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Increased Fall Risk is Associated with Elevated Ankle Co-contraction in Older Adults ,[object Object],Ryan Appell, Michael McKay, Hannah Nawaz, Joanna Roth, Robert Sigler, Jacqueline Third, Mark Walker, Erika Nelson-Wong,[object Object]
Background,[object Object],Increased co-contraction in older adults (Hortobogyi et al. 2009; Chu et al. 2009; Cenciarini et al. 2009; Benjuya et al. 2004),[object Object], Increased co-contraction associated with history of falls (Ho and Bendrups 2002),[object Object],Co-contraction is not predictive of postural sway (Reynolds 2010),[object Object],Does co-contraction during static balance tasks predict fall risk?,[object Object]
Purpose,[object Object],To determine if co-contraction of the anterior and posterior ankle musculature during static balance challenges is associated with fall risk, as determined by the Four Square Step Test (FSST) in older adults.  ,[object Object],European Journal of Applied Physiology, 2011, Submitted in review.,[object Object]
Inclusion Criteria,[object Object],Recruited from independent living facilities and surrounding community,[object Object],Age > 55 years,[object Object],Absence of cardiovascular and pulmonary co-morbidities,[object Object],Independence with community mobility with or without assistive device,[object Object]
Methods,[object Object],Participant Characteristics,[object Object],8 male, 15 female,[object Object],Age: 73.0 ± 6.4 years,[object Object],Electromyography (EMG),[object Object],Anterior Tibialis,[object Object],Lateral Gastrocnemius,[object Object]
Methods – Static Balance,[object Object],Romberg (ROM),[object Object],Sharpened Romberg (SROM),[object Object],Single Leg Standing (SLS),[object Object]
Methods – Four Square Step Test,[object Object],At risk to fall > 12 sec,[object Object],Not at risk to fall < 12 sec,[object Object],Dite et al (2002),[object Object]
Methods – EMG Analysis,[object Object],Co-contraction quantified by co-contraction index (CCI),[object Object],High CCI = Top 50th percentile,[object Object],Low CCI = Bottom 50th percentile,[object Object],Lewek et al (2004),[object Object]
Methods – Statistical Treatment,[object Object],Chi-square,[object Object],High/Low CCI and at-risk/not-at-risk to fall,[object Object],Sn, Sp, + LR, - LR, OR,[object Object],Pearson product moment correlation,[object Object],Actual CCI score vs. actual FSST time ,[object Object],One-way ANOVA,[object Object],CCI score by fall risk category ,[object Object],p< 0.05,[object Object]
Results,[object Object],No group differences between average ages,[object Object],14.22 s,[object Object],   8.87 s,[object Object],n = 8,[object Object],p < 	0.001,[object Object],n = 15,[object Object]
Results,[object Object],High/Low CCI associated (p< 0.05) with fall risk except ROM eyes closed,[object Object],FSST times correlated with CCI values for SROM eyes open (r = 0.42) and eyes closed (r = 0.57) and SLS (r = 0.54),[object Object]
Fall risk presentation
Fall risk presentation
Results,[object Object],* p < 0.05,[object Object]
Conclusions,[object Object],Co-contraction is positively correlated with fall-risk as determined by the FSST,[object Object],Participants with high CCI scores on ROM were 21 times more likely to be in at-risk to fall group,[object Object],Participants who had higher fall-risk demonstrated clearly different muscle activation patterns than participants not at-risk to fall,[object Object]
Clinical Implications,[object Object],Co-contraction may be an important predictor in determining patients who are at risk for falls,[object Object],Provides insight into commonly used static balance tests and translation to dynamic balance performance ,[object Object],Intervention efforts may need to focus on a dissociation of co-contraction about the ankle  ,[object Object]
Future Work,[object Object],Specific intervention studies that target co-contraction,[object Object],Subjects with various balance disorders, diagnoses,[object Object],Determination of specific cut-off scores for determination of fall risk via co-contraction measures,[object Object]
Thank You!,[object Object],Special Thanks to: ,[object Object],Residents of Highland and Argyle Senior Centers,[object Object],Dr. Wendy Anamaet,[object Object],Dr. Amy Hammerich,[object Object],Dr. Larisa Hoffman,[object Object],Dr. Marcia Smith,[object Object],Dr. Barb Tschoepe,[object Object],Mr. Ira Gorman,[object Object],Regis University DPT Class of 2011,[object Object],Regis University Sponsored Projects Academic Research Council (SPARC),[object Object]

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Fall risk presentation

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Editor's Notes

  1. During balance challenges
  2. You can see our subjects were an older sample, greater than 55
  3. Took an average CCI for one second windows for the time the duration they were successful in the balance challenge because some were able to hold for 30 vs. 3 and we wanted to be able to compare individualsPreface CCI with “Because there are no norms”
  4. Relationship forpearsonThese are the stats we ran for each balance challenge condition
  5. “here’s what we found out” describe axisWe wanted to make sure there wasn’t an age difference between average age of these groups and there wasn’t
  6. Say that if you had a higher co-contraction it took you longer to complete the FSST
  7. We created contingency tables from each balance condition and these are what we found from thoseNot a contingency table
  8. We created contingency tables from each balance condition and these are what we found from thoseNot a contingency table
  9. This was part of a larger intervention study that we were able to collect these data on