Effects of Muscle Activation Pattern and Stability of the Lower Extremity's Joint on Falls in the Elderly Walking -Half a Year Prospective Study-

노인 보행 시 하지 근 활동 양상과 관절의 안정성이 낙상에 미치는 영향 -전향적 연구(Prospective Study)-

  • Ryu, Ji-Seon (Department of Health and Exercise Science, Korea National Sport University)
  • Received : 2019.06.11
  • Accepted : 2019.06.17
  • Published : 2019.06.30


Objective: The aim of this study was to determine the peak torques of the knee and ankle joint and local stability of the lower extremity's joints, and muscle activation patterns of the lower extremity's muscles between fallers and non-fallers in the elderly women during walking. Method: Four elderly women (age: $74.5{\pm}5.2yrs.$; height: $152.1{\pm}5.6cm$; mass: $55.3{\pm}5.4kg$; preference walking speed: $1.19{\pm}0.06m/s$) who experienced falls within six months since experiment had been conducted (falls group) and thirty-six subjects ($74.2{\pm}3.09yrs.$; height: $153.6{\pm}4.9cm$; mass: $56.7{\pm}6.4kg$; preference walking speed: $1.24{\pm}0.10m/s$) who had no experience in falls (non-falls group) within this periods participated in this study. They were measured torque peaks of the knee and ankle joint using a Human Norm and while they were walking on a treadmill at their natural pace, kinematic variables and EMG signals were collected with using a 3-D motion capture system and a wireless EMG system, respectively. Lyapunov Exponent (LyE) was determined to observe the dynamic local stability of the lower extremity's joints, and muscles activation and their co-contraction index were also analysed from EMG signals. Hypotheses between falls and non-falls group were tested using paired t-test and Mann-Whitey. Level of significance was set at p<.05. Results: Local dynamic stability in the adduction-abduction movement of the knee joint was significantly lower in falling group than non-falling group (p<.05). Conclusion: In conclusion, muscles which act on the abduction-adduction movement of the knee joint need to be strengthened to prevent from potential falls during walking. However, a small number of samples for fallers make it difficult to generalize the results of this study.


OOOSBL_2019_v29n2_79_f0001.png 이미지

Figure 1. Scene of experiment for strength (left) and gait test (right).

OOOSBL_2019_v29n2_79_f0002.png 이미지

Figure 2. Example of 3-dimensional hip (top), knee (middle), and ankle joint (lower) for an individual of the fallers.

OOOSBL_2019_v29n2_79_f0003.png 이미지

Figure 3. Example of raw EMG (top), rectified EMG (middle), filtered EMG signals (lower) of BF, RF, AT, GA for an individual of nonfallers.

Table 1. Peak torque of the knee and ankle joints and their statistic test results between falls and non-falls group

OOOSBL_2019_v29n2_79_t0001.png 이미지

Table 2. LyE values of the ankle, knee, and hip joint and their statistic test results between falls and non-falls group

OOOSBL_2019_v29n2_79_t0002.png 이미지

Table 3. Peak torque of the knee and ankle joints and their statistic test results between falls and non-falls group

