Welcome back for another installment of Research Bites! For all of you who missed my research posts on my Instagram (@science_of_falling), you came to the right place. Every few weeks I will be posting a new set of five quick and dirty research reviews with the main findings, how it was performed, and my quick take on it.

The trick is, I only have the space of an Instagram caption (2200 characters) to dive in and extract main points. It makes for a fun challenge! If you want to see these posts sooner, head on over to Instagram and hit that follow button.

Enjoy that tasty research!

Study Details

🔸Used data from 808 elderly adults (65+) collected during the KORA Age study from 2008-2009
🔸409 men/399 women; 78 yo +/- 6 y
🔸Data collected at at start and end of a 3 year period
🔸Participants utillized a hand held dynamometer to determine grip strength in domininat hand
-3 trials with highest trial utilized for analyses
*During face-to-face interview participants asked if they had fallen in the past 12 months
-The 12 months prior to start of the 3 year period, and finally the 12 months prior to the end of the 3 year period
🔸Confounding variables such as vertigo or dizziness inquired about and assessed

Study Findings

🔹Men showed overall higher maximal grip strength compared to women
-Men 36kg initial and 35kg follow up
-Women 22kg initial and 21kg follow up
🔹Women more frequently affected by falls in the past 12 months as well as reported balance problems
🔹Both men and women had more falls overall at follow up than at baseline
🔹Lower maximal grip strength was correlated highly with increased falls in both groups
🔹Those with lower grip strength at baseline had higher risk of falls
🔹After adjusting for age/gender, risk of falls in study reduced by avg of 3% for every 1kg increase in maximal grip strength

My Take 🤔

Although grip strength and falling seem pretty unrelated, the real story is total bodily strength. Grip strength has been shown in the past to be a good determinant of overall bodily health and strength. So essentially, if you have a good grip you are more likely to have strong legs that can support you. I would be interested to see how grip strength correlates with power output though, seeing as power is equally important as strength in regards to fall prevention.

Study Details

🔸within subject repeated-measure design used
🔸22 subjects, mean age 55.4 years, 50% women/50% men
🔸Subjects underwent 13 varying types of footwear during testing including: barefoot, conventional shoe, control minimal shoe, and varying minimal shoe designs which each changed one feature from the control
🔸Testing in each footwear type included:
-Postural stability assessed via pressure plate and Center of Pressure (CoP) movement during standing
-Dynamic stability assessed via movement of CoP while ambulating on a pressure plate
-Physical function via a Timed Up-and-Go (TUG) test
-Perceptions of the footwear via the Monitor Orthopaedic Shoes questionnaire (MOS)
-Physical characteristics: age, sex, weight, height, BMI, foot length
🔸Testing for all shoes was undergone in a single session of ~2hrs

Study Findings

🔹Participants showed significantly more postural stability in all minimal shoes compared to the conventional shoes overall
🔹All minimal shoes were comparable to barefoot in regards to postural stability
🔹Conventional shoes less stable during dynamic stability trials compared to wearing minimal shoes with wider sole, higher ankle collar, softer rubber, and harder rubber
🔹All minimal shoes comparable to barefoot for dynamic stability
🔹TUG test times improved when wearing minimal shoe with wider sole compared to conventional shoe and control minimal shoe

My Take 🤔

Overall it makes sense that minimal footwear showed increased stability over conventional footwear. Our foot is meant to splay out giving us more surface are to balance on which conventional shoes disrupt. Additionally, minimal shoes create better ground feedback in the foot allowing better postural adjustments. That does not even include the muscular and mobility benefits wearing more minimalist footwear can bring which can further improve balance and stability.

It's important to note that there is some research that contradicts these findings and more data is needed.

