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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 39932

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Special Issue Editors

Dr. Harish Chander

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Guest Editor

Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA
Interests: human factors; ergonomics; biomechanics; motor control; fall prevention; slip, trips, and falls; postural control; balance
Special Issues, Collections and Topics in MDPI journals

Dr. Jennifer C. Reneker

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Guest Editor

1) Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS 39216, USA
2) Department of Neurosurgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
3) Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS 39216, USA
Interests: fall prevention; traumatic brain injury; concussion; extended reality; virtual reality; augmented reality

Special Issue Information

Dear Colleagues,

According to the National Safety Council (NCS), National Council on Aging (NCOA), and Bureau of Labor Statistics (BLS), falls are one of the major contributors to both fatal and non-fatal injuries across various populations (e.g., clinical, elderly, and occupational). Falls are also extremely common in various environments such as at home, at nursing home facilities, at long term care facilities, and at the workplace. Falls and fall-related injuries can be attributed to postural instability caused by an induced loss of balance and failure to recover from the imbalance. Falls can happen due to a variety of intrinsic (human) factors and extrinsic (environmental) factors, and can be of different types, such as loss-of-balance-induced, slip-induced, trip-induced, and external-perturbation-induced, and can also be from elevated levels or at ground levels. Depending upon the severity, the consequences of falls can range from fatality to hospitalization for neurological and musculoskeletal injuries, functional impairment, longstanding pain, loss of independence, time away from work, etc. Falls also cause a significant financial burden to both the individual and to the institution.

Falls are preventable, and as such various approaches to mitigate and prevent falls among high-risk populations exist, such as traditional balance and gait training that are exercise-based, the use of specific techniques such as Tai Chi, yoga, hydrotherapy, and perturbation-based balance training. Advances in technology also allow the use of newer intervention measures such as extended reality, virtual reality, augmented reality, and various types of wearable sensors and wearable technology to detect falls through active monitoring and prevent future falls through advanced rehabilitation. With research in advances in fall prevention constantly evolving, this Special Issue “Advances in Fall Prevention” will focus on the application of principles of neuroscience, biomechanics, motor control, biomedical engineering, human factors, ergonomics, public health, and epidemiology to fall prevention in various populations. Advances in fall monitoring, assessment, detection, intervention, and rehabilitation are of interest. A wide range of topics addressing fall prevention methods for preventive monitoring, assessment, detection, intervention, and rehabilitation for falls and fall-related injuries will be covered. Contributions including empirical research, review articles, case reports, etc. on advances in fall prevention are encouraged.

Dr. Harish Chander
Dr. Jennifer C. Reneker
Guest Editors

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Keywords

fall prevention
slips, trips, and falls
postural control
balance
gait
injury prevention
technology
wearables
sensors
extended reality
virtual reality
augmented reality

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Published Papers (10 papers)

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Research

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9 pages, 879 KiB

Open AccessArticle

Quick on Your Feet: Modifying the Star Excursion Balance Test with a Cognitive Motor Response Time Task

by Russell K. Lowell, Nathan O. Conner, Hunter Derby, Christopher M. Hill, Zachary M. Gillen, Reuben Burch, Adam C. Knight, Jennifer C. Reneker and Harish Chander

Int. J. Environ. Res. Public Health 2023, 20(2), 1204; https://doi.org/10.3390/ijerph20021204 - 10 Jan 2023

