Response time is more important than walking speed for the ability of older adults to avoid a fall after a trip

We previously reported that the probability of an older adult recovering from a forward trip and using a "lowering" strategy increases with decreased walking velocity and faster response time, To determine the within-subject interaction of these variables we asked three questions: (1) Is the body orientation at the time that the recovery foot is lowered to the ground ("tilt angle") critical for successful recovery? (2) Can a simple inverted pendulum model, using subject-specific walking velocity and response time as input variables, predict this body orientation, and thus success of recovery? (3) Is slower walking velocity or faster response time more effective in preventing a fall after a trip? Tilt angle was a perfect predictor of a successful recovery step, indicating that the recovery foot placement must occur before the tilt angle exceeds a critical value of between 23degrees and 26degrees from vertical. The inverted pendulum model predicted the tilt angle from walking velocity and response time with an error of 0.4+/-2.2degrees and a correlation coefficient of 0.93. The model predicted that faster response time was more important than slower walking velocity for successful recovery. In a typical individual who is at risk for falling, we predicted that a reduction of response time to a normal value allows a 77% increase in safe walking velocity. The mathematical model produced patient-specific recommendations for fall prevention, and suggested the importance of directing therapeutic interventions toward improving the response time of older adults. (C) 2002 Elsevier Science Ltd. All rights reserved.