Volume 28, Issue 2 (4-2025)
J Arak Uni Med Sci 2025, 28(2): 85-90 |
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Jalalvand A. The Effect of Backward Gait Training Protocol on Postural Sway and Balance in Elderly Men with a History of Fall. J Arak Uni Med Sci 2025; 28 (2) :85-90
URL: http://jams.arakmu.ac.ir/article-1-7944-en.html
URL: http://jams.arakmu.ac.ir/article-1-7944-en.html
Department of Sports Biomechanics, Hamadan Branch, Islamic Azad University, Hamadan, Iran , jalalvand_ali@yahoo.com
Abstract: (882 Views)
Introduction: This study aimed to investigate the effect of the backward gait training protocol on postural sway and balance in elderly men with a history of falls.
Methods: A total of 28 healthy elderly individuals with a history of falls participated in this research. The backward gait protocol was considered the independent variable, and the mean parameters of postural sway, including range, center of pressure displacement, center of pressure velocity, and center of pressure acceleration, were examined as dependent variables. A Kistler force platform was used to assess postural sway. A mixed-design repeated measures ANOVA was performed at a significance level of 0.05.
Results: No significant differences were found in the anterior-posterior amplitude and medio-lateral acceleration of the center of pressure between healthy elderly individuals and those with a history of falls (P > 0.05). However, individuals with a history of falls exhibited greater medio-lateral amplitude, anterior-posterior displacement, anterior-posterior velocity, and anterior-posterior acceleration of the center of pressure (P = 0.001). Conversely, they demonstrated lower medio-lateral displacement (P = 0.001) and medio-lateral velocity of the center of pressure (P = 0.005).
Conclusions: Changes in center of pressure parameters may predict fall risk in the older adults. These parameters have varying sensitivities for detecting subtle differences in postural control. The responses of various parameters are influenced by compensatory mechanisms, weaknesses, and balance disorders. The backward gait protocol serves as a targeted intervention to improve balance and stability in elderly individuals at risk of falls.
Methods: A total of 28 healthy elderly individuals with a history of falls participated in this research. The backward gait protocol was considered the independent variable, and the mean parameters of postural sway, including range, center of pressure displacement, center of pressure velocity, and center of pressure acceleration, were examined as dependent variables. A Kistler force platform was used to assess postural sway. A mixed-design repeated measures ANOVA was performed at a significance level of 0.05.
Results: No significant differences were found in the anterior-posterior amplitude and medio-lateral acceleration of the center of pressure between healthy elderly individuals and those with a history of falls (P > 0.05). However, individuals with a history of falls exhibited greater medio-lateral amplitude, anterior-posterior displacement, anterior-posterior velocity, and anterior-posterior acceleration of the center of pressure (P = 0.001). Conversely, they demonstrated lower medio-lateral displacement (P = 0.001) and medio-lateral velocity of the center of pressure (P = 0.005).
Conclusions: Changes in center of pressure parameters may predict fall risk in the older adults. These parameters have varying sensitivities for detecting subtle differences in postural control. The responses of various parameters are influenced by compensatory mechanisms, weaknesses, and balance disorders. The backward gait protocol serves as a targeted intervention to improve balance and stability in elderly individuals at risk of falls.
References
1. Sundstrup E, Jakobsen MD, Andersen JL, Randers MB, Petersen J, Suetta C, et al. Muscle function and postural balance in lifelong trained male footballers compared with sedentary elderly men and youngsters. Scand J Med Sci Sports. 2010;20(Suppl 1):90-7. pmid: 20210903 doi: 10.1111/j.1600-0838.2010.01092.x.
2. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl-2):ii37-ii41. pmid: 16926202 doi: 10.1093/ageing/afl084.
3. Shepard NT, Telian SA. Practical management of the balance disorder patient. 1st ed. Boston, MA: Cengage Learning; 1996.
