http://www.pslgroup.com/dg/past7days.htm
Inexpensive Computer Chip Helps Predict Older Persons Who Will
Fall
BOSTON, March 3, 1997 -- A small, inexpensive, computerized foot switch is
helping scientists identify older adults who are prone to falling, and may
ultimately let doctors intervene early enough to save elderly patients from
serious injury. This is good news for older Americans, nearly half of whom
fall at least once a year.
With the help of this foot switch system, researchers from Beth Israel
Deaconess Medical Center have proven for the first time that older Americans
with measurable walking unsteadiness actually do run a greater risk of
falling. The team used foot switches, or paper thin force-sensitive sensors,
to measure gait unsteadiness in a small group of senior citizens. Their
research appears in the March issue of Archives of Physical Medicine and
Rehabilitation.
Falls are a significant cause of hip fractures and death among the elderly,
and billions of dollars are spent annually on hospitalization,
rehabilitation, and care of older Americans who fall and seriously injure
themselves.
"While it may seem intuitive that if you watch an elderly person and they
appear unsteady when they walk that this individual will be more likely to
fall, until you actually quantify gait unsteadiness you can't be sure
whether this is the case," says Jeffrey Hausdorff, PhD, division of
gerontology, Beth Israel Deaconess Medical Center, and principal
investigator of, "Increased Gait Unsteadiness in Community-Dwelling Elderly
Fallers."
Dr. Hausdorff and his colleagues conducted a retrospective study of 35
individuals, aged 70 and older living at home. Miniature foot switches were
placed under the toe and heel of one foot to measure the stride-to-stride
gait variations among the study subjects. Then, the researchers asked their
older volunteers to walk at a normal pace for six minutes without stopping.
Twenty-two younger adult participants aged 21 to 29 years served as a
control group.
The researchers found that variations in gait were not different in the
elderly nonfallers, but were significantly increased in the elderly fallers.
Interestingly, they also found that foot stance and walking speed were not
determinants of who would fall.
Hausdorff, who developed the foot switch, first became interested in using
it to predict who among the elderly might be at greatest risk of falling
after completing a study in which Holter monitors were used to measure
changes in the heart rhythms of older adults during physical activity. In
Hausdorff's current study on the elderly, the foot switches measured the
force applied to the floor during walking. Output from the computerized
sensors was stored in tiny ankle recorders that are smaller but similar to
portable Holter monitors. The signals from the foot switches were analyzed
to determine initial and end foot contact time for each cycle of an
individual's stride.
Hausdorff says that if these measures of gait unsteadiness can predict who
are more likely to fall, then researchers will be better able to find out
why these particular seniors are more likely to fall. Muscle weakness,
depression, and the use of medications have been associated with a risk of
falling in some studies.
Hausdorff believes that neurological dysfunction may also increase an
individual's risk of falling. This is a conclusion based on previous work
that he has done, with patients who have Huntington's disease, and
Parkinson's disease and who have a measurable unsteadiness to their walk.
But diseases, such as congestive heart failure, that weaken not only the
heart muscle but muscle function overall, could also predispose someone to
falling, surmises Hausdorff.
According to Hausdorff's colleague, Dr. Helen Edelberg, division of
gerontology, Beth Israel Deaconess Medical Center, the foot switches show
promise as a predictor of who might fall and may help clinicians intervene
early enough to avert what she calls "the vicious cycle in which the elderly
are afraid of falling, become less active and therefore more prone to falls"
and finally loose much of their ability to function and are placed in
nursing homes.
Hausdorff, who says that he plans to conduct a one-year prospective study to
further assess the predictive value of the small electronic device, doesn't
expect the foot switches will become widely available anytime soon. But he
quickly adds, that "Our vision for the future is that use of this small
computer chip would become part of the routine medical evaluation for
persons in their 60s and 70s in an effort to reduce the possibility of falls."
Beth Israel Deaconess Medical Center is a major teaching affiliate of
Harvard Medical School.
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