Although much has been learned in recent decades about the deterioration of muscular strength, gait adaptations, and sensory degradation among older adults, little is known about how these intrinsic changes affect biomechanical parameters associated with slip-induced fall accidents. In general, the objective of this laboratory study was to investigate the process of initiation, detection, and recovery of inadvertent slips and falls. We examined the initiation of and recovery from foot slips among three age groups utilizing biomechanical parameters, muscle strength, and sensory measurements. Forty-two young, middle-age, and older participants walked around a walking track at a comfortable pace. Slippery floor surfaces were placed on the track over force platforms at random intervals without the participants' awareness. Results indicated that younger participants slipped as often as the older participants, suggesting that the likelihood of slip initiation is similar across all age groups; however, older individuals? recovery process was much slower and less effective. The ability to successfully recover from a slip (thus preventing a fall) is believed to be affected by lower extremity muscle strength and sensory degradation among older individuals. Results from this research can help pinpoint possible intervention strategies for improving dynamic equilibrium among older adults.
Get full access to this article
View all access options for this article.
References
1.
Agnew, J., & Suruda, A. J. (1993). Age and fatal work-related falls. Human Factors, 35731–736.
2.
American Geriatrics Society, British Geriatrics Society, & American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49664–672.
3.
Astrand, P. O., & Rodahl, K. (1986). Textbook of work physiology. New York: McGraw-Hill.
4.
Bard C., Fleury M., Teasdale N., Paillard J., & Nougier, V. (1995). Contribution of proprioception for calibrating and updating the motor space. Canadian Journal of Physiology and Pharmacology, 73246–254.
5.
Black, F. O. (2001). Clinical status of computerized dynamic postur-ography in neurotology. Current Opinion in Otolarynogology --- Head and Neck Surgery, 9314–318.
6.
Bonder, B. R., & Wagner, M. B. (1994). Functional performance in older adults.Philadelphia: F. A. Davis.
7.
Brady, R. APavol, M. JOwings, T. M & Grabiner, M.D. (2000). Foot displacement but not velocity predicts the outcome of a slip induced in young subjects while walking. Journal of Biome-chanics, 33803–808.
8.
Brocklehurst, J. CRobertson, D. & James-Groom, P. (1982). Clinical correlates of sway in old age --- Sensory modalities. Age and Ageing, 111–10.
9.
Campbell, A. JReinken, J.Allan, B. C., & Martinez, G. S. (1981). Falls in old age: A study of frequency and related factors. Age and Ageing, 10264–270.
10.
Chaffin, D. B., & Andersson, G. B. J. (1991). Occupational biome-chanics.New York: Wiley.
11.
Chaffin, D. BHerrin, G. D & Keyserling, W.M. (1978). Pre-employment strength testing, Journal of Occupational Medicine, 20403–408.
12.
Chaffin, D. BWoldstad, J. C & Trujillo, A. (1992). Floor/shoe slip resistance measurement. American Industrial Hygiene Association Journal, 53283–289.
13.
Cham, R., & Redfern, M. S. (2001). Lower extremity corrective reactions to slip events. Journal of Biomechanics, 341439–1445.
14.
Cohen, H.Heaton, L. G., Congdon, S. L., & Jenkins, H. A. (1996). Changes in sensory organization test scores with age. Age and Ageing, 2539–44.
15.
Cohn, T. E., & Lasley, D. J. (1985). Visual depth illusion and falls in the elderly. Clinics in Geriatric Medicine, 1601–610.
16.
Cooper, J. M., & Glassow, R. B. (1963). Kinesiology.New York: Mosby.
17.
Courtney, T. KSorock, G. SManning, D. PCollins, J. W & Holbein-Jenny, M. A. (2001). Occupational slip, trip, and fall-related injuries --- Can the contribution of slipperiness be isolated. Ergonomics, 441118–1137.
18.
Do, M. CBreniere, Y. & Brenguier. P. (1982) A biomechanical study of balance recovery during the fall forward. Journal of Biomechanics, 15933–939.
19.
Donald, I. P., & Bulpitt, C. J. (1999). The prognosis of falls in elderly people living at home. Age and Ageing, 28121–125.
20.
