Medical

Communication

Biosci. Biotech. Res. Comm. 11(2): 224-230 (2018)

Screening in healthy individuals for risk of falls by

employing various tools: A clinical study

Aksh Chahal

and Nitesh Malhotra

Department of Physical Therapy, Jazan University Jazan, Saudi Arabia

Department of Physiotherapy, Shri Jagdishprasad Jhabarmal Tibrewala University Churela, Rajasthan

333001 India

ABSTRACT

Body posture involves the relative position and control of the musculature with respect to each other. Muscles play

a pivotal role in maintaining the balance which controls the posture. Present study involves the use of TETRAX®

related tools to determine the risk of falls in different young adults group. In this approach we employ modi ed

Romberg’s Test, Static Postural Alignment Examination and TETRAX® Posturographic method in order to validate

our hypothesis. We have chosen subjects of different age group such as 20-25 years, 26-30 years, 31-35 years and

36-40 years designated as Group A, B,C and D respectively. Present approach segregated all the subjects on the basis

of demographic analysis. Comparison was done in different age groups for risk of fall. In descriptive analysis, it was

concluded that there is high risk of fall is observed in case of group A as compared to other groups. Statistical analy-

sis did not prove the same due to the limitation in number of subjects.

KEY WORDS: SCREENING; HEALTHY INDIVIDUALS; POSTURE; BALANCE; RISK OF FALL

224

ARTICLE INFORMATION:

*Corresponding Author: malhotra.nitesh@gmail.com

Received 10

Jan, 2018

Accepted after revision 19

March, 2018

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC / Clarivate Analytics USA and

Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 SJIF 2017: 4.196

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/11.1/5

INTRODUCTION

Body Posture involves the relative position and control of

the musculature with respect to each other (Andre et al.,

2015). Muscle recruitment is necessary for maintaining

the postural control; therefore muscle should be active

for maintaining the balance. Balance is a condition in

which all forces acting on the body are being at equilib-

rium such that the centre of gravity lies within the base

of support (Quitschal

et al., 2014). Balance and posture is

being de ned by the System Model of Balance, its com-

ponents are visual, somato-sensory and vestibular. The

impairments in balance can be a consequence of changes

in motor, sensory and integrative aspects of motor control

(Rey et al., 2017). The central nervous system integrates

all the cues coming from the environmental organiza-

Aksh Chahal and Nitesh Malhotra

tion and the sensory system orients it. Incidence of high

risk of fall and increased postural sway is being seen

in older adults and due to these falls there are higher

incidence of fractures other than any injuries (Villiers

and Kalula, 2015), whereas some literatures report that

young adults are also affected with poor posture control

and balance and therefore, more cases of upper extrem-

ity fractures have been reported in young adults due

to falls (Quitschal

et al., 2014, Akdeniz et al., 2016 and

Aydın et al., 2017).

Various tools or measures were employed such as

plumb line or weighted line for normal postural align-

ment, visual inspection for postural alignment and inter-

active posturography system for postural stability (Pail-

lard et al., 2015). Researchers also employed measures

of the initial stance position, centre of alignment, mean

sway path, total excursion and the zone of stability

and considered as reliable measures of postural control

(Anna et al., 2015 and Hung et al., 2016). Amalgamation

of other tools were also being employed such as TET-

RAX® biofeedback video games for balance training is a

feasible adjunctive program that may augment conven-

tional therapy in persons with chronic hemiplegic stroke

(Hung et al., 2016 and Yun & Yoo, 2016). The study

concluded that there is relation risk of fall, balance and

neuromuscular function in 60 years women (Akdeniz

et al., 2016).

Aforementioned studies employed the TETRAX® tool

in combination with other interventions but there is lim-

ited study on the age group 20-40 years. Therefore, there

is need to determine that whether the risk of fall is the

problem in geriatric population only or is it an alarm-

ing problem within young adults of age group (Garcia &

Navarro, 2016 and Rey

et al., 2017).

