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Handbook of Human Motion pp 1–22Cite as

Slip and Fall Risk Assessment

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Abstract

The cumulative effect of falls on older adults and on the healthcare system is immense; the results are debilitating injuries, loss of independence, and transfer to a healthcare institution, or even death. Slip-related falls contribute up to 40 % of all outdoor falls in seniors, which often cause serious injuries such as hip fractures and high economic burden. Therefore, it is pressing to develop fall prevention interventions to prevent falls from happening. To identify individuals with high risk of falls could be equivalently important to the development of fall prevention paradigms because it allows the limited resources assigned to fall prevention to be directed to those who truly need the interventions. It is thus essential to establish accurate and effective fall risk assessment tools to identify those with elevated risk of falls. This chapter intends to review the approaches which can be applied in research or clinics to evaluate one’s risk of falls after a slip. Dynamic gait stability and lower limb support have been identified as two key factors leading to slip-initiated falls. In addition, muscle weakness was associated with high risk of slips and falls. Other measures including dynamic stability based on linear and nonlinear dynamics and gait parameters could also play a certain role in predicting a fall initiated by a slip. These measurements provide some useful and objective tools for the early identification of individuals with a higher risk of falling, which is important for effective deployment of fall prevention interventions.

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References

  • Bean JF, Leveille SG, Kiely DK, Bandinelli S, Guralnik JM, Ferrucci L (2003) A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol Ser A: Biol Sci Med Sci 58:M728–M733

    Article  Google Scholar 

  • Berg WP, Alessio HM, Mills EM, Tong C (1997) Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 26:261–268

    Article  Google Scholar 

  • Bhatt T, Espy D, Yang F, Pai Y-C (2011) Dynamic stability, clinical correlates, and prognosis of falls among community-dwelling older adults. Arch Phys Med Rehabil 92:799–805

    Article  Google Scholar 

  • Borelli GA (1680) De Motu Animalium (On the movement of animals). Springer, Berlin

    Google Scholar 

  • Bruijn SM, Kate WR, Faber GS, Meijer OG, Beek PJ, van Dieen JH (2010) Estimating dynamic gait stability using data from non-aligned inertial sensors. Ann Biomed Eng 38:2588–2593

    Article  Google Scholar 

  • Bruijn SM, Bregman DJJ, Meijer OG, Beek PJ, van Dieen JH (2011) The validity of stability measures: A modelling approach. J Biomech 44:2401–2408

    Article  Google Scholar 

  • Callisaya ML, Blizzard L, Schimidt MD, Martin KL, McGinley JL, Sanders LM, Srikanth VK (2011) Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age Ageing 40:481–487

    Article  Google Scholar 

  • Cham R, Redfern MS (2001) Lower extremity corrective reactions to slip events. J Biomech 34:1439–1445

    Article  Google Scholar 

  • Ding L, Yang F (2016) Muscle weakness is related to slip-initiated falls among community-dwelling older adults. J Biomech 49:238–243

    Article  Google Scholar 

  • Dingwell JB, Cusumano JP (2000) Nonlinear time series analysis of normal and pathological human walking. Chaos 10:848–863

    Article  MATH  Google Scholar 

  • Dingwell JB, Kang HG (2007) Differences between local and orbital dynamic stability during human walking. J Biomech Eng 129:586–593

    Article  Google Scholar 

  • Dingwell JB, Cusumano J, Cavanagh P, Sternad D (2001) Local dynamic stability versus kinematic variability of continuous overground and treadmill walking. J Biomech Eng 123:27–32

    Article  Google Scholar 

  • Dingwell JB, Gu KH, Marin LC (2007) The effects of sensory loss and walking speed on the orbital dynamic stability of human walking. J Biomech 40:1723–1730

    Article  Google Scholar 

  • Donelan JM, Shipman DW, Kram R, Kuo AD (2004) Mechanical and metabolic requirements for active lateral stabilization in human walking. J Biomech. 37:827–835

    Article  Google Scholar 

  • El-Khoury F, Cassou B, Charles M-A, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013:1–13

    Google Scholar 

  • England SA, Granata KP (2007) The influence of gait speed on local dynamic stability of walking. Gait Posture 25:172–178

    Article  Google Scholar 

  • Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41:733–746

    Article  Google Scholar 

  • Evans WJ (2000) Exercise strategies should be designed to increase muscle power. J Gerontol Ser A: Biol Sci Med Sci 55:M309–M310

    Article  Google Scholar 

  • Feldman F, Robinovitch SN (2006) Recalling the mechanics of falls. Young adults cannot accurately describe the sites of impact immediately after a fall occurs. Osteoporos Int 17:955