Ekkubus, C. F., & Killey, W. (1973). Validity of 0.5 static coefficient of friction (James Machine) as a measure of safe walkway surfaces. Soap/Cosmetics/Chemical Specialties, 49 (2), 40–45.
21.
El-Kashlan, (n.i.), Hussam, K., Shaepard, N. T., Asher, A. M., Smith-Wheelock, M., & Telian, S. A. (1998). Evaluation of clinical measures of equilibrium. Laryngoscope, 108311–319.
22.
Englander F., Hodson, T. J., & Terregrossa, R. A. (1996). Economic dimensions of slip and fall injuries. Journal of Forensic Science, 41733–746.
23.
Ford-Smith, C., Wyman, J., Elswick, R. K., & Fernandez, T. (1995). Test-retest reliability of the sensory organization test in nonin-stitutionalized older adults. Archives of Physical Medicine and Rehabilitation, 7677–81.
24.
Ghez, C., & Sainburg, R. L. (1995). Proprioceptive control of inter-joint coordination. Canadian Journal of Physiology and Pharmacology, 73273–284.
25.
Gillis, B.Gilroy, K.Lawley, H.Mott, L.Wall, J. C. (1986). Slow walking speeds in healthy young and elderly females. Physiotherapy Canada, 38350–352.
26.
Goldman, R. (1986). Decline in organ function with aging. In I. Rossman (Ed.), Clinical geriatrics (pp. 23–59). Philadelphia: Lippincott.
27.
Grönqvist, R., Abeysekera, J., Gard, G., Hsiang, S. M., Leamon, T. B., Newman, D. J., et al. (2001). Human-centered approaches in slipperiness measurement. Ergonomics, 441167–1199.
28.
Hanson, J. PRedfern, M. S & Mazumdar, M. (1999). Predicting slips and falls considering required and available friction, Ergonomics, 421619–1633.
29.
Houmard, J. AWeidner, M. LGavigan, K. ETyndall, G. LHickey, M. S & Alshami, A. (1998). Fiber type and citrate syn-thase activity in the human gastrocnemius and vastus lateralis with aging. Journal of Applied Physiology, 851337–1341.
30.
Hubert, H. BBloch, D. A & Fries, J.F. (1993). Risk factors for physical disability in an aging cohort: The NHANES I epidemi-ologic follow-up study. Journal of Rheumatology, 20480–488.
31.
Imms, F. J., & Edholm, O. G. (1979). The assessment of gait and mobility in the elderly. Age and Ageing, 8261–267.
32.
Inglis, J. TShupert, C. LHlavacka, F. & Horak, F.B. (1995). Effect of galvanic vestibular stimulation on human postural responses during support surface translations. Journal of Neurophysiology, 73896–901.
33.
Isaacs, B. (1985). Clinical and laboratory studies of falls in old people. Clinics in Geriatric Medicine, 1513–524.
34.
Johnsson, L. G., & Hawkins, J. E., Jr. (1972). Sensory and neural degeneration with aging, as seen in microdissections of the inner ear. Annals of Otology, Rhinology and Laryngology, 81179–193.
35.
Judge, J. OLindsey, C.Underwood, M. & Winsemius, D. (1993). Balance improvements in older women: Effects of exercise training. Physical Therapy, 73254–265.
36.
Keshner, E. AAllum, J. H. J., & Pfaltz, C. R. (1987). Postural activation and adaptation in the sway stabilizing responses of normals and patients with bilateral deficit. Experimental Brain Research, 6977–92.
37.
Kornzweig, A. L. (1977). Visual loss in the elderly. Hospital Practice, 1251–59.
38.
Kristinsdottir, K. EJarnlo, G.-B., & Magnusson, M. (2000). Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures. Scandinavian Journal of Rehabilitation Medicine, 3256–60.
39.
Lacour, M.Vidal, P. P.Xerri, C. (1983). Dynamic characteristics of vestibular and visual control of rapid postural adjustments. In J. Desmedt (Ed.), Motor control mechanisms in health and disease (n.p.). New York: Raven Press.
40.
Larsson, L. (1982). Aging in mammalian skeletal muscle. In J. A. Mortimer, P. J. Pirazzolo, & G. J. Meletta (Eds.), The aging motor system (n.p.). New York: Praeger.
41.
Larsson, L.Grimby, G.Karlsson, J. (1979). Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology, 46451–456.
