Comparative analysis of postural stability and risk of falling and developing disability among overweight and obese women over 40 years.

BACKGROUND: Increased body mass index (BMI) adversely affects the mechanics of the musculoskeletal system. It is known that obese people have poorer postural stability and mobility-related outcomes compared to normal weight people, but there is limited research comparing overweight and class 1 obese people, two consecutive and prevalent BMI categories. AIMS: To compare postural stability, functional mobility, and risk of falling and developing disability between overweight and obese women, and to investigate the relationship of BMI and body weight with the outcomes. METHODS: Thirty women with class 1 obesity and 30 overweight women were included. Standing postural stability with eyes-open and eyes-closed and stability limits were assessed using the Prokin system. The Timed Up and Go Test (TUG) was used to assess functional mobility and risk of falling (≥11 s) and developing disability (≥9 s). RESULTS: The average center of pressure displacements on the y-axis (COPY) obtained during quiet standing with both eyes-open and eyes-closed were higher in obese women than overweight women (p < 0.05) and the effect sizes were moderate for the results. The COPY values in the eyes-open and eyes-closed conditions were correlated with BMI (r = 0.295 and r = 0.285, p < 0.05). Furthermore, the COPX value in the eyes-open condition and the TUG score were correlated with body weight (r = 0.274 and r = 0.257, p < 0.05). CONCLUSIONS: Obese women had poorer static standing stability in the anteroposterior direction than overweight women, while functional mobility and risk of falling and developing disability did not differ. Furthermore, BMI and body weight were related to poorer static standing stability.

The Impact of Patient Education on Inpatient Fall Risk: A Review.

¼ Patient falls in the hospital are one of the leading sentinel events identified by the Joint Commission.¼ Hospital falls affect orthopaedic patients of older age at higher rates, and up to 34% of falls lead to injury such as fractures.¼ Patients often misperceive their fall risk, and modalities aimed at educating patients to address the incongruence between perceived and actual fall risk significantly reduce fall rate and injurious fall rate.¼ Adequate communication with patients and their families with the goal of educating them may diminish the physical, psychological, and emotional detriment to orthopaedic patients.

A method for calculating fall risk parameters from discrete stride time series regardless of sensor placement.

BACKGROUND: To complement traditional clinical fall risk assessments, research is oriented towards adding real-life gait-related fall risk parameters (FRP) using inertial sensors fixed to a specific body position. While fixing the sensor position can facilitate data processing, it can reduce user compliance. A newly proposed step detection method, Smartstep, has been proven to be robust against sensor position and real-life challenges. Moreover, FRP based on step variability calculated from stride times (Standard deviation (SD), Coefficient of Variance (Cov), fractal exponent, and sample entropy of stride duration) proved to be useful to prospectively predict the fall risk. RESEARCH QUESTIONS: To evaluate whether Smartstep is convenient for calculating FRP from different sensor placements. METHODS: 29 elderly performed a 6-minute walking test with IMU placed on the waist and the wrist. FRP were computed from step-time estimated from Smartstep and compared to those obtained from foot-mounted inertial sensors: precision and recall of the step detection, Root mean square error (RMSE) and Intraclass Correlation Coefficient (ICC) of stride durations, and limits of agreement of FRP. RESULTS: The step detection precision and recall were respectively 99.5% and 95.9% for the waist position, and 99.4% and 95.7% for the wrist position. The ICC and RMSE of stride duration were 0.91 and 54 ms respectively for both the waist and the hand position. The limits of agreement of Cov, SD, fractal exponent, and sample entropy of stride duration are respectively 2.15%, 25 ms, 0.3, 0.5 for the waist and 1.6%, 16 ms, 0.23, 0.4 for the hand. SIGNIFICANCE: Robust against the elderly's gait and different body locations, especially the wrist, this method can open doors toward ambulatory measurements of steps, and calculation of different discrete stride-related falling risk indicators.

Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study.

BACKGROUND: More than one-third of older adults (aged ≥65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults' self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults' needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. OBJECTIVE: This qualitative study aims to explore older adults' use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. METHODS: Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. RESULTS: The qualitative data showed that the informants' social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. CONCLUSIONS: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals.