    Google Scholar 

  • Foldvari M, Clark M, Laviolette LC, Bernstein MA, Kaliton D, Castaneda C, Pu CT, Hausdorff JM, Fielding RA, Singh MA (2000) Association of muscle power with functional status in community-dwelling elderly women. J Gerontol Ser A: Biol Sci Med Sci 55:M192–M199

    Article  Google Scholar 

  • Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol Ser A: Biol Sci Med Sci 61:1059–1064

    Article  Google Scholar 

  • Graafmanc WC, Lips P, Wijlhuizen GJ, Pluijm SM, Bouter LM (2003) Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting. Z Gerontol Geriatr 36:23–28

    Article  Google Scholar 

  • Granata KP, Lockhart TE (2008) Dynamic stability differences in fall-prone and healthy adults. J Electromyogr Kinesiol 18:172–178

    Article  Google Scholar 

  • Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331

    Article  Google Scholar 

  • Haines T, Kuys SS, Morrison G, Clarke J, Bew P (2008) Balance impairment not predictive of falls in geriatric rehabilitation wards. J Gerontol: Med Sci 63A:523–528

    Article  Google Scholar 

  • Hamacher D, Singh NB, Van Dieen JH, Heller MO, Taylor WR (2011) Kinematic measures for assessing gait stability in elderly individuals: a systematic review. J R Soc Interface 8:1682–1698

    Article  Google Scholar 

  • Han L-Z, Yang F (2015) Strength or power: which is more important to prevent slip-related falls? Hum Mov Sci 44:192–200

    Article  MathSciNet  Google Scholar 

  • Hardy R, Cooper R, Shah I, Harridge S, Guralnik J, Kuh D (2010) Is chair rise performance a useful measure of leg power? Aging Clin Exp Res 22:412–418

    Article  Google Scholar 

  • Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei J-Y (1997) Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 78:278–283

    Article  Google Scholar 

  • Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056

    Article  Google Scholar 

  • Hayes WC, Myers ER, Robinovitch SN, Van Den Kroonenberg A, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip fractures. Bone 18:77s–86s

    Article  Google Scholar 

  • Hedlund R, Lindgren U (1987) Trauma type, age, and gender as determinants of hip fracture. J Orthop Res 5:242–246

    Article  Google Scholar 

  • Heinrich S, Rapp K, Rissmann U, Becker C, Kunig H-H (2010) Cost of falls in old age: a systematic review. Osteoporos Int 21:891–902

    Article  Google Scholar 

  • Hof AL, Gazendam MG, Sinke WE (2005) The condition for dynamic stability. J Biomech 38:1–8

    Article  Google Scholar 

  • Horlings CGC, van Engelen BGM, Allum JHH, Bloem BR (2008) A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol 4:504–515

    Article  Google Scholar 

  • Hurmuzlu Y, Basdogan C (1994) On the measurement of dynamic stability of human locomotion. J Biomech Eng 116:30–36

    Article  Google Scholar 

  • Jenkins P, Earle-Richardson G, Slingerland DT, May J (2002) Time dependent memory decay. Am J Ind Med 41:98–101

    Article  Google Scholar 

  • Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, Vuori I (1999) Fall-induced injuries and deaths among older adults. J Am Med Assoc 281:1895–1899

    Article  Google Scholar 

  • Kavanagh JJ, Menz HB (2008) Accelerometry: a technique for quantifying movement patterns during walking. Gait Posture 28:1–5

    Article  Google Scholar 

  • Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, Frankenfeld CL, Taulvydas M, Larson EB (2004) Footwear style and risk of falls in older adults. J Am Geriatr Soc 52:1495–1501

    Article  Google Scholar 

  • Kraemer WJ, Newton RU (2000) Training for muscular power. Phys Med Rehabil Clin N Am 11:341–368

    Google Scholar 

  • Labrador MA, Delahoz YS (2014) Survey on fall detection and fall prevention using wearable and external sensors. Sensors 14:19806–19842

    Article  Google Scholar 

  • Lajoie Y, Gallagher SP (2004) Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 38:11–26

    Article  Google Scholar 

  • Lockhart TE, Liu J (2008) Differentiating fall-prone and healthy adults using local dynamic stability. Ergonomics 51:1860–1872

    Article  Google Scholar 

  • Luukinen H, Herala M, Koski K, Honkanen R, Laippala P, Kivela SL (2000) Fracture risk associated with a fall according to type of fall among the elderly. Osteoporos Int 11:631–634

    Article  Google Scholar 

  • Maki BE, McIlroy WE (1997) The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther 77:488–507

    Google Scholar 

  • Melzer I, Benjuya N, Kaplanski J (2004) Postural stability in the elderly: a comparison between fallers and non-fallers. Age Ageing 33:602–607