Cited by 1 | Viewed by 4380

Abstract

The Star Excursion Balance Test (SEBT) is a common assessment used across clinical and research settings to test dynamic standing balance. The primary measure of this test is maximal reaching distance performed by the non-stance limb. Response time (RT) is a critical cognitive component of dynamic balance control and the faster the RT, the better the postural control and recovery from a postural perturbation. However, the measure of RT has not been done in conjunction with SEBT, especially with musculoskeletal fatigue. The purpose of this study is to examine RT during a SEBT, creating a modified SEBT (mSEBT), with a secondary goal to examine the effects of muscular fatigue on RT during SEBT. Sixteen healthy young male and female adults [age: 20 ± 1 years; height: 169.48 ± 8.2 cm; weight: 67.93 ± 12.7 kg] performed the mSEBT in five directions for three trials, after which the same was repeated with a response time task using Blazepod™ with a random stimulus. Participants then performed a low-intensity musculoskeletal fatigue task and completed the above measures again. A 2 × 2 × 3 repeated measures ANOVA was performed to test for differences in mean response time across trials, fatigue states, and leg reach as within-subjects factors. All statistical analyses were conducted in JASP at an alpha level of 0.05. RT was significantly faster over the course of testing regardless of reach leg or fatigue state (p = 0.023). Trial 3 demonstrated significantly lower RT compared to Trial 1 (p = 0.021). No significant differences were found between fatigue states or leg reach. These results indicate that response times during the mSEBT with RT is a learned skill that can improve over time. Future research should include an extended familiarization period to remove learning effects and a greater fatigue state to test for differences in RT during the mSEBT. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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10 pages, 961 KiB

Open AccessArticle

Leg Muscle Activity and Joint Motion during Balance Exercise Using a Newly Developed Weight-Shifting-Based Robot Control System

by Go Yamako, Kirari Ito, Takanori Muraoka and Etsuo Chosa

Int. J. Environ. Res. Public Health 2023, 20(2), 915; https://doi.org/10.3390/ijerph20020915 - 4 Jan 2023

Cited by 2 | Viewed by 2587

Abstract

A novel and fun exercise robot (LOCOBOT) was developed to improve balance ability. This system can control a spherical robot on a floor by changing the center of pressure (COP) based on weight-shifting on a board. The present study evaluated leg muscle activity and joint motion during LOCOBOT exercise and compared the muscle activity with walking and sit-to-stand movement. This study included 10 healthy male adults (age: 23.0 ± 0.9 years) and examined basic LOCOBOT exercises (front–back, left–right, 8-turn, and bowling). Electromyography during each exercise recorded 13 right leg muscle activities. Muscle activity was represented as the percentage maximal voluntary isometric contraction (%MVIC). Additionally, the joint motion was simultaneously measured using an optical motion capture system. The mean %MVIC differed among LOCOBOT exercises, especially in ankle joint muscles. The ankle joint was primarily used for robot control. The mean %MVIC of the 8-turn exercise was equivalent to that of walking in the tibialis anterior, and the ankle plantar flexors were significantly higher than those in the sit-to-stand motion. Participants control the robot by ankle strategy. This robot exercise can efficiently train the ankle joint muscles, which would improve ankle joint stability. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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14 pages, 633 KiB

Open AccessArticle

Exploring Hospital Inpatients’ Awareness of Their Falls Risk: A Qualitative Exploratory Study

by Elissa Dabkowski, Simon J. Cooper, Jhodie R. Duncan and Karen Missen

Int. J. Environ. Res. Public Health 2023, 20(1), 454; https://doi.org/10.3390/ijerph20010454 - 27 Dec 2022

Cited by 5 | Viewed by 5712

Abstract

Patient falls in hospital may lead to physical, psychological, social and financial impacts. Understanding patients’ perceptions of their fall risk will help to direct fall prevention strategies and understand patient behaviours. The aim of this study was to explore the perceptions and experiences that influence a patient’s understanding of their fall risk in regional Australian hospitals. Semi-structured, individual interviews were conducted in wards across three Australian hospitals. Participants were aged 40 years and over, able to communicate in English and were mobile prior to hospital admission. Participants were excluded from the study if they returned a Standardised Mini-Mental State Examination (SMMSE) score of less than 18 when assessed by the researcher. A total of 18 participants with an average age of 69.8 years (SD ± 12.7, range 41 to 84 years) from three regional Victorian hospitals were interviewed for this study. Data were analysed using a reflexive thematic analysis identifying three major themes; (1) Environment (extrinsic) (2) Individual (intrinsic), and (3) Outcomes, as well as eight minor themes. Participants recognised the hazardous nature of a hospital and their personal responsibilities in staying safe. Falls education needs to be consistently delivered, with the focus on empowering the patient to help them adjust to changes in their clinical condition, whether temporary or permanent. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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21 pages, 2376 KiB

