TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders

A substantial number of older persons report insecure balance and experience falls and fear of falling. Prospective studies indicate that 20–30% of those over age 65 fall each year, and the proportion is even higher in hospitalized elderly and nursing home patients. Each year 8% of individuals 75 suffer a serious fall-related injury. Hip fractures often result in hospitalization and nursing home admission. For each person who is physically disabled, there are others whose functional independence is constrained by anxiety and fear of falling. Nearly one in five of elderly individuals voluntarily limit their activity because of fear of falling | Chapter 024. Gait and Balance Disorders A substantial number of older persons report insecure balance and experience falls and fear of falling. Prospective studies indicate that 20-30 of those over age 65 fall each year and the proportion is even higher in hospitalized elderly and nursing home patients. Each year 8 of individuals 75 suffer a serious fall-related injury. Hip fractures often result in hospitalization and nursing home admission. For each person who is physically disabled there are others whose functional independence is constrained by anxiety and fear of falling. Nearly one in five of elderly individuals voluntarily limit their activity because of fear of falling. With loss of ambulation there is a diminished quality of life and increased morbidity and mortality. Anatomy and Physiology Upright bipedal gait depends on the successful integration of postural control and locomotion. These functions are widely distributed in the central nervous system. The biomechanics of bipedal walking are complex and the performance is easily compromised by injury at any level. Command and control centers in the brainstem cerebellum and forebrain modify the action of spinal pattern generators to promote stepping. While a form of Active locomotion can be elicited from quadrupedal animals after spinal transection this capacity is limited in primates. Step generation in primates is dependent on locomotor centers in the pontine tegmentum midbrain and subthalamic region. Locomotor synergies are executed through the reticular formation and descending pathways in the ventromedial spinal cord. Cerebral control provides a goal and purpose for walking and is involved in avoidance of obstacles and adaptation of locomotor programs to context and terrain. Postural control requires the maintenance of the center of mass over the base of support through the gait cycle. Unconscious postural adjustments maintain standing balance long latency responses are measurable in the leg muscles .

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