Dynamic Limits of Balance Control during Daily Functional Activities Associated with Falling
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Falls are one of the most serious problems among the elderly, resulting in fatal physical injuries. Early identification of people at a high risk of falling is needed to facilitate rehabilitation to reduce future fall risk. The overall goal of this dissertation was to develop biomechanical models that identify dynamic limits of balance control in daily functional activities associated with falling, including sit-to-stand (STS) movement, standing (stance perturbation), and walking. Poor performance of STS movement has been identified as one of the risk factors of falls among elderly individuals. We proposed a novel method to identify dynamic limits of balance control during STS movement using whole body center of mass (COM) acceleration and assessed its feasibility to differentiate individuals with difficulty in STS movement from healthy individuals. The results demonstrated that our model with COM acceleration could better differentiate individuals with difficulty in STS movement from healthy individuals than the traditional model with COM velocity. Poor postural control ability is also a risk factor of falls. Postural recovery responses to backward support surface translations during quiet standing were examined for healthy young and elderly adults. The results demonstrated that functional base of support (FBOS) and ankle dorsiflexor strength could be sensitive measures to detect elderly individuals with declined balance control. Our biomechanical model, which determines a set of balance stability boundaries, showed a better predictive capability than the statistical model for identifying unstable balance recovery trials, while the statistical model better predicted stable recovery trials. Lastly, walking requires a fine momentum control where COM acceleration could play an important role. Differences in control of dynamic stability during walking were examined with our proposed boundaries of dynamic stability. Elderly fallers adapted a more conservative gait strategy than healthy individuals, demonstrating significantly slower forward COM velocity and acceleration with their COM significantly closer to the base of support at toe-off, which could be indicative of a poor momentum control ability. Overall, this study demonstrated that COM acceleration would provide further information on momentum control, which could better reveal underlying mechanisms causing imbalance and provide an insightful evaluation of balance dysfunction. This dissertation includes unpublished co-authored material.