As there is higher risk of fall and stability index in

individuals with low physical activity. The aim of this

study is screening of balance and postural control in

individuals. The objective of this study is to determine

the risk of fall in the healthy young population by

employing measures such as Modi ed Romberg’s Test,

TETRAX® Posturographic method and Static Postural

Alignment Examination. These tests have intrinsic char-

acteristic features such as accuracy, non-invasive and

weight distribution etc. (Lee et al., 2016) which make

them reliable tools for the determination of risk of fall

among different age group and also on gender bias.

MATERIAL AND METHODS

Young healthy adults between age 20-40 individual

were included in the study and were with 10 subjects

each in four respective Groups A (20-25) years, B (26-

30) years, C (31-35) years and D (36-40) years as per

their age. The study was performed at RLJT Hospital &

Research Centre, Jhunjhunu. All subjects were included

after performing Romberg’s test. Exclusion criteria

history of neurological (Guler et al., 2012) or muscu-

loskeletal disorder, laxity in joints pregnancy (Aydın

et al., 2017), ankle sprain, marked cognitive impairment

(Avni et al., 2006), low vision, insuf cient English and

Hindi language skills lack of interest to participate The

experiment was conducted on the basis of Demographic

data and Anthropometric characteristics of the subjects

was recorded including Name, Age, Gender, Height and

Weight, therefore BMI was also recorded prior to the

study. Manual Screening for Postural Control was done

by Modi ed Romberg’s test and Plumb line Posturogra-

phy method.

Tools employed for the screening of healthy indi-

viduals for risk of falls: Modi ed Romberg’s Test was

employed in four different conditions and each con-

dition must be ful lled in order to move to the next

condition. All the conditions were performed standing

with feet together and arms crossed. Condition 1: Each

subject would be supposed to stand on the  oor ( rm

surface) for 15 seconds eyes open. Condition 2: Each

subject would be supposed to stand on the  oor ( rm

surface) for 15 seconds eyes closed.

Condition 3: Each subject would be supposed to stand

to on the memory foam with eyes open for 30 seconds.

Condition 4: Each subject would be supposed to stand

on the memory foam with eyes closed for 30 seconds.

Documentation- It would be done by PASS/FAIL condi-

tion.

Failure of the test was de ned under three parameters

i.e 1) The subjects open their eyes in the condition 2 and

4 2) The subjects move their feet or arms to maintain

stability 3) Beginning to fall or requiring intervention of

the examiner to maintain the balance within 30 seconds

threshold time. Static Postural Alignment Examination:

Normal postural alignment in standing can be deter-

mined by using a plumb line. In standing position, the

centre of mass lies at the second sacral vertebrae. Static

posture is examined by using the plumb line method

in standing position with the feet apart, normal stance

width. When viewed from the Sagittal plane the verti-

cal line of gravity (LOG) is expected to fall close to the

external auditory meatus, anterior to the shoulder joint,

anterior to the thorax, posterior to the hip joint, and

slightly anterior to the knee and ankle joint.

TETRAX® Posturographic method: Tool used is TET-

RAX® Computerized Static Posturographic tool. This

system helps in the screening of the Static Postural bal-

ance in healthy individuals. The subjects was asked to

stand in the middle of the four force plates which would

be placed at the right rear, right front, left rear and left

front of the patient’s feet. The sensor plates would then

record the weight bearing based on vertical pressure

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS SCREENING IN HEALTHY INDIVIDUALS FOR RISK OF FALLS BY EMPLOYING VARIOUS TOOLS 225

Aksh Chahal and Nitesh Malhotra

being applied to the platform via the heels and the toes.

Documentation was done in eight different conditions

i.e.:

1. Normal open position (NO) that is standing straight

with eyes open

2. Normal closed position (NC) that is standing

straight with eyes closed

3. Pillow open (PO) that is standing straight on pil-

lows with eyes open

4. Pillow Closed (PC) that is standing straight on pil-

lows with eyes closed

5. Head right (HR) that is standing straight on sensor

plates with eyes closed, head turned to the right

6. Head left (HL) that is standing straight on sensor

plates with eyes closed, head turned to the left.