4. Sheldon J. The effect of age on the control of sway. Gerontol Clin (Basel). 1963;5(3):129-38. pmid: 13977074 doi: 10.1159/000244784.
5. Overstall P, Exton-Smith A, Imms F, Johnson A. Falls in the elderly related to postural imbalance. Br Med J. 1977;1(6056):261-4. pmid: 837061 doi: 10.1136/bmj.1.6056.261
6. Fernie GR, Gryfe CI, Holliday PJ, Llewellyn A. The relationship of postural sway in standing to the incidence of falls in geriatric subjects. Age Ageing. 1982;11(1):11-6. pmid: 7072557 doi: 10.1093/ageing/11.1.11
7. Fernie GR, Holliday PJ. Postural sway in amputees and normal subjects. J Bone Joint Surg Am. 1978;60(7):895-8. pmid: 701337
8. Woollacott MH. Postural reflexes and aging. Advances in neurogerontology. 1982;3:98-119.
9. Kwok B-C, Clark RA, Pua Y-H. Novel use of the Wii Balance Board to prospectively predict falls in community-dwelling older adults. Clin Biomech (Bristol). 2015;30(5):481-4. pmid: 25796535 doi: 10.1016/j.clinbiomech.2015.03.006.
10. Zech A, Hübscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. J Athl Train. 2010;45(4):392-403. pmid: 20617915 doi: 10.4085/1062-6050-45.4.392
11. Sarma M. Effect of Additional Backward Walking Training on Balance and Functional Outcome in Patients with Stroke (Master's thesis, Rajiv Gandhi University of Health Sciences (India);2013.
12. Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J Neurophysiol. 1998;80(4):1868-85. pmid: 9772246 doi: 10.1152/jn.1998.80.4.1868
13. Marden-Lokken SM, Killough J. Effects of backward walking training on neuromuscular efficiency in gait in an individual post-stroke. Journal of Neurologic Physical Therapy. 2006;30(4):213. doi: 10.1097/01.NPT.0000281312.32152.3f
14. Sozzi S, Honeine J-L, Do M-C, Schieppati M. Leg muscle activity during tandem stance and the control of body balance in the frontal plane. Clin Neurophysiol. 2013;124(6):1175-86. pmid: 23294550 doi: 10.1016/j.clinph.2012.12.001
15. Maki BE, McIlroy WE. The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther. 1997;77(5):488-507. pmid: 9149760 doi: 10.1093/ptj/77.5.488
16. Shumway-Cook A. Motor control: Translating research into clinical practice. Philadelphia, PA: Lippincoot Williams & Wilkins; 2007.
17. de Abreu DCC, Bandeira ACL, Magnani PE, de Oliveira Grigoletto DA, de Faria Junior JR, Teixeira VRS, et al. Standing balance test for fall prediction in older adults: a 6-month longitudinal study. BMC Geriatr. 2024;24(1):947. pmid: 39548372 doi: 10.1186/s12877-024-05380-9
18. Chen B, Liu P, Xiao F, Liu Z, Wang Y. Review of the upright balance assessment based on the force plate. Int J Environ Res Public Health. 2021;18(5):2696. pmid: 33800119 doi: 10.3390/ijerph18052696
19. Granacher U, Muehlbauer T, Gruber M. A qualitative review of balance and strength performance in healthy older adults: impact for testing and training. J Aging Res. 2012;2012:708905. pmid: 22315687 doi: 10.1155/2012/708905
20. Luecha T, Takesue S, Yeoh WL, Loh PY, Muraki S. Backward walking styles and impact on spatiotemporal gait characteristics. Healthcare (Basel). 2022;10(12):2487. pmid: 36554011 doi: 10.3390/healthcare10122487. .