OOOSBL_2019_v29n2_79_t0003.png 이미지


Supported by : 한국연구재단


  1. American Geriatrics Society, British geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001). Guideline for the prevention of falls in older person. Journal of American Geriatrics Society, 49, 664-672.
  2. Benjuy, N., Melze, I. & Kaplanski, J. (2004). Aging-induced shifts from a reliance on sensory input to muscle cocontraction during balanced standing. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59(2), 166-171.
  3. Bento, P. C. B., Pereira, G., Ugrinowitsch, C. & Rodacki, A. L. F. (2010). Peak torque and rate of torque development in elderly with and without fall history. Clinical Biomechanics, 25, 450-454.
  4. Berry, S. D., & Miller, R. R. (2008). Falls: Epidemiology, pathophysiology, and relationship to fracture. Current Osteoporosis Reports, 6(4), 149-154.
  5. Bizovska, L., Svoboda, Z., Janura, M. & Bisic, M. C. (2018). Local dynamic stability during gait for predicting falls in elderly people: A one-year prospective study. PLOS ONE, 13(5), e0197091.
  6. Buchner, D. M., Cress, M. E., de Lateur, B. J., Esselman, P. C., Margherita, A. J., Price, R. & Wagner, E. H. (1997). The effects of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. The Journal of Gerontol, 52(4), 218-224.
  7. Buzzi, U. H., Stergiou, N., Kurz, M. J., Hageman, P. A. & Heidel, J. (2003). Nonlinear dynamics indicates aging affects variability during gait. Clincal Biomechanics, 18, 435-443.
  8. Chiu, S. L. & Chou, L. S. (2013). Variability in inter-joint coordination during walking of elderly adults and its association with clinical balance measures. Clinical Biomechanics, 28, 454-458.
  9. Dennis, D. A., Kittelson, A. J., Yang, C. C., Miner, T. M., Kim, R. H. & Stevens-Lapsley, J. E. (2016). Does tourniqet use in the affect recovery of lower extremity strength and function? A randomized trial. Clinical Orthopaedics and Related Research, 474, 69-77.
  10. Dingwell, J. B. & Cusumano, J. P. (2000). Nonlinear time series analysis of normal and pathological human walking. Chaos, 10(4), 848-863.
  11. Dingwell, J. B., Cusumano, J. P., Sternad, D. & Cavanagh, P. R. (2000). Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking. Journal of Biomechanics, 33, 1269-1277.
  12. Fernie, G. R., Gryfe, C. I., Holliday, P. J. & Llewellyn, A. (1982). The relationship of postural sway in standing to the incidence of falls in geriatric subjects. Age Ageing, 11, 11-16.
  13. Fontera, W. R., Meredith, C. N. & O'Relly, K. P. (1989). Strength conditioning in older men skeletal muscle hypertrophy and improved function. Journal of Applied Physiology, 64, 1044-1089.
  14. Hamill, J. & Ryu, J. (2003). Experiment in sport biomechanics. Daehanmedia, 111-121.
  15. Hausdorff, J., Rios, D. & Edelberg, H. (2001). Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82, 1050-1056.
  16. Hendrich, A. (2007). Predicting patient falls. American Journal of Nursing, 107(11), 50-58.
  17. Jennifer, C. N. & Nancy, L. C. (2004). The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomized controlled trial. Age and Aging, 33(1), 52-58.
  18. Jeon, M. Y., Jeong, H. C. & Choe, M. A. (2001). A study on the elderly patients hospitalized by the fracture from the fall. Korean Academy of Nursing, 31(3), 443-453.
  19. Kellis, E., Arabatzi, F. & Papadopoulos, C. (2003). Muscle coactivation around the knee in drop jumping using the cocontraction index. Journal of Electromyography and Kinesiology, 13(3), 229-238.
  20. Kesher, E. A., Allum, A. H. & Honegger, F. (1993). Predictors of less stable postural responses to support surface rotations in healthy human elderly. Journal of Vestibular Research, 3, 419-429.
  21. Kim, C. K. (2003). An analysis of fall incidence rate and the related factors of fall in hospitalized patients, Seoul National University, Graduate School, Nursing, Thesis.
  22. Kim, M. S. & Lee, E. N. (2006). A literature review of exercise intervention for falls prevention in the elderly. Journal of Muscle and Joint Health, 13(1), 7-19.
