Fall prevention – A serious Challenge in 21st Century

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More than 16,000 elderly people die from fall related injuries every year — and the problem is growing. According to the U.S. Centers for Disease Control and Prevention, an adult aged 65 or over is treated in an U.S. emergency department every 18 seconds — and every 35 minutes an older adult dies as a result of their injuries. One in three older adults falls every year in the United States. Falls are also the most common cause of traumatic brain injuries. If older adults break something serious like a hip after a fall, they have a 20 percent chance of dying within a year.
Unfortunately fall is very frequent in diabetic patients in particular those, who suffer from peripheral neuropathy. Peripheral neuropathy impacts foot sensation or somatosensory feedback. Somatosensory feedback provides key information about the orientation of body respect to gravity (e.g. whether we are standing on a flat surface or on an incline surface) as well as the type of surface (e.g. whether we are standing on a hard surface or a soft surface). The information from somatosensory feedback helps our brain to send an appropriate motor command to muscles for maintaining the balance in particular in the absence of visual feedback.

When treating a patient –in particular elderly people and diabetic patients- we should also pay attention on possible impact of our treatment on patient’s risk of falling and try to minimize that. For example, we may suggest a footwear or Orthoses for walking correction. But this new footwear in turn may increase gait unsteadiness and consequently increase the risk of falling at least during the adaptation phase. Such information could be gathered only from daily activity monitoring of patient rather than a short term monitoring in a gaitlab or in a clinic. In the other words, it might be possible that an individual walks well in a gaitlab environment but at home – for example during night time- his gait might be unsteady because of fatigue, attentional distraction, quality of light, and presence of various obstacles.

Monitoring of physical activity using unobtrusive body worn sensor can provide valuable information about patient’s risk of falling during activity of daily living. Recently our research team at CLEAR (Dr Scholl college of podiatric medicine – north Chicago) designed an innovative technology enabling monitoring the most important motor tasks during daily activity using a single sensor that can be worn easily by a subject. This device enables assessing user quality of physical activity including postural transition (sit-to-stand and stand-to-sit), turning, and walking. We demonstrated that by these qualifications, we can accurately identify elderly persons with high risk of falling. Furthermore, using the same sensor, we designed and validated an innovative algorithm for automatic identification of fall accident during activity of daily living. This will enable us to explore those activities during which patients might be more vulnerable for maintaining the balance and how it could be prevented. We recently received a NIH funded grant to expand the application of our technology for fall prevention in diabetic patients and elderly people.

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