42.
Lexell, J. (1995). Human aging, muscle mass, and fiber type composition. Journal of Gerontology, Series A, 50A (Suppl.), 11–16.
43.
Lockhart, T. E. (1997). The ability of elderly people to traverse slippery walking surfaces. In Proceedings of the Human Factors and Ergonomics Society 41st Annual Meeting (25–129). Santa Monica, CA: Human Factors and Ergonomics Society.
44.
Lockhart, T. EWoldstad, J. C & Smith, J.L. (2002). Assessment of slip severity among different age groups: Metrology of pedestrian locomotion and slip resistance. ASTM STP, 142417–32.
45.
Lockhart, T. EWoldstad, J. C & Smith, J.L. (2003). Effects of age-related gait changes on biomechanics of slips and falls. Ergonomics, 461136–1160.
46.
Lord, S. RClark, R. D & Webster I. W. (1991). Visual acuity and contrast to sensitivity in relation to falls in an elderly population. Age and Ageing, 20175–181.
47.
Mackinnon, C. D., & Winter, D. A. (1993). Control of whole body balance in the frontal plane during human walking. Journal of Biomechanics, 26633–644.
48.
Maki, B. EHolliday, P. J & Topper, A.K. (1994). A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. Journal of Gerontology, 104480–492.
49.
Melvill, J. G., & Watt, D. G. D. (1971a). Muscular control of landing from unexpected falls in man. Journal of Physiology (London), 219, 729–737.
50.
Melvill, J. G., & Watt, D. G. D. (1971b). Observations on the control of stepping and hopping movements in man. Journal of Physiology (London), 219, 709–727.
51.
Mills, P., & Barrett, R. (2001). Swing phase mechanics of healthy young and elderly men. Human Movement Science, 20427–446.
52.
Murphy, S. L. (2000). Deaths: Final data for 1998 (National Vital Statistics Reports, Vol. 48, No. 11). Hyattsville, MD: National Center for Health Statistics.
53.
Murray, M. PKory, R. C & Clarkson, B.H. (1969). Walking patterns in healthy old men. Journal of Gerontology, 24169–178.
54.
Nashner, L. M. (1982). Analysis of movement control in man using the movable platform. In J. Desmedt (Ed.), Motor control mechanisms in health and disease (n.p.). New York: Raven Press.
55.
Nashner, L. MBlack, F. O & Wall, C. (1982). Adaptation to altered support and visual conditions during stance: Patient with vestibular deficits. Journal of Neuroscience, 5117–124.
56.
National Safety Council. (2002). Accidents facts.Itasca, IL: Author.
57.
Nevitt, M. CCummings, S. RKidd, S. & Black, D. (1989). Risk factors for recurrent nonsyncopal falls: A prospective study. Journal of the American Medical Association, 2612663–2668.
58.
Norton, R.Campbell, J.Lee-Joe, T., Robinson, E., & Butler, M. (1997). Circumstances of falls resulting in hip fractures among older people. Journal of the American Geriatrics Society, 451108–1112.
59.
Overstall, P. WExton-Smith, A. N., Imms, F. J., & Johnson, A. L. (1977). Falls in the elderly related to postural imbalance. British Medical Journal, 1261–264.
60.
Perkins, P. J. (1978). Measurement of slip between the shoe and ground during walking. ASTM STP, 64971–87.
61.
Perkins, P. J., & Wilson, M. P. (1983). Slip resistance testing of shoes - New developments. Ergonomics, 2673–82.
62.
Petersen, H.Magnusson, M.Fransson, P.-A., & Johansson, R. (1994). Vestibular disturbances at frequencies above 1 Hz affect human postural control. Acta Oto-Laryngologica (Stockholm), 114225–230.
63.
Rabbitt, P., & Rogers, M. (1965). Age and choice between responses in a self-paced repetitive task. Ergonomics, 8435–444.
64.
Redfern, M. S., & Andres, R. O. (1984). The analysis of dynamic pushing and pulling: Required coefficients of friction. In Proceedings of the 1984 International Conference on Occupational Ergonomics, Ontario (pp. 569–571). Mississauga, Canada: Human Factors Association of Canada.
65.