Influence of aging on the relation between head control and hip joint kinematics during crossover stepping.

Falls in older individuals are a serious health issue in super-aged societies. The stepping reaction is an important postural strategy for preventing falls. This study aimed to reveal the characteristics of lateral stepping in response to mechanical disturbance by means of an analysis of the hip joint kinematics in the stepping leg and head stability during crossover steps. The participants included 11 healthy older and 13 younger individuals. An electromagnet-controlled disturbance-loading device induced crossover steps due to lateral disturbance. Responses were measured using a motion capture system and force plates. The righting reaction of the head was quantified by lateral displacement (sway), neck joint kinematics (angle displacement, angular velocity), and neck joint moment during crossover stepping. Moreover, the relationship between the neck lateral bending moment and angular velocity of hip flexion/adduction of the stepping leg was examined. The lateral head sway was significantly larger in the older participants (1.13±0.7 m/s2) than in the younger individuals (0.54±0.3 m/s2); whereas, the angle displacement (older -14.1±7.1 degree, young -8.3±4.5 degree) and angular velocity (older 9.9±6.6 degree/s, 41.2±27.7 degree/s) of the head were significantly lower in the older than in the younger participants. In both groups, the moment of neck lateral bending exhibited a significant negative correlation with the hip flexion angular velocity of the stepping leg. Correlation analysis also showed a significant negative correlation between the neck lateral bending moment and hip adduction angular velocity only in the older group (r = 0.71, p<0.01). In conclusion, older individuals increased instability in the lateral direction of the head and decreased righting angle displacement and angular velocity of the head during crossover steps. The correlation between neck moment and hip flexion/adduction angular velocity suggested a decrease in step speed due to increased neck muscle tone, which could be influenced by vestibulospinal reflexes.

Delayed center of mass feedback in elderly humans leads to greater muscle co-contraction and altered balance strategy under perturbed balance: A predictive musculoskeletal simulation study.

Falls are one of the leading causes of non-disease death and injury in the elderly, often due to delayed sensory neural feedback essential for balance. This delay, challenging to measure or manipulate in human studies, necessitates exploration through neuromusculoskeletal modeling to reveal its intricate effects on balance. In this study, we developed a novel three-way muscle feedback control approach, including muscle length feedback, muscle force feedback, and enter of mass feedback, for balancing and investigated specifically the effects of center of mass feedback delay on elderly people's balance strategies. We conducted simulations of cyclic perturbed balance at different magnitudes ranging from 0 to 80 mm and with three center of mass feedback delays (100, 150 & 200 ms). The results reveal two key points: 1) Longer center of mass feedback delays resulted in increased muscle activations and co-contraction, 2) Prolonged center of mass feedback delays led to noticeable shifts in balance strategies during perturbed standing. Under low-amplitude perturbations, the ankle strategy was predominantly used, while higher amplitude disturbances saw more frequent employment of hip and knee strategies. Additionally, prolonged center of mass delays altered balance strategies across different phases of perturbation, with a noticeable increase in overall ankle strategy usage. These findings underline the adverse effects of prolonged feedback delays on an individual's stability, necessitating greater muscle co-contraction and balance strategy adjustment to maintain balance under perturbation. Our findings advocate for the development of training programs tailored to enhance balance reactions and mitigate muscle feedback delays within clinical or rehabilitation settings for fall prevention in elderly people.

Balance performance among horseback-rider compared to non-horseback-rider women in Saudi Arabia: A cross-sectional study.

Horseback riding requires adapting to constant changes in balance conditions, maintaining equilibrium on the horse, and preventing falls. However, differences in balance performance among horseback riders and non-rider-healthy young women in Saudi Arabia have not been explored. This study investigates whether horseback-rider women would perform better on static and dynamic balance tests than non-rider women. Also, the study examined the effect of years of horseback riding on balance performance in the rider group. Twenty healthy young females participated in the study using a convenience sampling method. Ten were riders, and ten were non-riders. Static and dynamic balance tests, including the Berg balance scale (BBS), timed up and go (TUG), and unipedal stance test (UPST), was obtained from all subjects. Descriptive and inferential statistics were used to compare balance performance between the horseback riders and non-riders groups. The horseback-rider group had statistically significantly higher scores on both the static and dynamic tests than non-riders: BBS test (Z = -2.537, P = .011), TUG (t = -3.889, P = .001), and unipedal stance test with the eyes open and closed (t = 14.048, t = 13.639, P = .000). Our rider sample did not show a statistically significant correlation between years of riding and balance scores. The horseback riders have greater static and dynamic balance abilities than non-riders. Further study is needed to compare the balance performance between experienced riders versus beginners among healthy adults in Saudi Arabia.