    Article  Google Scholar 

  • Mille ML, Rogers MW, Martinez K, Hedman LD, Johnson ME, Lord SR, Fitzpatrick RC (2003) Thresholds for inducing protective stepping responses to external perturbations of human standing. J Neurophysiol 90:666–674

    Article  Google Scholar 

  • Moreland JD, Richardson JA, Goldsmith CH, Clase CM (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52:1121–1129

    Article  Google Scholar 

  • Morley JE (2002) A fall is a major event in the life of an older person. J Gerontol Ser A Biol Sci Med Sci 57:M492–M495

    Article  Google Scholar 

  • Moyer BE, Chambers AJ, Redfern MS, Cham R (2006) Gait parameters as predictors of slip severity in younger and older adults. Ergonomics 49:329–343

    Article  Google Scholar 

  • Moyer BE, Redfern MS, Cham R (2009) Biomechanics of trailing leg response to slipping - Evidence of interlimb and intralimb coordination. Gait Posture 29:565–570

    Article  Google Scholar 

  • Muir SW, Berg KO, Chesworth B, Klar N, Speechley M (2010) Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: a prospective study. Phys Ther 90:338–347

    Article  Google Scholar 

  • Muir SW, Gopaul K, Montero Odasso MM (2012) The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41:299–308

    Article  Google Scholar 

  • Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. J Am Med Assoc 261:2663–2668

    Article  Google Scholar 

  • O’Sullivan SB (2007) Examination of motor function. In: O’Sullivan SB, Schmitz TJ (eds) Physical rehabilitation. F.A. Davis Company, Philadelphia, pp 249–253

    Google Scholar 

  • Orr R (2010) Contribution of muscle weakness to postural instability in the elderly. Eur J Phys Rehabil Med 46:183–220

    Google Scholar 

  • Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA (2006) Power training improves balance in healthy older adults. J Gerontol Ser A: Biol Sci Med Sci 61A:78–85

    Article  Google Scholar 

  • Owings TM, Grabiner MD (2004) Step width variability, but not step length variability or step time variability, discriminates gait of healthy young and older adults during treadmill locomotion. J Biomech 37:935–938

    Article  Google Scholar 

  • Pai Y-C, Patton JL (1997) Center of mass velocity-position predictions for balance control. J Biomech 30:347–354

    Article  Google Scholar 

  • Pai Y-C, Yang F, Wening JD, Pavol MJ (2006) Mechanisms of limb collapse following a slip among young and older adults. J Biomech 39:2194–2204

    Article  Google Scholar 

  • Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187

    Article  Google Scholar 

  • Patton JL, Lee WA, Pai Y-C (2000) Relative stability improves with experience in a dynamic standing task. Exp Brain Res 135:117–126

    Article  Google Scholar 

  • Pavol MJ, Pai Y-C (2007) Deficient limb support is a major contributor to age differences in falling. J Biomech 40:1318–1325

    Article  Google Scholar 

  • Pijnappels M, Bobbert MF, van Dieen JH (2005) Control of support limb muscles in recovery after tripping in young and older subjects. Exp Brain Res 160:326–333

    Article  Google Scholar 

  • Redfern MS, Cham R, Gielo-Perczak K, Gronqvist R, Hirvonen M, Lanshammar H, Marpet M, Pai Y-C, Powers C (2001) Biomechanics of slips. Ergonomics 44:1138–1166

    Article  Google Scholar 

  • Riva F, Bisi MC, Stagni R (2013) Orbital stability analysis in biomechanics: a systematic review of a nonlinear technique to detect instability of motor tasks. Gait Posture 37:1–11

    Article  Google Scholar 

  • Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41

    Google Scholar 

  • Rubenstein LZ, Josephson KR (2006) Falls and their prevention in elderly people: what does the evidence show? Med Clin N Am 90:807–824

    Article  Google Scholar 

  • Rubenstein LZ, Josephson KR, Robbins AS (1994) Falls in the nursing home. Ann Intern Med 121:442–451

    Article  Google Scholar 

  • Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65-89 years. Age Ageing 23:371–377

    Article  Google Scholar 

  • Skelton DA, Kennedy J, Rutherford OM (2002) Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing 31:119–125

    Article  Google Scholar 

  • Sleet DA, Moffett DB, Stevens J (2008) CDC’s research portfolio in older adults fall prevention: A review of progress, 1985 - 2005, and future research directions. J Safety Res 39:259–267

    Article  Google Scholar 

  • Smeesters C, Hayes WC, McMahon TA (2001) Disturbance type and gait speed affect fall direction and impact location. J Biomech 34:309–317

    Article  Google Scholar 

  • Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295

    Article  Google Scholar 

  • Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126

    Article  Google Scholar 

  • Tinetti ME (2003) Preventing falls in elderly persons. N Engl J Med 388:42–49

    Article  Google Scholar 

  • Toebes MJ, Hoozemans MJ, Furrer R, Dekker J, van Dieen JH (2012) Local dynamic stability and variability of gait are associated with fall history in elderly subjects. Gait Posture 36:527–531

