Stair Negotiation in an older adult population: Analysis of the lower limb

Abstract

Stair negotiation has been identified by older adults as one of the most challenging locomotor tasks, one that is associated with a high risk for falls and serious injury. Currently lacking is a comprehensive understanding of the lower limb during stair negotiation in an older adult population. It has been identified that more research is needed to determine key determinants of difficulty and safety on stairs. The objective of this thesis was to investigate lower limb kinematics and kinetics during stair negotiation and evaluate the impact of handrail use on stair ambulation in young adults, older adults, and older adults with a fear of falling (FOF). The four studies that make up this dissertation provide a detailed picture of the lower limb joint kinematics and kinetics during stair ambulation, as well as provide insight into the role of handrail use and FOF in performance of stair negotiation. Specifically, in the first study principal component analysis (PCA) was used, of the scores generated from the PCA models four principal component (PC) scores were identified that could be used to correctly classify 95% of young and older adults. The second study provided a comprehensive data set of lower limb joint kinematics and kinetics during stair negotiation. The third study identified comparable centre of pressure velocities (VCOP) between young adults and older adults during stair negotiation with and without a handrail. Whereas older adults with FOF demonstrated reduced VCOP during stair negotiation without a handrail and further reduced VCOP when using the handrail. Furthermore, no significant difference in lower limb moments during stair negotiation with and without a handrail were found in older adults, as was similar for older adults with FOF. However, a gait assessment revealed that older adults with FOF demonstrated differences from ‘normal’ gait patterns during stair negotiation with and without a handrail. These studies provide a comprehensive normative dataset of the lower limb joint kinematics and kinetics during stair negotiation, as well as provide insight into the role of handrail use and fear of falling in performance of stair ambulation. It is important to appreciate the nature and extent of normal age-related adaption and compensatory strategies to identify unique patterns of movement due to the superimposition of pathology.