Elderly Subjects' Ability to Recover Balance With a Single Backward Step Associates With Body Configuration at Step Contact

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Abstract
Background. In the event of a slip or trip, one's ability to recover a stable upright stance by stepping should depend on (a) the configuration of the body at the instant of step contact and (b) the forces generated between the foot and ground during step contact. In this study, we tested whether these two variables associate with elderly subjects' ability to recover balance by taking a single backward step after sudden release from an inclined position. Methods. Twenty-six community-dwelling subjects (12 women, 14 men) of mean age 75 ± 4 (SD) years each underwent five trials in which they were suddenly released from a backward inclination of 7° and instructed to “recover balance with a single step.” Body segment motions and foot contact forces were analyzed to determine step contact times, stepping angles, body lean angles at step contact, and the magnitudes and times (after step contact) of peak foot-floor contact forces and peak sagittal-plane torques at the ankle, knee, and hip of the stepping leg. Results. Fifty percent of subjects were predominantly single steppers (successful at recovering with a single step in greater than three of five trials), 27% were multiple steppers (successful in less than two of five trials), and 23% were mixed response steppers (successful in two of five or three of five trials). Recovery style associated with the ratio of stepping angle divided by body lean angle at step contact ( p = .003), which averaged 1.4 ± 0.5 for single steppers and 0.6 ± 0.5 for multiple steppers, but not with step contact time, stepping angle, or contact forces and joint torques during step contact. Conclusions. These results suggest that elderly subjects' ability to recover balance with a single backward step depends primarily on the configuration of the body (in particular, the ratio of stepping angle to body lean angle) at step contact.