk, as determined by the Four Square Step Test (FSST) in older adults.
European Journal of Applied Physiology, 2011, Submitted in review.
![Page 4: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/4.jpg)
Inclusion Criteria
•Recruited from independent living facilities and surrounding community
•Age > 55 years•Absence of cardiovascular and pulmonary
co-morbidities•Independence with community mobility
with or without assistive device
![Page 5: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/5.jpg)
Methods
• Participant Characteristics▫ 8 male, 15 female▫ Age: 73.0 ± 6.4 years
• Electromyography (EMG)▫ Anterior Tibialis▫ Lateral Gastrocnemius
![Page 6: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/6.jpg)
Methods – Static Balance
Romberg (ROM) Sharpened Romberg (SROM)
Single Leg Standing (SLS)
![Page 7: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/7.jpg)
Methods – Four Square Step Test
Dite et al (2002)At risk to fall > 12 secNot at risk to fall < 12 sec
![Page 8: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/8.jpg)
Methods – EMG Analysis
•Co-contraction quantified by co-contraction index (CCI)
•High CCI = Top 50th percentile•Low CCI = Bottom 50th percentile
Lewek et al (2004)
![Page 9: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/9.jpg)
Methods – Statistical Treatment
•Chi-square▫High/Low CCI and at-risk/not-at-risk to fall
•Sn, Sp, + LR, - LR, OR•Pearson product moment correlation
▫Actual CCI score vs. actual FSST time •One-way ANOVA
▫CCI score by fall risk category •p < 0.05
![Page 10: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/10.jpg)
Results
n = 8
n = 15
14.22 s
8.87 s
No group differences between average ages
p < 0.001
![Page 11: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/11.jpg)
Results
•High/Low CCI associated (p < 0.05) with fall risk except ROM eyes closed
•FSST times correlated with CCI values for SROM eyes open (r = 0.42) and eyes closed (r = 0.57) and SLS (r = 0.54)
![Page 12: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/12.jpg)
Balance Challenge Condition
Sn (95% CI)
Sp (95% CI)
+LR(95% CI)
-LR(95% CI)
OR(95% CI)
Romberg, Eyes Open
0.88 (0.53, 0.98)
0.75 (0.47, 0.91)
3.5 (1.3, 9.7)
0.17 (0.03, 1.1)
21.0 (1.78, 248.1)
Romberg, Eyes Closed
0.62 (0.31, 0.86)
0.50 (0.25, 0.75)
1.25 (0.57, 2.7)
0.75 (0.26, 2.2)
1.67 (0.27, 10.3)
Sharpened Romberg, Eyes Open
0.86 (0.49, 0.97)
0.67 (0.39, 0.86)
2.57 (1.09, 6.05)
0.21 (0.03, 1.37)
12.0 (1.05, 136.8)
Sharpened Romberg,
Eyes Closed
0.88 (0.53, 0.98)
0.64 (0.35, 0.85)
2.41 (1.06, 5.50)
0.20 (0.03, 0.30)
12.3 (1.08, 139.0)
Single Leg Standing
0.88 (0.53, 0.98)
0.67 (0.39, 0.86)
2.62 (1.13, 6.09)
0.19 (0.03, 1.23)
14.0 (1.25, 156.6)
![Page 13: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/13.jpg)
Balance Challenge Condition
Sn (95% CI)
Sp (95% CI)
+LR(95% CI)
-LR(95% CI)
OR(95% CI)
Romberg, Eyes Open
0.88 (0.53, 0.98)
0.75 (0.47, 0.91)
3.5 (1.3, 9.7)
0.17 (0.03, 1.1)
21.0 (1.78, 248.1)
Romberg, Eyes Closed
0.62 (0.31, 0.86)
0.50 (0.25, 0.75)
1.25 (0.57, 2.7)
0.75 (0.26, 2.2)
1.67 (0.27, 10.3)
Sharpened Romberg, Eyes Open
0.86 (0.49, 0.97)
0.67 (0.39, 0.86)
2.57 (1.09, 6.05)
0.21 (0.03, 1.37)
12.0 (1.05, 136.8)
Sharpened Romberg,
Eyes Closed
0.88 (0.53, 0.98)
0.64 (0.35, 0.85)
2.41 (1.06, 5.50)
0.20 (0.03, 0.30)
12.3 (1.08, 139.0)
Single Leg Standing
0.88 (0.53, 0.98)
0.67 (0.39, 0.86)
2.62 (1.13, 6.09)
0.19 (0.03, 1.23)
14.0 (1.25, 156.6)
![Page 14: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/14.jpg)
Results
* p < 0.05
![Page 15: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/15.jpg)
Conclusions
•Co-contraction is positively correlated with fall-risk as determined by the FSST
•Participants with high CCI scores on ROM were 21 times more likely to be in at-risk to fall group
•Participants who had higher fall-risk demonstrated clearly different muscle activation patterns than participants not at-risk to fall
![Page 16: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/16.jpg)
Clinical Implications
•Co-contraction may be an important predictor in determining patients who are at risk for falls
•Provides insight into commonly used static balance tests and translation to dynamic balance performance
• Intervention efforts may need to focus on a dissociation of co-contraction about the ankle
![Page 17: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/17.jpg)
Future Work
•Specific intervention studies that target co-contraction
•Subjects with various balance disorders, diagnoses
•Determination of specific cut-off scores for determination of fall risk via co-contraction measures
![Page 18: Fall risk presentation](https://reader033.vdocuments.us/reader033/viewer/2022061115/546340bbaf79599b048b54ac/html5/thumbnails/18.jpg)
Thank You!
Special Thanks to: ▫ Residents of Highland and
Argyle Senior Centers▫ Dr. Wendy Anamaet▫ Dr. Amy Hammerich▫ Dr. Larisa Hoffman▫ Dr. Marcia Smith▫ Dr. Barb Tschoepe▫ Mr. Ira Gorman▫ Regis University DPT Class of
2011Regis University Sponsored Projects Academic Research Council (SPARC)