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Aftab E. Patla and Anne Shumway-Cook

Mobility, the ability to move independently, is critical to maintaining independence and quality of life. Among older adults, mobility disability results when an individual cannot meet the demands of the environment. Current approaches to defining mobility rely on distance and time measures, or decompose mobility into subtasks (e.g., climbing, sit to stand), but provide limited understanding of mobility in the elderly. In this paper, a new conceptual framework identifies the critical environmental factors, or dimensions, that operationally define mobility within a given community, such as ambient conditions (light levels, weather conditions) and terrain characteristics (stairs, curbs). Our premise is that the environment and the individual conjointly determine mobility disability. Mobility in the elderly is defined not by the number of tasks a person can or cannot perform, but by the range of environmental contexts in which tasks can be safely carried out: the more disabled, the more restrictive the dimensions.

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Marjorie H. Woollacott and Anne Shumway-Cook

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.