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities.

OBJECTIVES: To retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities. METHODS: The study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery. RESULTS: The clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18-59) and 26.8 ± 4.4 (riding group, aged 19-35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05. CONCLUSIONS: Male bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Impact of standing perturbation intensities on fall and stability outcomes in healthy young adults.

Motorized treadmills have been extensively used in investigating reactive balance control and developing perturbation-based interventions for fall prevention. However, the relationship between perturbation intensity and its outcome has not been quantified. The primary purpose of this study was to quantitatively analyze how the treadmill belt's peak velocity affects the perturbation outcome and other metrics related to the reactive balance in young adults while the total belt displacement is controlled at 0.36 m. Thirty-one healthy young adults were randomly assigned into three groups with different peak belt speeds: low (0.9 m/s), medium (1.2 m/s), and high (1.8 m/s). Protected by a safety harness, participants were exposed to a forward support surface translation while standing at an unexpected timing on an ActiveStep treadmill. The primary (perturbation outcome: fall vs. recovery) and secondary (dynamic stability, hip descent, belt distance at liftoff, and recovery step latency) outcome measures were compared among groups. Results revealed that a higher perturbation intensity is correlated with a greater faller rate (p < 0.001). Compared to the low- and medium-intensity groups, the high-intensity group was less stable (p < 0.001) with a larger hip descent (p < 0.001) and a longer belt distance (p < 0.001) at the recovery step liftoff. The results suggest that the increased perturbation intensity raises the risk of falling with larger instability and poorer reactive performance after a support surface translation-induced perturbation in healthy young adults. The findings could furnish preliminary guidance for us to design and select the optimal perturbation intensity that can maximize the effects of perturbation-based training protocols.

The extent to which healthy older adults rely on anticipatory control following simulated slip exposure.

As the recovery from gait perturbations is coordinatively complex and error-prone, people often adopt anticipatory strategies when the perturbation is expected. These anticipatory strategies act as a first line of defence against potential balance loss. Since age-related changes in the sensory and neuromotor systems could make the recovery from external perturbations more difficult, it is important to understand how older adults implement anticipatory strategies. Therefore, we exposed healthy young (N = 10, 22 ± 1.05 yrs.) and older adults (N = 10, 64.2 ± 6.07 yrs.) to simulated slips on a treadmill with consistent properties and assessed if the reliance on anticipatory control differed between groups. Results showed that for the unperturbed steps in between perturbations, step length decreased and the backward (BW) margin of stability (MOS) increased (i.e., enhanced dynamic stability against backward loss of balance) in the leg that triggered the slip, while step lengths increased and BW MOS decreased in the contralateral leg. This induced step length and BW MOS asymmetry was significantly larger for older adults. When exposed to a series of predictable slips, healthy older adults thus rely more heavily on anticipatory control to proactively accommodate the expected backward loss of balance.

Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study.

BACKGROUND: There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. METHODS: A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening. RESULTS: At baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan-Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041-1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223-1.983) for osteoporosis (P <  0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527-0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%. CONCLUSIONS: The current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.

The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study.

Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.

Intra and Inter-Device Reliabilities of the Instrumented Timed-Up and Go Test Using Smartphones in Young Adult Population.

