Comparing Balance in Patients with Fall History

Purpose: With falls being the leading cause of mortality with injury, risk factors of falls should be explored further (Lohman). Postural Sway is a method in which you can quantify balance and postural control. Increase in postural sway is shown to be correlated with error in postural control modalities. (Dewan). Having a quantifiable fall-risk metric that can be quickly obtained, could prevent falls, and thereby reduce mortality and surgical interventions necessary. This experiment explores the effect of fall history on postural sway using the Bertec force plate’s measurement of change of pressure, CoP. Methods/Materials: Family Medicine and Geriatric patient participants on a volunteer basis were asked to perform two 30 second intervals of quiet standing on a Bertec force plate as an additional vital sign. Two conditions were performed on firm surfaces: with eyes open (EO) and with eyes closed (EC). Patients were asked to stare at a target for the EO portion and stand still on the force plate for 30 seconds while data was collected. After this, the patient was asked to close their eyes and stand still for another 30 seconds for the eyes closed portion. Postural sway was measured in accordance with CoP using the Clinical Test of Sensory Integration and Balance (mCTSIB) protocol, which describes quiet standing under various conditions to assess fall risk and balance problems. A group of 22 patients with a documented history of a fall was compared against 129 patients without a documented history of a fall. The values of the Range of the CoP in anterior-posterior (AP) direction/axis and medial-lateral (ML) direction/axis were compared using a 2-tail T-test. The values of standard deviation and average of the Radial Distance (RD), the displacement of the CoP points from the center of the stabiligram, a graphical representation of the movements of a person’s quiet standing, were also compared using a 2-tail T-test. Significant values at both conditions, EO and EC, were noted at p < 0.05. Results: The Range of the CoP (AP) was significantly increased in both conditions, EO and EC. The Range of the CoP (ML) was significantly increased in EC, but nonsignificant in EO. The Average RD was significant in EC but nonsignificant in EO, with the Standard Deviation RD with a significant increase in both EO and EC. Conclusion: These findings suggest that there is increased sway in patients with a reported history of a fall compared to those without. This could be a result of error in the vestibular, somatosensory, or visual systems. These errors could point to an increased fall risk. Future studies should investigate the effects these systems have on fall risk as there was more consistent statistical difference of the groups during the eyes closed portion. Some limitations include small sample size, other factors altering sway, and potential non reported fallers in the control group. The ability to measure fall risk quickly and objectively through a simple and non-invasive method like postural sway could prove instrumental in preventing falls with further studies.