7. Head back (HB) that is standing straight on sensor

plates with neck in extension

8. Head Forward (HF) that is standing straight on

sensor plates with neck fully  exed.

The study was performed at same time of the day. Each

position is maintained for 30 seconds. Tetrax® Software

computed the following parameters. Risk of falls with

Numeric value of (0-100)

• Low fall risk: 0-35

• Moderate fall risk- 36-57

• High fall risk- 58-100

Data Analysis: The data analysis was done using Sta-

tistical Package for Social Sciences software Version 17

applying the descriptive data included mean standard

deviation were also calculated Anova test was applied to

calculate the difference in between four groups using F

distribution . The data was analysed using the F- value

and the F crit value. If the F value is greater than the

F crit value then the null hypothesis is rejected but if

F value is less than the F crit value then the research

hypothesis is rejected.

RESULTS

Segregation of healthy individuals according to demo-

graphic analysis:

Subjects (40) were included in the study with mean age

of 30.77 ± 5.78 years. The mean height was 164.25 ±

7.70 cm and mean weight was 64.43 ± 13.83 kg. The

mean BMI was also calculated as 23.98 ± 4.35 and mean

risk of fall was calculated as 34.25 ± 20.32. The ratio of

male and female in the group under investigation was

3:2 (Table 1).

Comparison within groups for risk of fall: Compari-

son was done between the risk of fall 34.25 ± 20.32

years of 4 different age groups30.77 ± 5.78 years and it

was found that there was no signi cant difference seen

in the risk of fall between different age group of healthy

population. (F value> F crit value), (p value > 0.05)

(Table 2.)

For Intra- group comparison, descriptive analysis was

done in which each group subjects were classi ed under

low risk of fall, moderate risk of fall and high risk of fall

It was found that in Group A equal number of people

fall under the category of moderate and high risk of fall.

In Group B 50% of the population was under low risk of

fall and 20% of population is under high risk of fall .As

Table 1. Demographic and anthropometric data of the

subjects

Characteristics Mean ± Standard Deviation

Age 30.77 ±5.78

Height ( cm) 164.25 ±7.70

Weight (kg) 64.43 ± 13.83

Body Mass Index (kg/m) 23.98 ± 4.35

Gender (Male/Female) 24/16

Table 2. Comparison of risk of fall and Age

Age (Mean ±SD) Risk of fall (Mean ±SD) F value p value F crit value

30.77±5.78 34.25±20.32 2.575758 0.068935 2.866266

Signi cant at F value Signi cant at ≤0.05 level or> F critical value

Table 3. Result analysis

ANOVA

Source of Variation SS Df MS F P-value F crit

Between Groups 2847.5 3 949.1667 2.575758 0.068935 2.866266

Within Groups 13266 36 368.5

Total 16113.5 39

Signi cant at ≤0.05 level or Signi cant at F value > F critical value

226 SCREENING IN HEALTHY INDIVIDUALS FOR RISK OF FALLS BY EMPLOYING VARIOUS TOOLS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Aksh Chahal and Nitesh Malhotra

FIGURE 1. Illustrate the intragroup risk of fall in percentage

FIGURE 2. Representation of percentage Risk of fall on the basis of gender

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS SCREENING IN HEALTHY INDIVIDUALS FOR RISK OF FALLS BY EMPLOYING VARIOUS TOOLS 227

Aksh Chahal and Nitesh Malhotra

Table 6. Classi cation of Risk of fall on the Basis of gender

Low risk

of fall

Moderate

Risk of fall

Moderate

Risk of fall

Group A

(20-25years)

Male 1 2 2

Female 3 1 1

Group B

(26-30 years)

Male 3 3 0

Female 2 0 2

Group C

(31-35 years)

Male 3 3 1

Female 3 0 0

Group D

(36-40 years)

Male 3 3 0

Female 3 1 0

Table 4. Intragroup relation between Demographic details and Risk of fall

Characteristics

Group A

(20-25 years)

Group B

(26-30 years)

Group C

(31-35 years)

Group D

(36-40 years)