21. Balasukumaran T, Gottlieb U, Springer S. Muscle activation patterns during backward walking in people with chronic ankle instability. BMC Musculoskelet Disord. 2020; 21(1):489. doi: 10.1186/s12891-020-03512-x. pmid: 32711488 doi: 10.1186/s12891-020-03512-x
22. Elnahhas AM, Elshennawy S, Aly MG. Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review. Clin Rehabil. 2019;33(1):3-12. pmid: 30043634 doi: 10.1177/0269215518790053
23. Brech GC, Fonseca AMd, Bagnoli VR, Baracat EC, Greve JMDA. Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis. Clinics (Sao Paulo). 2013;68(10):1293-8. pmid: 24212834 doi: 10.6061/clinics/2013(10)01
24. Choi H, Kim W-S. Anterior-posterior displacement of center of pressure measured by insole foot pressure measurement system in subacute recovery stage of post-stroke hemiplegia. Technology and Health Care. 2018;26(4):649-57. pmid: 30124457 doi: 10.3233/THC-181310
25. Fujimoto M, Bair W-N, Rogers MW. Center of pressure control for balance maintenance during lateral waist-pull perturbations in older adults. J Biomech. 2015;48(6):963-8. pmid: 25728580 doi: 10.1016/j.jbiomech.2015.02.012
26. Arnold N, Wilson O, Thompson L. Virtual Reality Training Affects Center of Pressure (COP)-Based Balance Parameters in Older Individuals. Appl Sci. 2024;14(16):7182. doi: 10.3390/app14167182
27. Tisserand R, Robert T, Chabaud P, Bonnefoy M, Chèze L. Elderly fallers enhance dynamic stability through anticipatory postural adjustments during a choice stepping reaction time. Front Hum Neurosci. 2016;10:613. pmid: 27965561 doi: 10.3389/fnhum.2016.00613
28. Wang Y, Mei Q, Jiang H, Hollander K, Van den Berghe P, Fernandez J, et al. The biomechanical influence of step width on typical locomotor activities: a systematic review. Sports Med Open. 2024;10(1):83. pmid: 39068296 doi: 10.1186/s40798-024-00750-4
29. Sarvari M, Shanbehzadeh S, Shavehei Y, ShahAli S. Postural control among older adults with fear of falling and chronic low back pain. BMC geriatr. 2024;24(1):862. pmid: 39443870 doi: 10.1186/s12877-024-05455-7
30. Rose MJ, Costello KE, Eigenbrot S, Torabian K, Kumar D. Inertial measurement units and application for remote health care in hip and knee osteoarthritis: Narrative review. JMIR Rehabil Assist Technol. 2022;9(2):e33521. pmid: 35653180 doi: 10.2196/33521
31. Delmas S, Watanabe T, Yacoubi B, Christou EA. Age-associated increase in postural variability relate to greater low-frequency center of pressure oscillations. Gait Posture. 2021;85:103-9. pmid: 33524665 doi: 10.1016/j.gaitpost.2020.12.019
32. Chen T, Chou L-S. Altered center of mass control during sit-to-walk in elderly adults with and without history of falling. Gait Posture. 2013;38(4):696-701. pmid: 23578795 doi: 10.1016/j.gaitpost.2013.03.007.
33. Chien J-E, Hsu W-L. Effects of dynamic perturbation-based training on balance control of community-dwelling older adults. Sci Rep. 2018;8(1):17231. pmid: 30467355 doi: 10.1038/s41598-018-35644-5.
34. Laufer Y. Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed. J Gerontol A Biol Sci Med Sci. 2005;60(5):627-32. pmid: 15972616 doi: 10.1093/gerona/60.5.627
35. Sundstrup E, Jakobsen MD, Andersen JL, Randers MB, Petersen J, Suetta C, et al. Muscle function and postural balance in lifelong trained male footballers compared with sedentary elderly men and youngsters. Scand J Med Sci Sports. 2010;20(Suppl 1):90-7. pmid: 20210903 doi: 10.1111/j.1600-0838.2010.01092.x.
36. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl-2):ii37-ii41. pmid: 16926202 doi: 10.1093/ageing/afl084.