    Article  Google Scholar 

  • Verghese J, Holtzer R, Lipton RB, Wang C (2009) Quantitative gait markers and incident fall risk in older adults. J Gerontol Med Sci 64:896–901

    Article  Google Scholar 

  • Wang T-Y, Bhatt T, Yang F, Pai Y-C (2011) Generalization of motor adaptation to repeated-slip perturbation across tasks. Neuroscience 180:85–95

    Article  Google Scholar 

  • Wang T-Y, Bhatt T, Yang F, Pai Y-C (2012) Adaptive control reduces trip-induced forward gait instability among young adults. J Biomech 45:1169–1175

    Article  Google Scholar 

  • Wijlhuizen GJ, Chorus AMJ, Hopman-Rock M (2010) The FARE: a new way to express FALLs Risk among older persons including physical activity as a measure of exposure. Prev Med 50:143–147

    Article  Google Scholar 

  • Woledge RC, Birtles DB, Newham DJ (2005) The variable component of lateral body sway during walking in young and older humans. J Gerontol Ser A: Biol Sci Med Sci 60:1463–1468

    Article  Google Scholar 

  • World Health Organization (2007) Global age-friendly cities: A guide. Geneva, Switzerland, pp 76

    Google Scholar 

  • Yang F, Pai Y-C (2010a) Reactive control and its operation limits in responding to a novel slip in gait. Ann Biomed Eng 38:3246–3256

    Article  Google Scholar 

  • Yang F, Pai Y-C (2010b) Role of individual lower limb joints in reactive stability control following a novel slip in gait. J Biomech 43:397–404

    Article  Google Scholar 

  • Yang F, Pai Y-C (2011) Automatic recognition of falls in gait-slip training: Harness load cell based criteria. J Biomech 44:2243–2249

    Article  Google Scholar 

  • Yang F, Pai Y-C (2014) Can stability really predict an impending slip-related fall among older adults? J Biomech 47:3876–3881

    Article  Google Scholar 

  • Yang F, Anderson FC, Pai Y-C (2007) Predicted threshold against backward balance loss in gait. J Biomech 40:804–811

    Article  Google Scholar 

  • Yang F, Anderson FC, Pai Y-C (2008a) Predicted threshold against backward balance loss following a slip in gait. J Biomech 41:1823–1831

    Article  Google Scholar 

  • Yang F, Passariello F, Pai Y-C (2008b) Determination of instantaneous stability against backward balance loss: Two computational approaches. J Biomech 41:1818–1822

    Article  Google Scholar 

  • Yang F, Bhatt T, Pai Y-C (2009) Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities. J Biomech 42:1903–1908

    Article  Google Scholar 

  • Yang F, Bhatt T, Pai Y-C (2011) Limits of recovery against slip-induced falls while walking. J Biomech 44:2607–2613

    Article  Google Scholar 

  • Yang F, Espy D, Bhatt T, Pai Y-C (2012) Two types of slip-induced falls among community dwelling older adults. J Biomech 45:1259–1264

    Article  Google Scholar 

  • Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI (2007) Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 55:603–615

    Article  Google Scholar 

  • Zijlstra GA, van Haastregt JCM, Ambergen T, van Rossum E, van Eijk JTM, Tennstedt SL, Kempen GIJM (2009) Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: Results of a randomized controlled trial. J Am Geriatr Soc 57:2020–2028

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Kinesiology, The University of Texas at El Paso, 1851 Wiggins Way, El Paso, TX, 79968, USA

    Feng Yang

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  1. Feng Yang
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Correspondence to Feng Yang .

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Editors and Affiliations

  1. Motion & More, Barcelona, Spain

    Bertram Müller

  2. Klinik für Orthopädie und Unfallchirurgi, Universitätsklinikum Heidelberg, Heidelberg, Germany

    Sebastian I. Wolf

  3. Institut for Biomechanics und Orthopedic, German Sport University Cologne, Cologne, Germany

    Gert-Peter Brueggemann

  4. Houston, Texas, USA

    Zhigang Deng

  5. ACRISP, FedUniversity, Cremorne, New South Wales, Australia

    Andrew McIntosh

  6. Wilmington, Delaware, USA

    Freeman Miller

  7. Research, C-Motion, Inc., Germantown, Maryland, USA

    William Scott Selbie

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Yang, F. (2016). Slip and Fall Risk Assessment. In: Müller, B., et al. Handbook of Human Motion. Springer, Cham. https://doi.org/10.1007/978-3-319-30808-1_45-1

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  • DOI: https://doi.org/10.1007/978-3-319-30808-1_45-1

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