Objectives: To test the hypothesis that vertical footlift asymmetries and low obstacle clearing distance during obstacle avoidance are characteristics of elderly people classified as high risk for falls.
Design: Controlled cross-sectional design with two conditions to cue selection of the foot-for-step initiation: sound cue and visual cue.
Setting: Senior independent living facilities.
Participants: Eighteen community-dwelling elderly with a history of falling or prolonged Timed Up and Go score greater than 13.5 seconds, 16 elderly with no fall history and Timed Up & Go score of 13.5 seconds or less, and 15 younger subjects.
Measurements: Video kinematic analysis of bilateral footlift displacement and velocity using reflective markers as subjects stepped over foam obstacles scaled to a maximum tolerated height.
Results: High-risk elders contacted the obstacle more frequently and had significantly greater vertical footlift asymmetries adjusted for obstacle/subject height (mean±standard error asymmetry index for sound cue 3.25±0.42 cm, for visual cue 2.51±0.45 cm) than low-risk and younger subjects (P<.001). In low-risk elderly and younger subjects, the asymmetry index approached 0, which indicated symmetrical lower limb movements when stepping over the obstacles.
Conclusion: High-risk elderly show a marked asymmetry in foot clearance while stepping over an obstacle, with the lag foot clearing the obstacle at a much lower distance than the lead foot. Possible mechanisms responsible for these findings (limited hip extension and deficits in executive cognitive function) are discussed.