摘要：

Background: To test the hypothesis that minimum toe clearance and maximum angular inclination of the sole relative to the floor during the swing phase of gait and the maximum lateral sway of the trunk relative to lateral foot separation discriminate fallers from non-fallers in the elderly. Methods: We studied 25 community-dwelling elderly subjects with a history of two or more falls in the previous year and 31 age- and sex-matched controls with no such history. Studies were conducted in the Gait Laboratory, Tohoku University School of Medicine, Sendai, Japan. Subjects were asked to walk normally, during which time we made three-dimensional kinematic spatial and temporal gait measurements using a motion capturing system with reflective markers defining different segments of trunk and limbs. Results: The toe clearance of fallers (12.0 ± 0.7 mm, mean ± SE) was significantly smaller than non-fallers (15.2 ± 1.0 mm) ( P < 0.001). The maximal sole inclination of fallers (7.4 ± 0.8°) was significantly smaller than non-fallers (14.3 ± 0.9°) ( P < 0.001). The lateral sway ratio (lateral excursion of trunk center relative to the mediolateral separation of the feet) was significantly larger in fallers (0.23 ± 0.01) compared with non-fallers (0.18 ± 0.01) ( P < 0.002). Conclusions: These results support the idea that impairment in toe clearance, maximal sole inclination and dynamic trunk sway reflect quantifiable mechanisms that may predispose elderly individuals to falling, and that these kinematic measurements may be clinically useful in identifying patients at risk of falling and monitoring changes in gait patterns, and may lead to effective interventions to prevent falls.

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