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Fall simulations provide insight into skin-surface impact dynamics but have focused on vertical force magnitude. Loading direction and location (relative to the femur) likely influence stress generation. The current study characterized peak impact vector magnitude, orientation, and center of pressure over the femur during falls, and the influence of biological sex and trochanteric soft tissue thickness (TSTT). Forty young adults completed fall simulations including a vertical pelvis release, as well as kneeling and squat releases, which incorporate lateral/rotational motion. Force magnitude and direction varied substantially across fall simulations. Kneeling and squat releases elicited 57.4 and 38.8% greater force than pelvis release respectively, with differences accentuated in males. With respect to the femoral shaft, kneeling release had the most medially and squat release the most distally directed loading vectors. Across all fall simulations, sex and TSTT influenced force magnitude and center of pressure. Force was 28.0% lower in females and was applied more distally than in males. Low-TSTT participants had 16.8% lower force, applied closer to the greater trochanter than high-TSTT participants. Observed differences in skin-surface impact dynamics likely interact with underlying femur morphology to influence stress generation. These data should serve as inputs to tissue-level computational models assessing fracture risk.

Objective This study evaluated the hazard (risk of unrecovered balance loss and hazardous fall) and strategies associated with grab bar use, compared to no grab bar use, during unexpected balance loss initiated whilst exiting a bathtub. Background While independent bathing is critical for maintaining self-sufficiency, injurious falls during bathing transfer tasks are common. Grab bars are recommended to support bathing tasks, but no evidence exists regarding fall prevention efficacy. Method Sixty-three adults completed a hazardous bathtub transfer task, experiencing an unpredictable external balance perturbation while stepping from a slippery bathtub to a dry surface. Thirty-two were provided a grab bar, while 31 had no grab bar available. Slips and grab bar use were recorded via four video cameras. Slip occurrence and strategy were identified by two independent video coders. Results Participants who had a grab bar were 75.8% more likely to recover their balance during the task than those who did not have a grab bar. Successful grab bar grasp was associated with balance recovery in all cases. Attempts to stabilize using other environmental elements, or using internal strategies only, were less successful balance recovery strategies. Grab bar presence appeared to cue use of the environment for stability. Proactive grasp and other strategies modified grasping success. Conclusion Grab bars appear to provide effective support for recovery from unexpected balance loss. Grab bar presence may instigate development of fall prevention strategies prior to loss of balance. Application Bathroom designs with grab bars may reduce frequency of fall-related injuries during bathing transfer tasks.

Muscle activation has been demonstrated to influence impact dynamics during scenarios including running, automotive impacts, and head impacts. This study investigated the effects of targeted muscle activation magnitude on impact dynamics during low energy falls on the hip with human volunteers. Fifteen university-aged participants (eight females, seven males) underwent 12 lateral pelvis release trials. Half of the trials were muscle-'relaxed'; in the remaining 'contracted' trials participants isometrically contracted their gluteus medius to 20-30% of maximal voluntary contraction before the drop was initiated onto a force plate. Peak force applied to the femur-pelvis complex averaged 9.3% higher in contracted compared to relaxed trials (F = 6.798, p = .022). Muscle activation effects were greater for females, resulting in (on average) an 18.5% increase in effective pelvic stiffness (F = 5.838, p = .046) and a 23.4% decrease in time-to-peak-force (F = 5.109, p = .042). In the relaxed trials, muscle activation naturally increased during the impact event, reaching levels of 12.8, 7.5, 11.1, and 19.1% MVC at the time of peak force for the gluteus medias, vastus lateralis, erector spinae, and external oblique, respectively. These findings demonstrated that contraction of trunk and hip musculature increased peak impact force across sexes. In females, increases in the magnitude and rate of loading were accompanied (and likely driven) by increases in system stiffness. Accordingly, incorporating muscle activation contributions into biomechanical models that investigate loading dynamics in the femur and/or pelvis during lateral impacts may improve estimate accuracy.

In-vivo fall simulations generally evaluate hip fracture risk through differences in impact force magnitude; however, the distribution of force over the hip likely modulates loading and subsequent injury risk of the underlying femur. The current study characterized impact force distribution over the hip during falls, and the influence of biological sex and trochanteric soft tissue thickness (TSTT). Forty young adults completed fall simulation protocols (FSP) including highly controlled vertical pelvis and more dynamic kneeling and squat releases. At the instant of peak force, percentage of impact force applied in a circular region (r = 5 cm) centered over the greater trochanter (FGT%) was determined to characterize force localization. To assess the need for anatomically aligned pressure analysis, this process was repeated utilizing peak pressure location as a surrogate for the greater trochanter (FPP%). FGT% was 10.8 and 21.9% greater in pelvis release than kneeling and squat releases respectively. FGT% was 19.1 and 30.4% greater in males and low-TSTT individuals compared to females and high-TSTT individuals. TSTT explained the most variance (43.7–55.3%) in FGT% across all protocols, while sex explained additional variance (5.3–19.0%) during dynamic releases. In all FSP, TSTT-groups and sexes, average peak pressure location was posterior and distal to the GT. FPP% overestimated FGT% by an average of 15.7%, highlighting the need for anatomically aligned pressure analysis. This overestimation was FSP and sex dependent, minimized during pelvis release and in males. The data have important implications from clinical and methodological perspectives, and for implementation in tissue-level computational models.

