Comparison between investigations of induced stepping postural responses and voluntary steps to better detect community-dwelling elderly fallers

Abstract

In this paper, we review a physiological task that is predominant in preventing humans from falling, but that simultaneously also challenges balance: taking a step. In particular, two variants of this task are presented and compared: the voluntary step versus a step induced by an external and unpredictable perturbation. We show that, while these contribute different information, it is interesting to compare these. Indeed, they both are relevant in a global balance assessment and should be included within this, at the same level as tests usually dispensed in the clinical environment such as posturography. We choose to focus on the community-dwelling elderly population, to discuss means of early detection of risk of falls, in order to prescribe an appropriate prevention. An overview of posture-movement coordination and balance recovery strategies is also provided. Finally, a working hypothesis is suggested on how "compensatory protective" steps are controlled and how their evaluation could bring additional information to the global balance assessment of risk of fall.

Keywords: Ajustements posturaux anticipés (APA); Ajustements posturaux compensateurs (APC); Anticipatory Postural adjustments (APA); Balance recovery; Chute; Community-dwelling elderly; Compensatory postural adjustments (CPA); Faire un pas; Fall; Personnes âgées autonomes; Rattrapage de l’équilibre; Stepping.