  23. Kim, W. O. (1998). The literature review for fall in the elderly. The Korean Journal of Rehabilitation Nursing, 1(1), 43-50.
  24. Laughton, C. A., Slavin, M., Katdare, K., Nolan, L., Bean, J. F., Kerrigan, D. C., ... & Collins, J. J. (2003). Aging, muscle activity, and balance control: physiologic changes associated with balance impairment. Gait Posture, 18(2), 101-108.
  25. Lee, D. C., Oh, B. H., Lee, H. R., Sim, J. Y., Kim, D. H. & Too, K. J. (1996). Depression in relation to fall, urinary incontinence and sleep disturbance in elderly. Journal Korean Academy of Family Medicine, 17(5), 285-292.
  26. Maki, B. E. (1997). Gait changes in older adults: Predictors of falls or indicators of fear? Journal of the American Geriatrics Society, 45, 313-320.
  27. Maki, B. E., Holliday, P. J. & Topper, A. K. (1994). A prospective study of postural balance and risk of falling in an ambulatory and independent dlderly population. The Journal of Gerontology, 49, 72-84.
  28. Masud, T. & Morris, R. O. (2001). Epidemiology of falls. Age Aging, 30(Suppl. 4), 3-7.
  29. Melzer, I., Benjuya, N. & Kaplanski, J. (2004). Postural stability in the elderly: a comparison between fallers and non-fallers. Age and Ageing, 33(6), 602-607.
  30. Melzer, I., Kurz, I. & Oddsson L. I. E. (2010). A retrospective analysis of balance control parameters in elderly fallers and non-fallers. Clinical Biomechanics, 25, 984-988.
  31. Owings, T. M., Pavol, M. J., Foley, K. T. & Grabiner, M. D. (2000). Measures of postural stability are not predictors of recovery from large postual disturbances in healthy older adults. Journal of the American Geriatrics Society, 48, 42-50.
  32. Park, S. K. & Ryu, J. S. (2018) The relationship between impact peak force and lower extremity kinematics during treadmill running. Korean Journal of Sports Biomechanics, 28(3), 159-164.
  33. Piirtola, M. & Era, P. (2006). Force platform measurements as predictors of falls among older people - a review. Gerontology, 52(1), 1-16.
  34. Prudham, D. & Evans, J. G. (1981). Factors associated with falls in the elderly: a community study. Age and Ageing, 10, 141-146.
  35. Rubenstein, L. Z. & Josephson, K. R. (2002). The epidemiology of falls and syncope. Clinics in the Geriatric Medicine, 18, 141-158.
  36. Ryu, J. S. (2017a). Lower extremities' joint stability during the elderly woman's walking. Korean Sport Biomechanics, 27(1), 45-51.
  37. Ryu, J. S. (2017b). Relationship between CoP and local stability of the lower joint during walking in the elderly women. Korean Sport Biomechanics, 27(2), 133-140.
  38. Ryu, J. S. (2018). Effects of muscle activation pattern and stability of the lower extremity's joint on falls in the elderly walkingretrospective-. The Korean Journal of Physical Education, 57(3), 345-356.
  39. Sohng, K. Y., Moon, J. S. & Lee, K. S. (2004). Prevalence and associated factors of falls among people with Parkinson's disease. Journal of Korean Academy of Nursing, 34(6), 1081-1091.
  40. Tinetti, M. E., Liu, W. L. & Claus, E. B. (1993). Predictors and prognosis of inability to get up after falls among elderly persons. The Journal of the American Medical Association, 269(1), 65-70.
  41. Tinetti, M. E. & Speechley, M. (1989). Prevention of the falls among the elderly. The New England Journal of Medicine, 320(16), 1055-1059.
  42. Tinetti, M. E., Speechley, M. & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319(26), 1701-1707.
  43. Verghese, J., Holtzer, R., Lipton, R. B. & Wang, C. (2009). Quantitative gait markers and incident fall risk in older adult Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 64A, 896-901s.
  44. Whipple, R. H., Wolfson, L. I. & Amerman, P. M. (1987). The relationship of knee and ankle weakness to falls in nursing home residents: an isokinetic study. Journal of the American Geriatrics Society, 35, 13-20.
  45. Wolfson, L., Judge, J. & Whipple, R. (1995). Strengthening is a major factor in balance, gait and the occurrence of falls. The Journals of Gerontology, 50, 64-67.