Study Details

🔸Review of articles before July 2017 from PubMed, EMBASE, CINAHL, Cochrane Database
🔸Used keywords: cross sectional. cohort, volitional step test, reactive step test, falls, older adults
🔸Target population was those over 60 yo
🔸Studies screened by three reviewers
🔸Initial search yielded 2107 articles wittled down 61 articles being used in the final meta-analysis based on required inclusion criteria

Study Findings

🔹Stepping performance found to be significantly worse in fallers compared to non-fallers
-This was true in both volitional and reactive stepping performance
🔹Stepping errors much higher in fallers
🔹Fallers tended to take significantly more steps after perturbation to recover balance compared to non-fallers
🔹Overall step tests have moderate sensitivity (.70) and specificity (.69) in discriminating fallers from non-fallers
-Volitional step tests showed moderate sensitivity (.67) and specificity (.71)
-Reactive step tests showed higher sensitivity (.73) and lower specificity (.59)

My Take 🤔

In previous research posts we have discussed how strength and power can increase step rate and allow a person to recover easier from falling. This meta-analysis took that idea further, and discovered that testing stepping ability with step tests can illuminate those with potential risk of falling.

Study Details

🔸Systematic review consisting of 9 included studies based on researcher's chosen criteria, widdled down from 1143 articles
-Included two randomized control trials, six cross-sectional studies, one case-control trial
🔸Criteria for inclusion: full text written in english, healthy subjects of any age, included at least one balance test and at least one test for toe flexor muscle strength, if a longitudinal study it needed baseline data
🔸Databases used included: Medline, SportDiscus, Scopus, Cinahl, Embase, PEDro, Cochrane, Google Scholar
🔸Total number of participants in all studies was 2200, all 60+ years old, 73% female/27% male

Study Findings

🔹Results found that there is a significant correlation between strong toe flexors and improved balance ability in older populations
🔹Although all studies tested balance and toe flexor strength slightly different, all tests showed general positive correlations in regards to toe flexor strength helping to improve both static and dynamic balance
🔹Additionally, the evidence suggests that progressive resistance training of the toe flexors is a valid and useful addition to a fall prevention/balance program for the older adult

My Take 🤔

Overall, this was a good look into the current research of toe flexor strength and balance ability for the older adult. Foot and ankle musculature strengthening has been repeatedly shown to be a valid way to improve balance. Toe flexor strength works in tandem with plantar flexor strength to prevent forward losses of balance, and thus increasing the strength of either set of muscles logically would help prevent falls.

Study Details

🔸46 children; 21 with strabismus, 25 aged matched controls; 5-10 yo
🔸All participants given detailed eye exam
-Included: visual acuity, stereopsis, fusion/binocularity, and strabismus
-Children with complete suppression of deviating eye included in the strabismus group (SG)
-Those with normal vision included in control group (CG)
🔸Experimental testing included: Sensory Organization Test (SOT) and Paediatric Balance Scale (PBS)
-SOT determined sensory weighting in postural control over 6 sensory testing conditions. -Gave an equilibrium score, strategy score, and sensory analysis
-PBS determined balance ability over varying activities imitating real world situations.
-Gave overall balance ability score in confines of testing challenges.

Study Findings

🔹Condition 1 (normal standing with all sensory input available) of the SOT showed significant difference between SG and CG
-SG showed significantly lower strategy scores (more hip strategy used vs ankle strategy), significantly lower equilibrium scores (general balance ability for the task)
🔹SG group showed significantly lower scores in the PBS vs the CG meaning less functional balance ability during goal-directed movements
🔹After subgroup analysis based on age, it was found that CG age showed a correlation between increased age and improved balance performance
-This correlation was NOT found in the SG meaning that increased age did not correlate with improved balance ability

My Take 🤔

Strabismus by definition is a misalignment of the eyes. Visual input is considered to be 1/3 of the balance system and thus has a large part to play in balance ability. Although the brain may help children adapt to a malalignment of the eyes, it seems that their is a limit to this adaptation during the growing years and, unlike those with no strabismus, balance does not improve as these children age. Additionally, it appears that balance during normal functional tasks is deficient in those with strabismus as well.

Thanks for reading the ninth volume of Research Bites! I hope you learned a tidbit or two. Be sure to follow my Instagram account to see these research bites right away, and comment below on what you think about the findings above.

Happy Falling!