37. Shepard NT, Telian SA. Practical management of the balance disorder patient. 1st ed. Boston, MA: Cengage Learning; 1996.
38. Sheldon J. The effect of age on the control of sway. Gerontol Clin (Basel). 1963;5(3):129-38. pmid: 13977074 doi: 10.1159/000244784.
39. Overstall P, Exton-Smith A, Imms F, Johnson A. Falls in the elderly related to postural imbalance. Br Med J. 1977;1(6056):261-4. pmid: 837061 doi: 10.1136/bmj.1.6056.261
40. Fernie GR, Gryfe CI, Holliday PJ, Llewellyn A. The relationship of postural sway in standing to the incidence of falls in geriatric subjects. Age Ageing. 1982;11(1):11-6. pmid: 7072557 doi: 10.1093/ageing/11.1.11
41. Fernie GR, Holliday PJ. Postural sway in amputees and normal subjects. J Bone Joint Surg Am. 1978;60(7):895-8. pmid: 701337
42. Woollacott MH. Postural reflexes and aging. Advances in neurogerontology. 1982;3:98-119.
43. Kwok B-C, Clark RA, Pua Y-H. Novel use of the Wii Balance Board to prospectively predict falls in community-dwelling older adults. Clin Biomech (Bristol). 2015;30(5):481-4. pmid: 25796535 doi: 10.1016/j.clinbiomech.2015.03.006.
44. Zech A, Hübscher M, Vogt L, Banzer W, Hänsel F, Pfeifer K. Balance training for neuromuscular control and performance enhancement: a systematic review. J Athl Train. 2010;45(4):392-403. pmid: 20617915 doi: 10.4085/1062-6050-45.4.392
45. Sarma M. Effect of Additional Backward Walking Training on Balance and Functional Outcome in Patients with Stroke (Master's thesis, Rajiv Gandhi University of Health Sciences (India);2013.
46. Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J Neurophysiol. 1998;80(4):1868-85. pmid: 9772246 doi: 10.1152/jn.1998.80.4.1868
47. Marden-Lokken SM, Killough J. Effects of backward walking training on neuromuscular efficiency in gait in an individual post-stroke. Journal of Neurologic Physical Therapy. 2006;30(4):213. doi: 10.1097/01.NPT.0000281312.32152.3f
48. Sozzi S, Honeine J-L, Do M-C, Schieppati M. Leg muscle activity during tandem stance and the control of body balance in the frontal plane. Clin Neurophysiol. 2013;124(6):1175-86. pmid: 23294550 doi: 10.1016/j.clinph.2012.12.001
49. Maki BE, McIlroy WE. The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther. 1997;77(5):488-507. pmid: 9149760 doi: 10.1093/ptj/77.5.488
50. Shumway-Cook A. Motor control: Translating research into clinical practice. Philadelphia, PA: Lippincoot Williams & Wilkins; 2007.
51. de Abreu DCC, Bandeira ACL, Magnani PE, de Oliveira Grigoletto DA, de Faria Junior JR, Teixeira VRS, et al. Standing balance test for fall prediction in older adults: a 6-month longitudinal study. BMC Geriatr. 2024;24(1):947. pmid: 39548372 doi: 10.1186/s12877-024-05380-9
52. Chen B, Liu P, Xiao F, Liu Z, Wang Y. Review of the upright balance assessment based on the force plate. Int J Environ Res Public Health. 2021;18(5):2696. pmid: 33800119 doi: 10.3390/ijerph18052696
53. Granacher U, Muehlbauer T, Gruber M. A qualitative review of balance and strength performance in healthy older adults: impact for testing and training. J Aging Res. 2012;2012:708905. pmid: 22315687 doi: 10.1155/2012/708905
54. Luecha T, Takesue S, Yeoh WL, Loh PY, Muraki S. Backward walking styles and impact on spatiotemporal gait characteristics. Healthcare (Basel). 2022;10(12):2487. pmid: 36554011 doi: 10.3390/healthcare10122487. .