A wide variety of accelerometer systems, with differing sensor characteristics, are used to detect impact loading during physical activities. The study examined the effects of system characteristics on measured peak impact loading during a variety of activities by comparing outputs from three separate accelerometer systems, and by assessing the influence of simulated reductions in operating range and sampling rate. Twelve healthy young adults performed seven tasks (vertical jump, box drop, heel drop, and bilateral single leg and lateral jumps) while simultaneously wearing three tri-axial accelerometers including a criterion standard laboratory-grade unit (Endevco 7267A) and two systems primarily used for activity-monitoring (ActiGraph GT3X+, GCDC X6-2mini). Peak acceleration (gmax) was compared across accelerometers, and errors resulting from down-sampling (from 640 to 100 Hz) and range-limiting (to ±6 g) the criterion standard output were characterized. The Actigraph activity-monitoring accelerometer underestimated gmax by an average of 30.2%; underestimation by the X6-2mini was not significant. Underestimation error was greater for tasks with greater impact magnitudes. gmax was underestimated when the criterion standard signal was down-sampled (by an average of 11%), range limited (by 11%), and by combined down-sampling and range-limiting (by 18%). These effects explained 89% of the variance in gmax error for the Actigraph system. This study illustrates that both the type and intensity of activity should be considered when selecting an accelerometer for characterizing impact events. In addition, caution may be warranted when comparing impact magnitudes from studies that use different accelerometers, and when comparing accelerometer outputs to osteogenic impact thresholds proposed in literature.

Stair design can influence the risk of stair falls. Stair nosings are intended to provide greater foot accommodation, although to date little is known about how the nosing shape can affect foot trajectory during stair ambulation. This study investigates the impact of different nosing shapes (round, square, tapered, and no nosing) on foot clearance and overhang measures during stair ascent and descent among healthy and post-stroke older adults. Slower cadence in ascent and descent, and greater foot overhang during descent highlighted the increased risk of stair falls for persons with chronic stroke. For both healthy and post-stroke participants, the tapered and round nosing shapes resulted in the largest horizontal foot clearance, and smallest foot overhang, respectively. However, given the greater step-to-step variability detected with round nosings, the tapered nosing presents as the safest choice among all evaluated designs. The results of this work can be used to inform architectural and accessible design standards for a safer built environment.

While metrics of pelvis and femur geometry have been demonstrated to influence hip fracture risk, attempts at linking geometry to underlying mechanisms have focused on fracture strength. We investigated the potential effects of femur and pelvis geometry on applied loads during lateral falls on the hip. Fifteen female volunteers underwent DXA imaging to characterize two pelvis and six femur geometric features. Additionally, participants completed low-energy sideways falls on the hip; peak impact force and pressure, contact area, and moment of force applied to the proximal femur were extracted. No geometric feature was significantly associated with peak impact force. Peak moment of force was significantly associated with femur moment arm (p = 0.005). Peak pressure was positively correlated with pelvis width and femur moment arm (p 0.05), while contact area was negatively correlated with metrics of pelvis width and femur neck length (p 0.05). This is the first study to link experimental measures of impact loads during sideways falls with image-based skeletal geometry from human volunteers. The results suggest that while skeletal geometry has limited effects on overall peak impact force during sideways falls, it does influence how impact loads are distributed at the skin surface, in addition to the bending moment applied to the proximal femur. These findings have implications for the design of protective interventions (e.g. wearable hip protectors), and for models of fall-related lateral impacts that could incorporate the relationships between skeletal geometry, external load magnitude/distribution, and tissue-level femur loads.