Open AccessArticle

Development and Pilot Testing of a Booklet Concerning Medications That Can Increase the Risk of Falls in Older People

by Mohammad Suhaidi Shaari, Mohd Shahezwan Abd Wahab, Izzati Abdul Halim Zaki, Rosmaliah Alias, Muhammad Harith Zulkifli, Aida Azlina Ali, Nur Wahida Zulkifli, Farhana Fakhira Ismail, Mizaton Hazizul Hasan, Rulia Meilina, Long Chiau Ming and Ching Siang Tan

Int. J. Environ. Res. Public Health 2023, 20(1), 404; https://doi.org/10.3390/ijerph20010404 - 27 Dec 2022

Viewed by 1947

Abstract

Background: A common contributory factor to falls is the use of medicines, especially those commonly known as “fall-risk increasing drugs” (FRIDs). The use of FRIDs is common among older people (OP). However, OP and their family caregivers (FCGs) are largely unaware of FRIDs and their risks in increasing the risk of falls (ROF). Methods: A booklet which aims to provide information on topics related to FRIDs was developed. The booklet was reviewed by a panel of 14 reviewers, and the content validity index (CVI) for each subsection of the booklet was computed. Pilot testing of the booklet utilized a pre-post intervention study design and included 50 OP and 50 FCGs as study participants. Perceived knowledge of the participants was assessed prior to and after completing the booklet. Participants’ opinions on the usefulness and usability of the booklet were also obtained. Results: The booklet contained eight sections and each subsection of the booklet had a CVI ranging from 0.93 to 1.00. Completing the booklet resulted in improved perceived knowledge scores for each perceived knowledge item among both the OP and FCG groups (all items: p-value < 0.001). The participants perceived the booklet as useful and usable, as evidenced by almost all the perceived usefulness and usability items having a score of over 4.0. Conclusions: The FRIDs booklet developed in this study had good content validity and was widely accepted by the OP and FCGs. The positive effect on the participants’ knowledge of topics related to FRIDs means that the booklet could be useful as a patient education tool to enhance FRIDs knowledge and awareness among OP and FCGs. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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12 pages, 336 KiB

Open AccessArticle

Preventing Patient Falls Overnight Using Video Monitoring: A Clinical Evaluation

by Rebecca Woltsche, Leanne Mullan, Karen Wynter and Bodil Rasmussen

Int. J. Environ. Res. Public Health 2022, 19(21), 13735; https://doi.org/10.3390/ijerph192113735 - 22 Oct 2022

Cited by 5 | Viewed by 6346

Abstract

Inpatient falls are devastating for patients and their families and an ongoing problem for healthcare providers worldwide. Inpatient falls overnight are particularly difficult to predict and prevent. The aim of this cohort study was to evaluate effectiveness of overnight portable video monitoring as an adjunct falls prevention strategy for high falls risk patients in inpatient clinical units. Over three months, three clinical inpatient wards were provided with baby monitor equipment to facilitate portable video monitoring. Portable video monitoring registers were completed nightly and nursing staff were invited to complete surveys (n = 31) to assess their experiences of using portable video monitoring. A total of 494 episodes of portable video monitoring were recorded over the three-month period, with clinical areas reporting a total of four inpatient falls from monitoring participants (0.8% of total portable video monitoring episodes). Overall, there was a statistically significant reduction in total inpatient falls overnight on the target wards. Surveyed nursing staff reported feeling better equipped to prevent falls and indicated they would like to continue using portable monitoring as a falls prevention strategy. This study provides evidence to support the use of portable video monitoring as an effective falls prevention strategy in the hospital environment. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

13 pages, 925 KiB

Open AccessArticle

Older Adults’ Perceptions and Recommendations Regarding a Falls Prevention Self-Management Plan Template Based on the Health Belief Model: A Mixed-Methods Study

by Jennifer L. Vincenzo, Susan K. Patton, Leanne L. Lefler, Pearl A. McElfish, Jeanne Wei and Geoffrey M. Curran