55. Balasukumaran T, Gottlieb U, Springer S. Muscle activation patterns during backward walking in people with chronic ankle instability. BMC Musculoskelet Disord. 2020; 21(1):489. doi: 10.1186/s12891-020-03512-x. pmid: 32711488 doi: 10.1186/s12891-020-03512-x
56. Elnahhas AM, Elshennawy S, Aly MG. Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review. Clin Rehabil. 2019;33(1):3-12. pmid: 30043634 doi: 10.1177/0269215518790053
57. Brech GC, Fonseca AMd, Bagnoli VR, Baracat EC, Greve JMDA. Anteroposterior displacement behavior of the center of pressure, without visual reference, in postmenopausal women with and without lumbar osteoporosis. Clinics (Sao Paulo). 2013;68(10):1293-8. pmid: 24212834 doi: 10.6061/clinics/2013(10)01
58. Choi H, Kim W-S. Anterior-posterior displacement of center of pressure measured by insole foot pressure measurement system in subacute recovery stage of post-stroke hemiplegia. Technology and Health Care. 2018;26(4):649-57. pmid: 30124457 doi: 10.3233/THC-181310
59. Fujimoto M, Bair W-N, Rogers MW. Center of pressure control for balance maintenance during lateral waist-pull perturbations in older adults. J Biomech. 2015;48(6):963-8. pmid: 25728580 doi: 10.1016/j.jbiomech.2015.02.012
60. Arnold N, Wilson O, Thompson L. Virtual Reality Training Affects Center of Pressure (COP)-Based Balance Parameters in Older Individuals. Appl Sci. 2024;14(16):7182. doi: 10.3390/app14167182
61. Tisserand R, Robert T, Chabaud P, Bonnefoy M, Chèze L. Elderly fallers enhance dynamic stability through anticipatory postural adjustments during a choice stepping reaction time. Front Hum Neurosci. 2016;10:613. pmid: 27965561 doi: 10.3389/fnhum.2016.00613
62. Wang Y, Mei Q, Jiang H, Hollander K, Van den Berghe P, Fernandez J, et al. The biomechanical influence of step width on typical locomotor activities: a systematic review. Sports Med Open. 2024;10(1):83. pmid: 39068296 doi: 10.1186/s40798-024-00750-4
63. Sarvari M, Shanbehzadeh S, Shavehei Y, ShahAli S. Postural control among older adults with fear of falling and chronic low back pain. BMC geriatr. 2024;24(1):862. pmid: 39443870 doi: 10.1186/s12877-024-05455-7
64. Rose MJ, Costello KE, Eigenbrot S, Torabian K, Kumar D. Inertial measurement units and application for remote health care in hip and knee osteoarthritis: Narrative review. JMIR Rehabil Assist Technol. 2022;9(2):e33521. pmid: 35653180 doi: 10.2196/33521
65. Delmas S, Watanabe T, Yacoubi B, Christou EA. Age-associated increase in postural variability relate to greater low-frequency center of pressure oscillations. Gait Posture. 2021;85:103-9. pmid: 33524665 doi: 10.1016/j.gaitpost.2020.12.019
66. Chen T, Chou L-S. Altered center of mass control during sit-to-walk in elderly adults with and without history of falling. Gait Posture. 2013;38(4):696-701. pmid: 23578795 doi: 10.1016/j.gaitpost.2013.03.007.
67. Chien J-E, Hsu W-L. Effects of dynamic perturbation-based training on balance control of community-dwelling older adults. Sci Rep. 2018;8(1):17231. pmid: 30467355 doi: 10.1038/s41598-018-35644-5.
68. Laufer Y. Effect of age on characteristics of forward and backward gait at preferred and accelerated walking speed. J Gerontol A Biol Sci Med Sci. 2005;60(5):627-32. pmid: 15972616 doi: 10.1093/gerona/60.5.627
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