Current research suggests that there are complex interactions between intrinsic factors related to the individual and extrinsic environmental factors, all of which contribute to falls in the older adult. A new approach to balance assessment, the task-oriented conceptual framework for clinical intervention, takes into account many of these intrinsic and extrinsic variables in assessing balance function. It contains three levels of assessment of balance and gait function: performance-based functional assessment, strategy assessment, and impairment assessment. This approach quantifies performance on functional tests of balance, determines the strategies used by the individual to carry out functional tasks, and evaluates the relative contribution of specific neural and musculoskeletal variables to normal postural control. Results of recent experiments suggest that older adults who are given a sensory training program that is designed to improve the organization of sensory inputs contributing to balance control (strategy level) are able to significantly improve sway and that this training effect transfers to other balance conditions.
Marjorie H. Woollacott is with the Department of Exercise and Movement Science and the Institute of Neuroscience, University of Oregon, Eugene, OR97403. Anne Shumway-Cook is with the Department of Physical Therapy, Northwest Hospital, Seattle, WA 98133.