Int. J. Environ. Res. Public Health 2022, 19(4), 1938; https://doi.org/10.3390/ijerph19041938 - 9 Feb 2022

Cited by 9 | Viewed by 4234

Abstract

Falls are the leading cause of fatal and non-fatal injuries among older adults. Self-management plans have been used in different contexts to promote healthy behaviors, but older adults’ perceptions of a falls prevention self-management plan template have not been investigated. Using mixed methods, we investigated older adults’ perceptions and recommendations of a falls prevention self-management plan template aligned with the Health Belief Model. Four focus groups (n = 27, average age 78 years) were conducted using semi-structured interview guides. Participants also ranked the written plan on paper with respect to each item by the level of importance, where item 1 was the most important, and 10 was the least important. Focus groups were transcribed and analyzed. Descriptive statistics were calculated for item rankings. Older adults felt that the plan would raise awareness and help them to engage in falls prevention behaviors. Participants recommended adding graphics and using red to highlight the risk of falling. Participants opined that ranking the items by level of importance was challenging because they felt all items were important. ‘What might happen to me if I fall’ was ranked as the most important item (average 2.6), while ‘How will I monitor progress’ was the least important (average = 6.6). Considering that older adults need support to engage in falls prevention, future research should investigate the impact of implementing an individually tailored falls prevention self-management plan on older adults’ engagement in falls prevention behaviors and outcomes of falls and injuries. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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10 pages, 1165 KiB

Open AccessArticle

Sensory Organization Test Conditions Influence Postural Strategy Rather than Footwear or Workload

by Harish Chander, Sachini N. K. Kodithuwakku Arachchige, Alana J. Turner, Reuben F. Burch V, Jennifer C. Reneker, Adam C. Knight, Chip Wade and John C. Garner

Int. J. Environ. Res. Public Health 2021, 18(19), 10511; https://doi.org/10.3390/ijerph181910511 - 7 Oct 2021

Cited by 2 | Viewed by 2856

Abstract

Background: Postural strategies such as ankle, hip, or combined ankle-hip strategies are used to maintain optimal postural stability, which can be influenced by the footwear type and physiological workload. Purpose: This paper reports previously unreported postural strategy scores during the six conditions of the sensory organization test (SOT). Methods: Fourteen healthy males (age: 23.6 ± 1.2 years; height: 181 ± 5.3 cm; mass: 89.2 ± 14.6 kg) were tested for postural strategy adopted during SOT in three types of occupational footwear (steel-toed work boot, tactical work boot, low-top work shoe) every 30 min during a 4-h simulated occupational workload. Postural strategy scores were analyzed using repeated measures analysis of variance at 0.05 alpha level. Results: Significant differences among postural strategy scores were only evident between SOT conditions, and but not between footwear type or the workload. Conclusions: Findings indicate that occupational footwear and occupational workload did not cause a significant change in reliance on postural strategies. The significant changes in postural strategy scores were due to the availability of accurate and/or conflicting sensory feedback during SOT conditions. In SOT conditions where all three types of sensory feedback was available, the ankle strategy was predominantly adopted, while more reliance on hip strategy occurred in conditions with absent or conflicting sensory feedback. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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Review

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17 pages, 20161 KiB

Open AccessReview

Emerging Trends and Hotspots in Tai Chi Fall Prevention: Analysis and Visualization

by Jiesi Chen, Xin Xue, Jing Xu, Jinshu Zeng and Fei Xu

Int. J. Environ. Res. Public Health 2022, 19(14), 8326; https://doi.org/10.3390/ijerph19148326 - 7 Jul 2022