Fall-related hip injuries are a concern for the growing population of older adults. Evidence suggests that soft tissue overlying the greater trochanter attenuates the forces transmitted to the proximal femur during an impact, reducing mechanical risk of hip fracture. However, there is limited information about the factors that influence trochanteric soft tissue thickness. The current study used ultrasonography and electromyography to determine whether trochanteric soft tissue thickness could be quantified reproducibly and whether it was influenced by: (1) gender; (2) hip postures associated with potential falling configurations in the sagittal plane (from 30° of extension to 60° of flexion, at 15° intervals), combined adduction-flexion, and combined adduction-extension; and (3) activation levels of the tensor fascia lata (TFL) and gluteus medius (GM) muscles. Our results demonstrated that soft tissue thickness can be measured reliably in nine hip postures and three muscle activation conditions (for all conditions, ICC >0.98). Mean (SD) thickness in quiet stance was 2.52 cm. Thickness was 27.0% lower for males than females during quiet stance. It was 16.4% greater at maximum flexion than quiet standing, 27.2% greater at maximum extension, and 12.5% greater during combined adduction-flexion. However, there was no significant difference between combined adduction-extension and quiet standing. Thickness was not affected by changes in muscle activity. Forces applied to the femoral neck during a lateral fall decrease as trochanteric soft tissue thickness increases; gender and postural configuration at impact could influence the loads applied to the proximal femur (and thus hip fracture risk) during falls on the hip.

Impact mechanics theory suggests that peak loads should decrease with increase in system energy absorption. In light of the reduced hip fracture risk for persons with high body mass index (BMI) and for falls on soft surfaces, the purpose of this study was to characterize the effects of participant BMI, gender, and flooring surface on system energy absorption during lateral falls on the hip with human volunteers. Twenty university-aged participants completed the study with five men and five women in both low BMI (22.5 kg/m(2)) and high BMI (27.5 kg/m(2)) groups. Participants underwent lateral pelvis release experiments from a height of 5 cm onto two common floors and four safety floors mounted on a force plate. A motion-capture system measured pelvic deflection. The energy absorbed during the initial compressive phase of impact was calculated as the area under the force-deflection curve. System energy absorption was (on average) 3-fold greater for high compared to low BMI participants, but no effects of gender were observed. Even after normalizing for body mass, high BMI participants absorbed 1.8-fold more energy per unit mass. Additionally, three of four safety floors demonstrated significantly increased energy absorption compared to a baseline resilient-rolled-sheeting system (% increases ranging from 20.7 to 28.3). Peak system deflection was larger for high BMI persons and for impacts on several safety floors. This study indicates that energy absorption may be a common mechanism underlying the reduced risk of hip fracture for persons with high BMI and for those who fall on soft surfaces.

This study sought to compare a new head impact-monitoring device, which is not limited to specific helmet styles, against reference accelerometer measurements. Laboratory controlled impacts were delivered using a linear pneumatic impactor to a Hybrid III headform (HIII) fitted with a football helmet and the impact monitoring device (gForce Tracker-GFT) affixed to the inside of the helmet. Linear regression analyses and absolute mean percent error (MAPE) were used to compare the head impact kinematics measured by the GFT to a reference accelerometer located at the HIII's center of mass. The coefficients of determination were strong for the peak linear acceleration, peak rotational velocity, and HIC15 across all impact testing locations (r(2) = 0.82, 0.94, and 0.70, respectively), but there were large MAPE for the peak linear acceleration and HIC15 (MAPE = 49 ± 21% and 108 ± 58%). The raw GFT was accurate at measuring the peak rotational velocity at the center of mass of the HIII (MAPE = 9%). Results from the impact testing were used to develop a correction algorithm. The coefficients of determination for all impact parameters improved using the correction algorithm for the GFT (r(2) > 0.97), and the MAPE were less than 14%. The GFT appears to be a suitable impact-monitoring device that is not limited to specific styles of football helmets, however, correction algorithms will need to be developed for each helmet style.

Background The incidence of hip fractures is highest for underweight females with low body mass index (BMI). However, it is unknown how these factors influence impact dynamics during in-vivo lateral hip impacts. We used a pelvis release paradigm to compare: (1) absolute and normalized forces applied to the femur-pelvis system across sex and BMI groups; (2) the force-prediction accuracy of vibration-based versus force-deflection-based estimates of effective pelvic stiffness; and (3) effective pelvic stiffness between BMI and sex groups. Methods Twenty-eight persons participated (7 low-BMI females, 7 low-BMI males, 7 high-BMI females, 7 high-BMI males, with BMI criteria of 28 for low- and high-BMI groups respectively). The participant's pelvis was released from heights of 0 to 5 cm. A force plate measured impact loads, while a motion capture system measured pelvic deflection. Findings Peak impact forces were 22.6% higher, while normalized peak forces were 31.2% lower, for high- compared to low-BMI participants. Accuracy of peak force predictions improved by 25% for the force-deflection versus the vibration-based stiffness estimation method. Effective pelvic stiffness was greater for males than females, but no significant differences were observed between BMI groups. Interpretation This study adds to clinical understanding of the effects of sex and BMI on impact dynamics during falls on the hip, and raises questions about the biomechanical mechanisms underlying the protective role of high BMI on hip fracture risk. Understanding the relationship between impact mechanics and faller characteristics should lead to more effective prevention of hip fractures.

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