Role of the upper limb in limiting head impact during laboratory-induced falls in at fall-risk older adults.

Lingjun Chen, Tobia Zanotto, James Fang, Ethan Scharf, Nathanael Garcia, Andrew Luzania, Rishav Mukherjee, Neil B Alexander, Jacob J Sosnoff
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Abstract

Background: Fall-related head impact is the leading cause of traumatic brain injury in older adults. There is limited understanding of factors related to fall-related head impact. This investigation examined characteristics of upper limb movements during standing-height falls and examined their association with fall-related head impact in older adults at risk for falls.

Methods: Older adults (n=29) at risk for fall-related injuries underwent experimentally induced falls in multiple directions (backwards and sideways). To characterize the upper limb movements and their association with head impact, a standardized analysis tool was used to analyze a total of 164 video-recorded falls. The association between upper limb movements (and their characteristics) and head impact was analyzed through logistic regression.

Results: Nearly 80% of falls involved upper limb movements. Absence of upper limb movements significantly increased head impact odds by approximately 4-fold. The odds of head impact were reduced in falls with energy absorption at the forearm (0.013-fold) and upper arm (0.018-fold), compared to falls without upper limb energy absorption. Backwards falls showed significantly higher odds of head impact (more than 4-fold).

Conclusion: Upper limb movements are common during fall descent and are associated with lower odds of experiencing head impact. Energy absorption with the upper limb seems to be an important protective mechanism. Future work should explore if these movements can be augmented with targeted training.

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实验室诱发高危老年人跌倒时,上肢在限制头部冲击力方面的作用。
背景:与跌倒相关的头部撞击是老年人脑外伤的主要原因。人们对与跌倒相关的头部撞击的相关因素了解有限。这项调查研究了有跌倒风险的老年人在站立高度跌倒时上肢运动的特征,并研究了这些特征与跌倒相关头部撞击的关系:方法:对有跌倒相关伤害风险的老年人(29 人)进行实验诱导,诱导他们从多个方向(后方和侧方)跌倒。为了确定上肢运动的特征及其与头部撞击的关系,我们使用标准化分析工具对总共 164 个跌倒视频进行了分析。通过逻辑回归分析了上肢运动(及其特征)与头部撞击之间的关联:结果:近 80% 的跌倒涉及上肢运动。没有上肢运动会使头部受到撞击的几率明显增加约 4 倍。与没有上肢能量吸收功能的跌倒相比,前臂(0.013 倍)和上臂(0.018 倍)有能量吸收功能的跌倒发生头部撞击的几率降低。向后跌倒时头部受到撞击的几率明显更高(超过4倍):结论:上肢运动在跌倒下落过程中很常见,与较低的头部撞击几率有关。上肢吸收能量似乎是一种重要的保护机制。未来的工作应探索是否可以通过有针对性的训练来增强这些动作。
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