Age Stratification and Sample Entropy Analysis Enhance the Limits of Stability Tests for Older Adults

in Journal of Applied Biomechanics
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $87.00

1 year subscription

USD  $116.00

Student 2 year subscription

USD  $165.00

2 year subscription

USD  $215.00

The objective of this study was to determine if a foam testing condition and/or nonlinear analysis methods can be used to identify differences between age stratified subgroups of older adults when conducting the Limits of Stability assessment. Ninety older adults participated in this study. A force plate was used to record center of pressure data during Limits of Stability testing on a firm and foam surface. Participants were grouped into age-stratified subgroups: young-old (60–69 years), middle-old (70–79 years), and old-old (80+ years). Anterior-posterior (A/P) and medial-lateral (M/L) sway ranges and sample entropy values were calculated. The young-old group had significantly larger A/P and M/L sway ranges than the old-old group on both surfaces. A/P sample entropy increased significantly with age. M/L sample entropy increased significantly with age between the young-old and old-old and the middle-old and old-old groups. Sample entropy values between surfaces significantly differed for all groups. These results indicate Limits of Stability differences occur between older adults of different age groups and should be taken into consideration for clinical and research testing. Nonlinear analysis may help further identify differences in Limits of Stability performance while use of a foam surface is of limited additional value.

Reinert was with the Department of Mechanical and Aerospace Engineering, University of Dayton, Dayton, OH, USA, at the time of submission. Kinney and Bigelow are with the Department of Mechanical and Aerospace Engineering, University of Dayton, Dayton, OH, USA. Jackson is with the Department of Physical Therapy, University of Dayton, Dayton, OH, USA. Diestelkamp is with the Department of Mathematics, University of Dayton, Dayton, OH, USA.

Address author correspondence to Senia Smoot Reinert at seniareinert@gmail.com.
  • 1.

    Wallmann HW . Comparison of elderly nonfallers and fallers on performance measures of functional reach, sensory organization, and limits of stability. J Gerontol Ser A Biol Sci Med Sci. 2001;56(9):580–583. doi:10.1093/gerona/56.9.M580

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Melzer I , Benjuya N , Kaplanski J . Postural stability in the elderly: a comparison between fallers and non-fallers. Age Ageing. 2004;33(6):602–607. PubMed doi:10.1093/ageing/afh218

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Brauer SG , Burns YR , Galley P . A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers. J Gerontol Ser A Biol Sci Med Sci. 2000;55(8):M469–M476. doi:10.1093/gerona/55.8.M469

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Boulgarides LK , McGinty SM , Willett JA , Barnes CW . Use of clinical and impairment-based tests to predict falls by community-dwelling older adults. Phys Ther. 2003;83(4):328–339. http://ptjournal.apta.org/content/83/4/328.short. Accessed December 2, 2014. PubMed

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Mancini M , Rocchi L , Horak FB , Chiari L . Effects of Parkinson’s disease and levodopa on functional limits of stability. Clin Biomech (Bristol, Avon). 2008;23(4):450–458. doi:10.1016/j.clinbiomech.2007.11.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Newstead AH , Hinman MR , Tomberlin JA . Reliability of the Berg Balance Scale and balance master limits of stability tests for individuals with brain injury. J Neurol Phys Ther. 2005;29(1):18–23. PubMed doi:10.1097/01.NPT.0000282258.74325.cf

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Schieppati M , Hugon M , Grasso M , Nardone A , Galante M . The limits of equilibrium in young and elderly normal subjects and in parkinsonians. Electroencephalogr Clin Neurophysiol. 1994;93(4):286–298. PubMed doi:10.1016/0168-5597(94)90031-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Rogers ME , Rogers NL , Takeshima N , Islam MM . Methods to assess and improve the physical parameters associated with fall risk in older adults. Prev Med. 2003;36(3):255–264. PubMed doi:10.1016/S0091-7435(02)00028-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Clark S , Rose DJ . Evaluation of dynamic balance among community-dwelling older adult fallers: a generalizability study of the limits of stability test. Arch Phys Med Rehabil. 2001;82(4):468–474. PubMed doi:10.1053/apmr.2001.21859

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Wolfson L , Whipple R , Derby CA , et al. A dynamic posturography study of balance in healthy elderly. Neurology. 1992;42(11):2069–2069. PubMed doi:10.1212/WNL.42.11.2069

