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Purpose: To examine head impact incidence and head acceleration during experimentally induced falls as a function of age., Methods: 15 young adults (21.2±2.7) and 10 older adults (61.9±4.3 years) underwent 6 experimentally induced sideways falls. Participants fell sideways onto a 20cm crash pad. The number of head impacts was tabulated from video recordings and head acceleration was calculated from motion capture data. A total of 147 falls were analyzed., Results: The young group underwent 88 falls, in which 11.4% resulted in head impact. The older group underwent 59 falls, in which 34.5% resulted in head impact. A proportion analysis revealed older adults had a significantly greater proportion of head impacts than young adults ( X 2 (1) = 11.445, p = 0.001). A two-way ANOVA only revealed a main effect of head impact on acceleration ( F (1,142) = 54.342, p<0.001)., Conclusion: The older adults experienced a greater proportion of head impacts during sideways falls. Head impact resulted in greater head acceleration compared to no head impact. Collectively, this data highlights the possibility that age-related neuromuscular changes to head control may result in elevated risk of fall-related TBIs. Future research examining mechanisms underlying increases in fall-related head impact is warranted.

Falls are common and potentially disastrous for older adults. A novel approach that could augment current fall prevention procedures is to teach older adults movement strategies to reduce the risk of injury. The purpose of the study was to determine whether older adults can learn a movement strategy ("tuck-and-roll") that reduces fall impact severity. Learning was quantified with short-term acquisition, bilateral transfer and 1-week-retention. 14 healthy older individuals participated (63.9 ± 5.6 years) in the investigation. Participants were randomly assigned into either training group (n = 7) or active control group (n = 7). All participants performed standardized sideway falls at baseline, immediately post intervention and 1-week-retention tests. During the falling assessments, kinetic and kinematic impact severity parameters were measured. The results for short-term learning revealed that the training group showed greater reduction in hip impact force (33% reduction) than the control group (16% reduction). Furthermore, there was partial bilateral transfer effect and 1-week retention observed in the training group. The observations provide preliminary evidence that teaching tuck-and-roll strategy to older adults has potential effect. The observations provide preliminary evidence that older adults might reduce impact severity utilizing tuck-and-roll strategy during unpredictably-timed sideway falls., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To systematically synthesize information on safe landing strategies for a fall, and quantitatively examine the effects of the strategies to reduce the risk of injury from a fall., Data Sources: PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library., Study Selection: Databases were searched using the combinations of keywords of "falls," "strategy," "impact," and "load." Randomized controlled trials, cohort studies, pre-post studies, and cross-sectional studies were included., Data Extraction: Fall strategies were extracted and categorized by falling direction. Measurements of impact loads that reflect the risk of injuries were extracted (eg, impact velocity, impact force, fall duration, impact angle). Hedges' g was used as effect size to quantify the effect of a protective landing strategy to reduce the impact load., Data Synthesis: A total of 7 landing strategies (squatting, elbow flexion, forward rotation, martial arts rolling, martial arts slapping, relaxed muscle, stepping) in 13 studies were examined. In general, all strategies, except for the martial arts slapping technique, significantly reduced impact load (g values=.73-2.70). Squatting was an efficient strategy to reduce impact in backward falling (g=1.77), while elbow flexion with outstretched arms was effective in forward falling (g=.82). Also, in sideways falling strategies, martial arts rolling (g=2.70) and forward rotation (g=.82) were the most efficient strategies to reduce impact load., Conclusions: The results showed that landing strategies have a significant effect on reducing impact load during a fall and might be effective to reduce the impact load of falling. The current study also highlighted limitations of the previous studies that focused on a young population and self-initiated falls. Further investigation with elderly individuals and unexpected falls is necessary to verify the effectiveness and suitability of the strategies for at-risk populations in real-life falls., (Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors., Design: Randomized controlled trial., Setting: Home-based training with assessments at research laboratory., Participants: A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45-75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention., Intervention: Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group., Measures: Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention., Results: A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05)., Conclusions: Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial.ClinicalTrials.org #NCT01956227., (© The Author(s) 2014.)

Objective: To examine the relationship between gait initiation, fall history, and physiological fall risk in individuals with multiple sclerosis (MS) during both cognitive distracting and nondistracting conditions., Design: Single time point cross-sectional analysis., Setting: University research laboratory., Participants: Ambulatory individuals (N=20) with MS ranging in age from 28 to 76 years., Intervention: Not applicable., Main Outcome Measures: Gait initiation time was quantified as the time to toe-off of the first step after an auditory cue. Gait initiation was performed with and without a concurrent cognitive challenge of reciting alternating letters of the alphabet. Additionally, participants underwent a test of fall risk using the Physiological Profile Assessment (PPA) and provided a self-report of the number of falls in the previous 3 months., Results: Gait initiation times ranged from .67 to 1.12 seconds during the single-task condition and .73 to 1.84 seconds during the cognitive challenge condition. PPA scores ranged from -.80 to 3.87. Participants reported a median of 0.0 falls (interquartile range, 0.0-2.75) in the previous 3 months. There was a significant correlation between PPA score and gait initiation times only in the cognitive distraction condition (ρ=.50). There was also a correlation between cognitive distraction gait initiation times and fall history (ρ=.60)., Conclusions: The observations provide preliminary evidence that gait initiation during cognitive challenge may represent a target for fall prevention strategies in MS., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Virtual time to contact (VTC) is a measure of postural stability that estimates the virtual time it would take to reach an individual's stability boundary. This study aimed to validate VTC as measured by a depth sensor and determine whether VTC from the depth sensor distinguishes between older adult fallers and nonfallers compared with a force platform. VTC was assessed in 10 young and 20 older adults by having participants lean in a circular direction followed by 5 balance tests: eyes open, dual task, eyes open foam, eyes closed, and eyes closed foam. Spearman rank correlations and Bland–Altman plots were conducted to determine validity, and receiver operating characteristic curves were constructed to discriminate between fallers and nonfallers. Significant correlations were found in the dual task (P =.03), eyes open foam (P <.01), and eyes closed foam conditions (P =.05). The depth sensor discriminated between fallers and nonfallers in the eyes open (P =.02), dual task (P =.03), and eyes open foam conditions (P =.04). VTC was in agreement between the 2 devices, and VTC derived from a depth sensor can be used to discriminate between older adult fallers and nonfallers during challenging balance conditions. [ABSTRACT FROM AUTHOR]