Falls in elderly
This document is for whom is interested in this issue and might want to invest in development of a unique device.
Balance 4-u
A device that evaluates and can help improve control of the
base of support (BoS), in standing possession to advance balance abilities. An innovative and basic approach to the issue of 'falling' in the elderly population.
Developed by a physiotherapist Bpt + MA, with 30+ years' experience of treating children and elderly people with neurological or/and orthopedic difficulties.
Everyone knows, or knows of, an ageing person who has lost his or her balance, fallen, broken bones and been put in mortal danger. Biomechanics and other professionals are making a major effort to deal with this ominously accelerating problem. Although much progress has been made, their explorations have not yet made the necessary breakthrough and seem to have been at an impasse for several years.
What follows below is an outline of a way to move forward, the result of 20 years of treatment and research, showing measurable and measured results in the real world, which will quickly and dramatically reduce the number of falls of aging people, save lives and improve quality of life in the process.
Postural control theory (PTC) has been developed to attempt to deal with the growing problem of elderly (and other) people falling, breaking bones, and even dying as result of their fall. PCT views balance as the output of the integration of the body as a mechanical system and the nervous system in a continuously changing manner.
What follows is a summary of research being done, a diagnosis of why it is failing to solve the problem, and a proposal of how to resolve the impasse PCT is in, and dramatically reduce the incidence of falls worldwide.
PCT details six important theoretical components-
(1) constraints on the biomechanical system
(2) movement strategies
(3) sensory strategies
(4) orientation in space
(5) dynamic control, and
(6) cognitive processing.
Deficit in any one of the components could lead to balance impairment. For the human body to be able to move comfortably and efficiently and at the same time avoid falling, it needs to be able to balance while standing, and manage gravity, defined as the ability to keep the center of mass within the base of support. This is a prerequisite for many functional activities of daily living. As one example is exercise that improves balance and has been comprehensively shown to increase mobility and as a result can reduce falls or minimize its outcomes.
From the studies it is evident that there are many ways being explored to improve balance, and one sees this clearly in the variety of contrasting methods being used. Such inconsistency in use of balance measures reflects the absence of a gold standard method for evaluating standing balance.
Thus, there is a need for a recommended minimum way of rigorously measuring outcomes or outcome measures. Only in this way will we be able to monitor and measure. This will optimize the effectiveness of a variety of development and implementation methods of evidence-based exercise programs for mobility enhancement and fall prevention worldwide.
To succeed with this, it is necessary to overcome the variation in reporting that is still going to be an issue and may impact the ability to synthesize balance intervention data. This would be one priority of my ongoing research focus.
Recent research has established that five exercise components are to be the most effective for reducing falls by older adults,
four of which are components of balance-
-anticipatory control
-dynamic stability
-functional stability limits
- reactive control.
The fifth is flexibility, which the researchers found as quite surprising.
What the research has not established, and generally not even attempted to establish, is how to integrate these components. That is, how to achieve synergy of the different components, to get each individual component to be far more potent when operating in tandem with the others.
My experience in actual practice has begun to demonstrate this synergy, but in the meantime exercise and rehabilitation professionals need to be far more aware that the findings about individual components of improving balance need to be integrated into any intervention and can use these findings to advance effective fall prevention exercise design.
Intended Clinical Performance
One of the crucial components I am suggesting is essential to move fall prevention forward is a technology I have developed and the success of which in the real world I can demonstrate with documented case studies.
Balance 4-u is waiting for a smart marketer who could eventually help take this device forward. I believe, this device is destined to revolutionize falls prevention programs.
"Balance 4-u" is a device which simultaneously provides accurate real-time visual measurement of center of mass (CoM) that is projected on to the mat in an innovative way (see below), center of pressure (CoP), pressure distribution (mapping) of the feet and different base of support (BoS) variables for monitoring balance, posture, and movement control to gain varied abilities of managing BoS including limits of stability.
balance 4-U device information
General
There are various existing methods for calculating or mapping in real time CoM, CoP, heat map of the feet, and skeleton on body front image. What the existing methods do not do is to simultaneously display the different forms of measurement and their effect on each other. They also do not incorporate visual biofeedback to improve the control of BoS and to enable variability in posture.
These deficiencies are crucial if one wants to resolve the issue of balance and falling. Balance 4-u addresses all components of balance.
The two main components of the system are off-the-shelf components including a 3D scanning camera for body positioning capture and a pressure-sensitive plate (floor mat), on which the user stands. In addition, it has a software application installed on a computer. Both the camera and the pressure floor mat are connected to the computer by each original USB.
Off-the Shelf 3D Camera
The camera is Microsoft Kinect for windows. The camera is a motion-sensing device that combines an RGB camera and IR.
Microsoft-Kinect for windows v2 sensor
Off-the shelf Pressure-sensitive Plate (floor mat)
The pressure plate is MatScan manufactured by Tekscan Inc. The MatScan pressure plate is a Class I device listed in the FDA database under product code JFC.
These two components are connected to a computer with a USB connection and displayed on a screen through a unique application, The user can see and feel the whole session in an online feedback method. The visual feedback is the most powerful sense that creates the on going proses of improvement in the chosen variables. (see next page).
Diagrams and a photo of the components and variables in use
Valuable information
The exercises and movement requested from the user are based on weight transfers and weight bearing with variety which will encourage the use of the entire base of support while moving the two X's in the illustrations above, the red and the black, and using the distribution of the pressures created by the feet. Users receive visual and sensory feedback that enables understanding of what is required of them during the practice.
User performance is continuously monitored and displayed, and performance data is stored for analysis. Users progress is monitored,
The system allows data and videos to be saved for tracking and documentation, which is vital for research purposes.
Summary remarks
1.Balance 4-u uses an innovative way to present center of mass in relation to center of pressure and displays them both online in the session. ( this is the only device, as far as I know, that does it).
2.This device is based on visual on-line feedback that is given to the user and helps interpret different sensations including the feeling of weight bearing and weight shifting within base of support.
3.Balance 4-u has a logical biomechanical concept behind it and needs to go through clinical trials that might show this is the way to help people with the growing problem of serious falls.
Bibliography, other sources, and data will be provided with request.
But one new research that gives a good reason for a new way of thinking on this topic –
Nørgaard JE, Andersen S, Ryg J, et al. Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(4):e238422. doi:10.1001/jamanetworkopen.2023.8422
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