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Colné P , Frelut ML , Pérès G , Thoumie P . Postural control in obese adolescents assessed by limits of stability and gait initiation. Gait Posture. 2008;28(1):164–169. doi:10.1016/j.gaitpost.2007.11.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Wöber C , Oder W , Kollegger H , et al. Posturographic measurement of body sway in survivors of severe closed head injury. Arch Phys Med Rehabil. 1993;74(11):1151–1156. PubMed

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Forman DE , Berman AD , McCabe CH , Baim DS , Wei JY . PTCA in the Elderly: the “Young-Old” versus the “Old-Old”. J Am Geriatr Soc. 1992;40(1):19–22. PubMed doi:10.1111/j.1532-5415.1992.tb01823.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Davis NC , Friedrich D . Age stereotypes in middle-aged through old-old adults. Int J Aging Hum Dev. 2010;70(3):199–212. PubMed doi:10.2190/AG.70.3.b

  • 15.

    McGuire FA , Norman WC , O’Leary JT . Constraints to participation in the arts by the young old, old, and oldest old. Adv Hospit Leisure. 2004;1:43–58. doi:10.1016/S1745-3542(04)01003-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Patel M , Fransson PA , Lush D , Gomez S . The effect of foam surface properties on postural stability assessment while standing. Gait Posture. 2008;28(4):649–656. PubMed doi:10.1016/j.gaitpost.2008.04.018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Abrahamova D , Hlavacka F . Age-related changes of human balance during quiet stance. Physiol Res. 2008;57(6):957. PubMed

  • 18.

    Manchester D , Woollacott M , Zederbauer-Hylton N , Marin O . Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontol. 1989;44(4):M118–M127. PubMed doi:10.1093/geronj/44.4.M118

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ramdani S , Seigle B , Lagarde J , Bouchara F , Bernard PL . On the use of sample entropy to analyze human postural sway data. Med Eng Phys. 2009;31(8):1023–1031. PubMed doi:10.1016/j.medengphy.2009.06.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Rigoldi C , Cimolin V , Camerota F , et al. Measuring regularity of human postural sway using approximate entropy and sample entropy in patients with Ehlers-Danlos syndrome hypermobility type. Res Dev Disabil. 2013;34(2):840–846. PubMed doi:10.1016/j.ridd.2012.11.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Deffeyes JE , Harbourne RT , Stuberg WA , Stergiou N . Approximate entropy used to assess sitting postural sway of infants with developmental delay. Infant Behav Dev. 2011;34(1):81–99. PubMed doi:10.1016/j.infbeh.2010.10.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Garfein AJ , Herzog AR . Robust aging among the young-old, old-old, and oldest-old. J Gerontol Ser B Psychol Sci Soc Sci. 1995;50B(2):S77–S87. doi:10.1093/geronb/50B.2.S77

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Yentes JM , Hunt N , Schmid KK , Kaipust JP , McGrath D , Stergiou N . The appropriate use of approximate entropy and sample entropy with short data sets. Ann Biomed Eng. 2013;41(2):349–365. PubMed doi:10.1007/s10439-012-0668-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Adams K , O’Shea P , O’Shea KL . Aging: its effects on strength, power, flexibility, and bone density. Strength Condit J. 1999;21:65–77

    • Search Google Scholar
    • Export Citation
  • 25.

    Duarte M , Zatsiorsky VM . On the fractal properties of natural human standing. Neurosci Lett. 2000;283(3):173–176. PubMed doi:10.1016/S0304-3940(00)00960-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Seigle B , Ramdani S , Bernard PL . Dynamical structure of center of pressure fluctuations in elderly people. Gait Posture. 2009;30(2):223–226. PubMed doi:10.1016/j.gaitpost.2009.05.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Lipsitz LA . Loss of “Complexity” and aging. JAMA. 1992;267(13):1806. PubMed doi:10.1001/jama.1992.03480130122036

  • 28.

    Lipsitz LA . Physiological complexity, aging, and the path to frailty. Sci Aging Knowl Environ. 2004;2004(16):pe16. doi:10.1126/sageke.2004.16.pe16

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Duarte M , Sternad D . Complexity of human postural control in young and older adults during prolonged standing. Exp Brain Res. 2008;191(3):265–276. PubMed doi:10.1007/s00221-008-1521-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Costa M , Goldberger AL , Peng CK . Multiscale entropy analysis of complex physiologic time series. Phys Rev Lett. 2002;89(6):68102. doi:10.1103/PhysRevLett.89.068102

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Redfern MS , Moore PL , Yarsky CM . The influence of flooring on standing balance among older persons. Hum Factors. 1997;39(3):445–455. PubMed doi:10.1518/001872097778827043

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 107 107 7
Full Text Views 7 7 0
PDF Downloads 3 3 0