Cited by 8 | Viewed by 4718

Abstract

Recently, substantial studies have increased around the topic of the tai chi fall-prevention field. Few studies, however, have revealed the current progress and hotspots under a bibliometric analysis. Therefore, the present study aimed to conduct Citespace, a significant application for bibliometric analysis, to carry out the situation and trend in this field. This study has identified the core countries are the United States, China, Australia, and England, which are also the origins of the core institutions. Besides this, we also have found two large research groups led by Li and Sherrington. Moreover, the result has revealed that J Aging Phys Act and J Am Geriatr Soc are the primary journals. Geriatrics and gerontology, sport sciences, rehabilitation, and gerontology are the leading categories. Furthermore, one of the more important findings to come out in this study are that “elderly”, “Parkinson’s disease”, “vestibular rehabilitation”, “frail patient”, and “community fall prevention” are the research hotspots. “Women”, “proprioception”, “cognitive impairment”, “dementia”, “osteoarthritis”, and “stroke” are the potential research trend in the future. These findings suggest that the tai chi fall-prevention field has a broad research prospect. Although several questions remain uncertain currently, it is worthy for scholars to do further study. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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11 pages, 1019 KiB

Open AccessReview

Multifactorial Programs for Healthy Older Adults to Reduce Falls and Improve Physical Performance: Systematic Review

by Vânia Loureiro, Margarida Gomes, Nuno Loureiro, Agustín Aibar-Almazán and Fidel Hita-Contreras

Int. J. Environ. Res. Public Health 2021, 18(20), 10842; https://doi.org/10.3390/ijerph182010842 - 15 Oct 2021

Cited by 3 | Viewed by 3042

Abstract

The aim of this systematic review of randomized controlled trials (RCTs) was to investigate the effects of multifactorial programs on the rate of falls and physical performance in ≥60 years old adults. A systematic literature search was conducted in four databases (PubMed, Scopus, Web of Science and Cochrane Library). A total of 518 articles were identified in the initial search, and six RCTs were finally included. Articles written in English, Portuguese and Spanish and published from January 2009 to May 2020 were included in this study. The methodological quality of the included studies was evaluated by the PEDro scale. A total of 518 studies were identified in the initial search, six RCTs were finally included, and three reached a level 1 of evidence. The findings of this systematic review of RCTs suggest that a physical exercise program, especially exercise group activities, combined with health education or with fall risk home assessment, were the most effective multifactorial program in reducing the rate of falls, although the results were not conclusive in all the studies included. Significant beneficial effects were observed in physical performance, particularly when assessed as gait, mobility and balance, regardless of the components of multifactorial program or exercise. This inconsistency in the results, particularly regarding the rate of falls, together with the variability among the multifactorial programs, suggest that any conclusion must be drawn with caution. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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11 pages, 436 KiB

Open AccessReview

Dual Tasking during Trip Recovery and Obstacle Clearance among Young, Healthy Adults in Human Factors Research

by Sachini N. K. Kodithuwakku Arachchige, Harish Chander, Adam C. Knight, Reuben F. Burch V, Chih-Chia Chen and Jennifer C. Reneker

Int. J. Environ. Res. Public Health 2021, 18(19), 10144; https://doi.org/10.3390/ijerph181910144 - 27 Sep 2021

Cited by 3 | Viewed by 2339

Abstract

Trip-induced falls are extremely common in ergonomic settings. Such situations can lead to fatal or non-fatal injuries, affecting the workers’ quality of life and earning capacity. Dual tasking (DT) is a leading cause of trips and ineffective obstacle clearance among workers. DT increases their attentional demand, challenging both postural control and concurrent secondary tasks. As the human brain has limited attentional processing capacity, even young, healthy adults need to prioritize duties during DT. This article aimed to analyze these secondary task types and their applications in recent trip-related studies conducted on young, healthy adults. An extensive review of the recent trip-related literature was performed to provide a condensed summary of the dual tasks used. In previous trip-related literature, distinct types of secondary tasks were used. The choice of the concurrent task must be made vigilantly depending on the occupation, environmental context, available resources, and feasibility. DT can be used as a tool to train workers on selective attention, which is a lifesaving skill in ergonomic settings, especially in the occupations of roofers, construction workers, or truck drivers. Such training can result in successful obstacle clearance and trip recovery skills, which eventually minimizes the number of falls at the workplace. Full article

(This article belongs to the Special Issue Advances in Fall Prevention)

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