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Exploring attentional focus of older adult fallers during heightened postural threat.

ABSTRACT: OBJECTIVES:Threats to balance, and subsequent increases in fall-related anxiety, can disrupt attentional processing during gait in older adults, leading to behavioral adaptations which may increase fall risk. However, limited research has investigated what changes in attention occur to contribute to these disruptions. The aim of this research was to describe changes in attention that occur during gait when older adults' balance is threatened, while exploring how previous fall history and trait movement reinvestment (conscious monitoring and control of movement) also influence attention. METHODS:Forty older adults reported where they focus their attention when walking during two scenarios: (1) when they are relaxed and there is little risk of falling, and; (2) when their balance is threatened and they are anxious of falling. RESULTS:During the high-threat condition, participants reported greater attention towards movement processes, threats to balance, worries/disturbing thoughts and self-regulatory strategies, with less attention directed towards task-irrelevant thoughts. However, fall history influenced attentional focus, with fallers directing greater attention towards worries/disturbing thoughts. Contrary to predictions, trait movement reinvestment was not associated with attention directed towards movement processes. DISCUSSION:As processing worries/disturbing thoughts will likely reduce attentional resources available for effective postural control, we highlight this as one potential area to target interventions aimed at reducing the likelihood of repeated falling.

SUBMITTER: Ellmers TJ

PROVIDER: S-EPMC7479009 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Exploring attentional focus of older adult fallers during heightened postural threat.

Ellmers Toby J TJ Cocks Adam J AJ Young William R WR

Psychological research 20190522 7

<h4>Objectives</h4>Threats to balance, and subsequent increases in fall-related anxiety, can disrupt attentional processing during gait in older adults, leading to behavioral adaptations which may increase fall risk. However, limited research has investigated what changes in attention occur to contribute to these disruptions. The aim of this research was to describe changes in attention that occur during gait when older adults' balance is threatened, while exploring how previous fall history and ...[more]

PMID: 31119367

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Project description:INTRODUCTION:Compared to controlled laboratory settings, the real world is highly distracting with constant demands on visual attention to avoid hazards and falling. Fall-risk assessments do not adequately take into account the potential role of everyday distractions and environmental hazards. The purpose of this project was to identify the effect of the environment on gait and gaze behavior during walking in older adult fallers relative to non-fallers. METHODS:Thirteen older adult fallers (76.8±9.4 years, 3.2±2.3 falls in last year) and 13 age-matched non-fallers (78.3±7.3 years, 0 falls in last year) participated. Participants walked in a real-world and lab setting while gait and gaze were recorded. Gait variables were stride length variability, stride duration variability, and stride velocity. Gaze was analyzed for percentage of time fixating and average fixation duration coded across 6 areas of interest (AOIs) in the visual surroundings. RESULTS:Non-fallers walked faster than fallers, but there were no other group or environment effects on gait. For gaze behavior, fallers had shorter fixation durations on the near environment than non-fallers, but only in the real world. In the real world relative to the lab, fallers decreased fixation durations on the near environment but increased durations on near people. In the real world, participants spent a greater proportion of time fixating on people than on the walking path or the near environment compared to the lab. After adjusting for baseline gait speed, fallers had shorter fixation durations than non-fallers in both environments. CONCLUSIONS:Our results indicate that in a busy environment, older adults concentrate most of their overt visual attention on people when navigating their walking path. Fallers in particular focus longer on people near to them and have overall shorter fixations than non-fallers. Visual focus while walking in a busy environment should be further explored as a fall-risk factor.

Project description:Older adults are at a high risk of falls, and most falls occur during locomotor activities like walking. This study aimed to improve our understanding of changes in neuromuscular control associated with increased risk of falls in older adults in the presence of dynamic balance challenges during walking. Motor module (also known as muscle synergy) analyses identified changes in the neuromuscular recruitment of leg muscles during walking with and without perturbations designed to elicit the visual perception of lateral instability. During normal walking we found that a history of falls (but not age) was associated with reduced motor module complexity and that age (but not a history of falls) was associated with increased step-to-step variability of module recruitment timing. Furthermore, motor module complexity was unaltered in the presence of optical flow perturbations. The specific effects of a history of falls on leg muscle recruitment included an absence and/or inability to independently recruit motor modules normally recruited to perform biomechanical functions important for walking balance control. These results suggest that fallers do not recruit the appropriate motor modules necessary for well-coordinated walking balance control even in the presence of perturbations. The identified changes in the modular control of walking balance in older fallers may either represent a neural deficit that leads to poor balance control or a prior history of falls that results in a compensatory motor adaptation. In either case, our study provides initial evidence that a reduced motor repertoire in older adult fallers may be a constraint on their ability to appropriately respond to balance challenges during walking. NEW & NOTEWORTHY This is the first study to demonstrate a reduced motor repertoire during walking in older adults with a history of falls but without any overt neurological deficits. Furthermore, using virtual reality during walking to elicit the visual perception of lateral instability, we provide initial evidence that a reduced motor repertoire in older adult fallers may be a constraint on their ability to appropriately respond to balance challenges during walking.

Dataset Information

Exploring attentional focus of older adult fallers during heightened postural threat.

Publications

Exploring attentional focus of older adult fallers during heightened postural threat.

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