Balance and fall

Gerontology
The scientific study of old age, the process of ageing ,
and the particular problems of old age
 Balance and postural
control
Balance is defined as the dynamic process by
which body’s position is maintained in
equilibrium. It is achieved by continually
positioning the body’s center of gravity over the
base of support (BOS) during both static and
dynamic situation
 Balance and postual
control
Postural control depends upon integration and co-
ordination of three body systems: sensory ,central
nervous system and neuromuscular
All the postural control components undergo
changes with aging. Accumulation of deficits across
multiple system may leads to instability and even fall
Component of postural control:
Sensory system
1)Somatosensory input
2)Visual input
3)Vestibular system
Central processing system (CNS)
It involves cortex, thalamus, basal ganglia,
vestibular nucleus and cerebellum
Neuromuscular system
Fall :
An unintentional loss of balance that leads to failure of
postural stability or sudden and unexpected change in
position which usually results in landing on the floor
Fall represent the most common mechanism of injury
and leading cause f death in people older than age 65.
The American Academy of neurology fall guidelines
suggested that people with the diagnoses of stroke ,
dementia, walking, and balance problems plus people
who use walking aids such as cane or walker are at the
highest risk of falling
Fall risk factors:
Intrinsic fall risk factors
Extrinsic (environmental)
Age related Health condition
changes related
Intrinsic (postural control mechanisms)
Somatosensory Decreased Stroke
proprioception, Multiple sclerosis
vibration sense

Visual Decreased visual Cataract

acuity Glucoma
Vestibular Decreased Vertigo
vestibular nerve Vestibular
fiber hypofunction
Fall risk factors:
Age related changes Health condition related
CNS Decreased coordination Parkinson’s disease
Stroke
Cerebellar atrophy
Neuromuscular Decreased flexibility Osteoprosis
Decreased muscle endurance Diabetes with motor
Decreased muscle strength, neuropathy
torque and power Spinal stenosis
Impaired postural alignment
cardiovascular Syncope, lightheadedness
Arrhythmias, ortostatis
hypotension
Psychosocial Fear of falling, Depression
cognitive impairment
others Incontinence
Alcohol abuse
Aging theory :concepts pertinent to
fall in elderly
There are several important postulates in gerontology
that should be considered in treatment of frail older
person. These postulates include

Functional reserve:
It refers to the excess or redundant function that is
present in virtually all physiological systems. In adults
functional reserve is markedly diminished and
threshold for clinically observable loss of function
increased
Heterogeneous :
The second important postulate is that aging
is heterogeneous. Variability between the individual
varies with age. It is therefore difficult to examine the
effect of age on any one physiological system
Loss of physiological system:
Function is the outcome produced by
integration several system. When single component is
affected , fuction can be maintained by compensatory
mechanism of other system
Social support:
A strong social support and sound judgment in risk
taking behavior may mitigate the effect of poor
balance control and reduce fall risk
Assessment of fall:

Ecological Biomedical
inputs inputs

Assessment
of fall

Functional Physiologic
inputs inputs
Postural control theory:
The body maintain the balance in following ways
First ,a person must acquire information about body
positon . This is done through sensory system
Second the body must determine effective and timely
response
Third , the body must carry out response through
effector system
Sensory system:
Somato sensory system
This system gathered information from receptors
located in joints, muscles and tendons and provide the
CNS with crucial information about body position.
Receptors include proprioceptors, muscle spindle,
Golgi tendons , cutaneous inputs
Visual system
It provides CNS with upright postural information.
Component of vision are
Visual acuity (refers to the clarity of vision)
Contrast sensitivity(ability to discriminate fine details )
Peripheral vision(is a part of vision that occurs outside
the center of gaze)
Depth perception(percieve size, and distance)
Vestibular system:
this system provide information about angular
acceleration of head via semicircular canal and linear
acceleration via otoliths
The vestibular system regulates the position of head and
neck. Anatomic and physiologic changes occur with aging
 Central processing
Central processing is an important physiological
component of the postural control system. CNS
receives sensory inputs, interprets and integrates, then
cordinate and execute the orders to neuromuscular
system to provide corrective motor output
Response strategies to postural perturbation:
There are five baic strategies,
1) Ankle strategy: is the activation of muscle around
ankle joint after small disturbance of BOS when
standing on normal surface
2)A Hip strategy is the activation of muscles around the hip
joint as a result of sudden and forceful disturbance of BOS while
standing on narrow surface.

3)The Stepping strategy has been defined as taking forward or

backward steps rapidly to regain equilibrium when the COG is
displaced.

4)The Reaching strategy includes moving the arm to grasp or

touch the object for support.

5)The Suspensory strategy includes bending knees during

standing or ambulation for maintaining a stable position during
perturbation
Neuromuscular system
The neuromuscular system represents the biomechanical
apparatus through which the CNS executes postural action
Muscle strength
Torque
Power
flexibility / ROM
Postural alignment
Most of these factors change with the advancing age that
decreases the ability of older adults to respond affectively
against disturbance
Relationship between postural control and
fall: a model
Balance impairments and falls is a complex and
multifaceted problem in aging adults
Factors outside of physical function i.e., psychosocial,
cognitive, environmental can modify the risk of falling
in person with impaired mobility
At highest level of physical mobility and balance
control, fall risk is very low and vice versa
Thus comprehensive assessment include not only
physiological impairments but also cognitive,
behavioral and environmental factors