The Timed-Up and Go (TUG) test is widely utilized by healthcare professionals for assessing fall risk and mobility due to its practicality. Currently, test results are based solely on execution time, but integrating technological devices into the test can provide additional information to enhance result accuracy. This study aimed to assess the reliability of smartphone-based instrumented TUG (iTUG) parameters. We conducted evaluations of intra- and inter-device reliabilities, hypothesizing that iTUG parameters would be replicable across all experiments. A total of 30 individuals participated in Experiment A to assess intra-device reliability, while Experiment B involved 15 individuals to evaluate inter-device reliability. The smartphone was securely attached to participants' bodies at the lumbar spine level between the L3 and L5 vertebrae. In Experiment A, subjects performed the TUG test three times using the same device, with a 5 min interval between each trial. Experiment B required participants to perform three trials using different devices, with the same time interval between trials. Comparing stopwatch and smartphone measurements in Experiment A, no significant differences in test duration were found between the two devices. A perfect correlation and Bland-Altman analysis indicated good agreement between devices. Intra-device reliability analysis in Experiment A revealed significant reliability in nine out of eleven variables, with four variables showing excellent reliability and five showing moderate to high reliability. In Experiment B, inter-device reliability was observed among different smartphone devices, with nine out of eleven variables demonstrating significant reliability. Notable differences were found in angular velocity peak at the first and second turns between specific devices, emphasizing the importance of considering device variations in inertial measurements. Hence, smartphone inertial sensors present a valid, applicable, and feasible alternative for TUG assessment.

Exploring Factors Associated with Falls in Multiple Sclerosis: Insights from a Scoping Review.

Multiple sclerosis (MS) is a chronic inflammatory condition that causes demyelination of the central nervous system accompanied by a wide range of symptoms. The high prevalence of falls among patients diagnosed with MS within the initial six months highlights the importance of this issue. The objective of this study is to identify factors associated with falls in MS patients in order to increase awareness and reduce the risk of falls. This scoping review used specific Mesh terms to formulate the literature search around falls and MS using Medline, Google Scholar, Scopus, and Embase search engines. English papers published between 2012 and 2022, studies with a clear definition of falls, McDonald's diagnostic criteria for MS, and those with Expanded Disability Status Scale (EDSS) or Patient Determined Disease Steps (PDDS) scores were included. Critical data from the selected articles were extracted and classified according to the different factors associated with falls in MS patients. Eighteen articles were included in this review. The most important factors associated with falls in MS patients identified were the severity and progression of the disease, mobility and balance problems, bladder dysfunction, fear of falling, fatigue, and cognitive dysfunction. In conclusion, this scoping review yielded the most common factors associated with falls in patients with MS. Study findings can be used to develop future interventions focusing on improving mobility, proprioception, and balance to decrease fall risk and injury amongst MS patients.

Falls in Older Adults: Approach and Prevention.

Falls are a major public health problem, occurring in more than 27% of adults 65 years and older and costing the U.S. health care system tens of billions of dollars each year. The most common risk factors are prior falls, balance disorders, fear of falling, and dementia. Regular physical activity reduces fall risk. Identifying injuries is the first step in evaluating older adults who have fallen. The patient's history may be inaccurate if they have cognitive impairment, and the physical examination can result in false-negative findings. If injury status cannot be determined and suspicion for injury remains high, clinicians can consider whole-body computed tomography (i.e., pan-scan) to evaluate the head, cervical spine, chest, abdomen, and pelvis. After addressing injuries, the next steps are to identify the cause of the fall and implement measures to reduce future fall risk. The Centers for Disease Control and Prevention has developed an easy-to-use tool to screen for and reduce fall risk, known as STEADI (Stopping Elderly Accidents, Deaths, and Injuries). An affirmative answer to any of the three STEADI screening questions indicates further evaluation with a timed up and go test, 30-second chair stand test, and four-stage balance test. If results of these tests are abnormal, multicomponent interventions are indicated to reduce future fall risk. These components include evaluating environmental and home safety factors and optimizing care of chronic medical conditions, such as diabetes mellitus, hypertension, osteoporosis, pain, urinary urgency and incontinence, and depression. Polypharmacy and drugs that increase risk of falls should be avoided, when possible. Optimization of vision and hearing correction, podiatry care, and appropriate use of ambulation devices are also important.

Sensory integration and segmental control of posture during pregnancy.

