PubMed · 11276188
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J VanSwearingen. 2001. Predicting falls.. https://pubmed.ncbi.nlm.nih.gov/11276188/
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We studied the kinematics and kinetics of human postural responses to "recoverable falls." To induce brief falling we used a Hold and Release (H&R) paradigm. Standing subjects actively resisted a force applied to their sternum. When this force was quickly released they were suddenly off balance. For a brief period, approximately 125 ms, until restoring forces were generated to shift the center of foot pressure in front of the center of mass, the body was in a forward fall acted on by gravity and ground support forces. We were able to describe the whole-body postural behavior following release using a multilink inverted pendulum model in a regime of "small oscillations." A three-segment model incorporating upper body, upper leg, and lower leg, with active stiffness and damping at the joints was fully adequate to fit the kinematic data from all conditions. The significance of our findings is that in situations involving recoverable falls or loss of balance the earliest responses are likely dependent on actively-tuned, reflexive mechanisms yielding stiffness and damping modulation of the joints. We demonstrate that haptic cues from index fingertip contact with a stationary surface lead to a significantly smaller angular displacement of the torso and a more rapid recovery of balance. Our H&R paradigm and associated model provide a quantifiable approach to studying recovery from potential falling in normal and clinical subjects.
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This article presents data on morbidity and mortality due to "external causes" among the Brazilian elderly and a review of the Brazilian and international literature on the theme. The data refer to the period from 1980 to 1998. The main sources were the Mortality Information System (SIM) and the Hospital Information System of the Unified National Health System (SIH-SUS). The basic cause of death was evaluated according to the 9th Review of the International Classification of Diseases (ICD9) for 1980 to 1995 and based on the 10th Review since then. The Brazilian and international literature review was based on texts from MEDLINE, LILACS, and Informa. Accidents and violence are the 6th most common cause of death among individuals 60 years of age and older in Brazil. The majority of hospitalizations from external causes involve lesions from falls and injuries to older pedestrians by motor vehicles. However, violence against elderly Brazilians is more widespread and varied than this, as reflected by cases of physical, psychological, sexual, and financial abuse and neglect that fail to reach the health care system; rather, such cases are "taken for granted", seen as basically natural within the daily routine of family relations and various forms of social and public policy neglect.