Detecting balance deficits in frequent fallers using clinical and quantitative evaluation tools

OBJECTIVE: This investigation sought to determine whether older idiopathic frequent fallers could be distinguished from healthy older adults on the basis of balance and movement coordination tests. A secondary objective was to determine the relationships among clinical balance test scores, balance performance data obtained by accelerometry, and quantitative motor coordination tests. DESIGN: Two group comparison designs. SETTING: A motor control research laboratory in a university setting. PARTICIPANTS: The 16 subjects recruited for this study included eight healthy older subjects and eight age-matched idiopathic fallers. MEASUREMENTS: Each participant's balance performance was assessed by accelerometry, as well as by coordination and clinical tests. Accelerometry scores, obtained by Ig accelerometers placed at the hip and on the head, were made with eyes open or closed, either standing on the floor or on a wedge of compliant foam. Clinical balance scores were obtained using variants of Romberg's test and the functional reach test. Motor coordination tests obtained included the heel-to-toe transition and rapid stepping tests. MAIN RESULTS: Statistically significant differences were obtained between groups for all accelerometry variables except root mean square. All accelerometry variables were successful in discriminating between head and hip sites. Moreover, the amplitude of sway obtained from accelerometry data identified significant differences among the four test conditions. The Romberg test, using right leg alone with eyes open, showed a significant difference between fallers and healthy older subjects. Walking velocity was significantly faster for normal older subjects than for fallers (1.10 m/sec vs 0.80 m/sec). No significant between-group differences were obtained using the functional reach test. Coordination skills yielded significant between-group differences using the rapid stepping test but no significant differences between groups with the heel-toe transition test. CONCLUSION: Accelerometry is an inexpensive and clinically useful technique that can distinguish between healthy older people and idiopathic frequent fallers. In conjunction with clinical procedures and commercially available tests to assess motor coordination, these techniques can identify older individuals susceptible to frequent falls.