[Reactive dynamic balance in the geriatric setting : Possibilities for evaluation and quantification in functionally heterogeneous persons]. / Reaktive dynamische Balance im geriatrischen Setting : Möglichkeiten zu Bewertung und Quantifizierung bei funktionell heterogenen Personen.

BACKGROUND: Most falls in older persons occur during walking and are often due to maladaptation in response to gait perturbations. Therefore, the assessment of reactive dynamic balance is highly relevant for determining the individual risk of falling and could enable an early initiation of interventions. OBJECTIVE: The methods available for perturbation of gait and for evaluating the corresponding reaction patterns are critically discussed in order to approach the assessment of reactive dynamic balance. MATERIAL AND METHODS: A diagnostic protocol for perturbation of gait on a treadmill was developed based on the literature. The application of the protocol to map reactive dynamic balance as comprehensively as possible is presented. RESULTS: After the initial determination of the individually preferred gait speed over ~ 6 min, the participant's gait is disrupted with 9 different types of perturbations over a time period of ~ 4:30 min. The evaluation options include spatiotemporal parameters and their variability, the margin of stability and the Lyapunov exponent. CONCLUSION: Dynamic reactive balance is a promising and specific parameter for quantifying the risk of falling in older persons. The comprehensive evaluation of the documented parameters is currently insufficient because there are no established methods or references. The development of a unified method for the sensitive determination of reactive dynamic balance is essential for its use in assessment of the risk of falling in the clinical context and for measuring the success of training.