Redfern, M. S., & DiPasquale, J. D. (1997). Biomechanics of descending ramps. Gait and Posture, 6119–125.
66.
Rice, C. L., & Cunningham, D. A. (2001). Aging of the neuromuscular system: Influences of gender and physical activity. In R. J. Shephard (Ed.), Gender, physical activity, and aging (pp. 212–250). Boca Raton, FL: CRC Press.
67.
Rosenhall, U., & Rubin, W. (1975). Degenerative changes in the human vestibular sensory epithelia. Acta Oto-Laryngologica (Stockholm), 7967–80.
68.
Rubenstein, L. ZRobbins, A. SSchulman, B. LRosado, J.Osterweil, D. & Josephson, K.R. (1988). Falls and instability in the elderly. Journal of the American Geriatrics Society, 36266–278.
69.
Ruckenstein, M. J., & Shepard, N. T. (2000). Balance function testing: A rational approach. Otolaryngologic Clinics of North America, 33507–518.
70.
Sainburg, R. LGhilardi, M. FPoizner, H. & Ghez, C. (1995). The control of limb dynamics in normal subjects and patients without proprioception. Journal of Neurophysiology, 73820–835.
71.
Sheldon, J. H. (1963). The effect of age on the control of sway. Gerontologia Clinica, 5129–138.
72.
Skinner, H. BBarrack, R. L & Cook, S.D. (1984). Age-related decline in proprioception. Clinical Orthopaedics, 184208–211.
73.
Stelmach, G. E., & Worringham, C. J. (1985). Sensimotor deficits related to postural stability: Implications for falling in the elderly. Clinics in Geriatric Medicine, 1679–694.
74.
Stephen, R.John, A.Philippa, W.Kaarin, J. (1994). Physiological factors associated with falls in older community-dwelling women. Journal of the American Geriatrics Society, 421110–1117.
75.
Strandberg, L., & Lanshammar, H. (1981). The dynamics of slipping accidents. Journal of Occupational Accidents, 3153–162.
76.
Thelen, D. GSchultz, A. BAlexander, N. B & Ashton-Miller, J. A. (1996). Effects of age on rapid ankle torque development. Journal of Gerontology: Medical Sciences, 51A, M226–M232.
77.
Tinetti, M. E. (2003). Clinical practice: Preventing falls in elderly persons. New England Journal of Medicine, 34842–49.
78.
Tinetti, M. ELiu, W. L & Claus, E. (1993). Predictors and prognosis of inability to get up after falls among elderly persons. Journal of the American Medical Association, 26965–70.
79.
Tinetti, M. E., & Speechley, M. (1989). Prevention of falls among the elderly. Medical Intelligence, 3201055–1059.
80.
Tinetti, M. ESpeechley, M. & Ginter, S.F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 3191701–1707.
81.
Whipple, R. HWolfson, L. I & Amerman, P.M. (1987). The relationship of knee and ankle weakness to falls in nursing home residents: An isokinetic study. Journal of the American Geriatrics Society, 3513–20.
82.
Winter, D. A. (1990). Biomechanics and motor control of human movement (2nd ed.). New York: Wiley.
83.
Winter, D. A. (1991). The biomechanics and motor control of human gait: Normal, elderly and pathological (2nd ed.). Waterloo, Canada: University of Waterloo Press.
84.
Winter, D. APatla, A. EFrank, J. S & Walt, S.E. (1990). Biomechanical walking pattern changes in the fit and healthy elderly. Physical Therapy, 70340–347.
85.
Wolfson L., Judge, J., Whipple, R., & King, M. (1995). Strength is a major factor in balance, gait, and the occurrence of falls. Journal of Gerontology, 50A, 64–67.
86.
Wolfson, L.Whipple, R.Amerman, P.Kaplan, J.Kleinberg, A. (1985). Gait and balance in the elderly. Clinics in Geriatric Medicine, 1, 649–659.
87.
Woolacott, M. H. (1986). Aging and postural control: Changes in sensory organization and muscular coordination. International Journal of Aging and Human Development, 2397–101.
88.
Woolacott, M. HShumway-Cook, A., & Nashner, L. (1982). Postural reflexes and aging. In J. A. Mortiner, F. J. Pirozzolo, & G. J. Maletta (Eds.), The aging motor system (n.p.). New York: Praeger.
