A clinical measure of maximal and rapid stepping in older women

Background. In older adults, clinical measures have been used to assess fal l risk based on the ability to maintain stance or to complete a functional task. However. in an impending fall situation, a stepping response is often used when strategies to maintain stance are inadequate. We examined how ma ximal and rapid stepping performance might differ among healthy young, heal thy older, and balance-impaired older adults, and how this stepping perform ance related to other measures of balance and Fall risk, Methods. Young (Y; n = 12; mean age, 21 years), unimpaired older (UO; n = 1 2; mean age, 69 years), and balance-impaired older women (IO; n = 10; mean age, 77 years) were tested in their ability to take a maximal step (Maximum Strip Length or MSL) and in their ability to take rapid steps in three dir ections (front. side, and back). termed the Rapid Step Test (RST). Time to complete thr RST and stepping en ors occurring during the RST were noted. Results. The IO group, compared with the Y and UO groups, demonstrated sign ificantly poorer balance and higher fall risk, based on performance on task s such as unipedal stance. Mean MSL was significantly higher (by 16%) in th e Y than in the UO group, and in the UO (by 30%) than in the IO group. Mean RST time was significantly faster in the Y group versus the UO group (by 2 4%) and in the UO group versus the IO group (by 15%). Mean RST errors tende d to be higher in the UO than in the Y group, but were significantly higher only in the UO versus the IO group. Both MSL and RST time correlated stron gly (0.5 to 0.8) with other measures of balance and fall risk including uni pedal stance. tandem walk, let; strength, and the Activities-Specific Balan ce Confidence (ABC) scale. Conclusions. We found substantial declines in the ability of both unimpaire d and balance-impaired older adults to step maximally and to step rapidly. Stepping performance is closely related to other measures of balance and fa ll risk and might be considered in future studies as a predictor of falls a nd fall-related injuries.