BACKGROUND: Approximately 25% of pregnant people fall, yet the underlying mechanisms of this increased fall-risk remain unclear. Prior studies examining pregnancy and balance have utilized center of pressure analyses and reported mixed results. The purpose of this study was to examine sensory and segmental contributions to postural control throughout pregnancy using accelerometer-based measures of sway. METHODS: Thirty pregnant people (first trimester: n = 10, second trimester: n = 10, third trimester: n = 10) and 10 healthy, nonpregnant control people stood quietly for one minute in four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam pad, and eyes closed on foam. Postural sway was quantified using the root mean square accelerations in the anterior-posterior and medial-lateral directions from an inertial sensor at the lumbar region. Sensory sway ratios, segmental coherence and co-phase, were calculated to assess sensory contributions and segmental control, respectively. FINDINGS: Pregnant people did not display greater sway compared to healthy, nonpregnant controls. There were no group differences in vestibular, visual, or somatosensory sway ratios, and no significant differences in balance control strategies between pregnant and nonpregnant participants across sensory conditions. INTERPRETATION: The small effects observed here contrast prior studies and suggest larger, definitive studies are needed to assess the effect of pregnancy on postural control. This study serves as a preliminary exploration of pregnant sensory and segmental postural control and highlights the need for future to hone the role of balance in fall risk during pregnancy.

Accurate fall risk classification in elderly using one gait cycle data and machine learning.

BACKGROUND: Falls among the elderly are a major societal problem. While observations of medium-distance walking using inertial sensors identified potential fall predictors, classifying individuals at risk based on single gait cycles remains elusive. This challenge stems from individual variability and step-to-step fluctuations, making accurate classification difficult. METHODS: We recruited 44 participants, equally divided into high and low fall-risk groups. A smartphone secured on their second sacral spinous process recorded data during indoor walking. Features were extracted at each gait cycle from a 6-dimensional time series (tri-axial angular velocity and tri-axial acceleration) and classified using the gradient boosting decision tree algorithm. FINDINGS: Mean accuracy across five-fold cross-validation was 0.936. "Age" was the most influential individual feature, while features related to acceleration in the gait direction held the highest total relative importance when aggregated by axis (0.5365). INTERPRETATION: Combining acceleration, angular velocity data, and the gradient boosting decision tree algorithm enabled accurate fall risk classification in the elderly, previously challenging due to lack of discernible features. We reveal the first-ever identification of three-dimensional pelvic motion characteristics during single gait cycles in the high-risk group. This novel method, requiring only one gait cycle, is valuable for individuals with physical limitations hindering repetitive or long-distance walking or for use in spaces with limited walking areas. Additionally, utilizing readily available smartphones instead of dedicated equipment has potential to improve gait analysis accessibility.

The decline in postural balance has a negative impact on the performance of functional tasks in individuals with Parkinson's Disease.

INTRODUCTION: An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as Computerized Dynamic Posturography (CDP) are not feasible for the clinical setting. Therefore, the present study's aim was to assess the correlation between the clinical Balance Evaluation Systems Test (BESTest) and CDP. METHODS: 20 male older adults with Parkinson's Disease (PD) were included in this study. Participants first executed the Sit-To-Stand (STS), Step/Quick turn (SQT), and Step Up and Over (SUO) tests on a Balance Master® force platform, followed by a clinical balance evaluation using the BESTest. RESULTS: Four outcomes of the CDP were negatively correlated with one or more BESTest domains or total BESTest score: STS sway velocity was negatively correlated with the anticipatory postural adjustment (p = 0.02) and sensory orientation (p = 0.01) domains. SQT turn time was negatively correlated with biomechanical restriction (for turns to the left, p = 0.01, and right, p = 0.03, respectively), postural response (p = 0.01, p = 0.01), dynamic balance during gait (p = 0.007, p = 0.001), and total score (p = 0.02, p = 0.01). Step over time to the right in SUP was negatively correlated with the limits of the stability domain (p = 0.002) and total BESTest score (p = 0.020). SUO impact index was negatively correlated with the anticipatory postural adjustment domain (p = 0.01). CONCLUSION: This study shows that several BESTest domains are significantly correlated with CDP outcomes, demonstrating that the BESTest can be used as a more clinically feasible alternative for computerized posturography, without loss of information.