Gender (Male: Female) 5:5 6:4 7:3 6:4

Age (Mean ± SD) 23±1 28±1.55 33±1.44 34±1.46

Height (In cm) (Mean ± SD) 167±8.89 163.44±7.59 164±6.93 162±7.41

Weight(In kg) (Mean ± SD) 62±14.50 60.5±8.54 69±9.31 67±19.9

BMI (Mean ± SD) 22±4.58 22.73±3.49 26±2.57 26±5.31

Risk of fall (Mean ± SD) 43±21.70 37.6±19.20 28±18.48 25±17.10

Table 5. Intragroup categorization of risk of fall

Risk of fall

Group A Group B Group C Group D

(20-25 years) (26-30 years) (31-35 years) (36-40 years)

Low Risk of fall. 4 5 6 6

Moderate Risk of fall. 3 3 3 4

High Risk of fall. 3 2 1 0

we move towards the higher Age groups C and D There

was large decrement in the risk of fall, In Group D 0%

Population is under high risk of fall (Figure .1).

It was also found that in higher age group i.e. Group

D neither Males nor Females fall under the category of

high risk of fall and in Group B and C females were not

seen in the category of moderate risk of fall (Table 5

Table 6 & Figure 2).

Statistically, Anova test was used and it was seen that

F value is less than F-crit value therefore the Research

hypothesis was rejected. But through descriptive anal-

ysis there is signi cant difference seen in risk of fall

within the Age groups

DISCUSSION

In previous studies TETRAX® tool was being used to

assess balance and postural control in individuals with

some disorders, may it be neurological or musculoskeletal

(Dunsky et.al., 2017 and Claeys et.al., 2016). One study

had revealed the reliability of TETRAX® tool in young

adults also with low physical activity According to this

study, TETRAX® measured low fall of risk with lower body

endurance with increment in vigorous activity and total

activity score (Akkaya et al 2015). Researchers employed

these tools for the risk of fall in geriatric population (Gar-

cia, 2016 & Rey

et al., 2017) but none of the studies has

screened only the young individuals. Therefore we were

aimed to introduce TETRAX® TOOL for measuring risk of

fall among various young individual groups.

The most important  nding of this study is that with

increase in age, within the group descriptive analysis

showed that 0 % of the subjects were under high risk of

fall. Previous studies also indicated that there is no cor-

relation between age and risk of fall. Through statistical

analysis, F value is higher than F crit value. Therefore,

228 SCREENING IN HEALTHY INDIVIDUALS FOR RISK OF FALLS BY EMPLOYING VARIOUS TOOLS BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Aksh Chahal and Nitesh Malhotra

statistically no signi cant difference is being seen in the

risk of fall between the various age groups. It can be

ascribed due to the fact that strict exclusion criteria and

small population size can be major setback in this  nd-

ing. Furthermore the subjects were also screened only

for one time. However descriptive analysis concluded

that there is signi cant difference seen in risk of fall

within the Age groups. In futuristic approach larger pop-

ulation may allow evaluation of correlation between risk

of fall and age statistically also. In descriptive analysis,

young age group (20 - 25 years) showed high risk of fall

as compared to older age group (36 - 40 years) which

can be due to the equal weight distribution on both the

lower limbs of older age group but low sample size is the

limitation of this discussion.

CONCLUSION

Present study involves the employment of TETRAX®

tool in combination with the Modi ed Romberg’s Test

and Static Postural Alignment Examination to deter-

mine the risk of fall within young adults of different age

group. Earlier reported literatures employ various tools

in geriatric population for risk of fall. Limited study was

performed in case of young adults. Therefore we were

directed to employ the tools in young adults for risk of

fall. Our results concluded that in descriptive analysis,

there is signi cant difference in the percentage of risk

of fall in different age group. Risk of fall is greater in

younger adults as compared to the subjects having more

age according to descriptive analysis. But statistically

our study did not proof the same due to the limited num-

ber of subjects. The results of this study demonstrates

difference is being observed in risk of fall within the

group of healthy population but after statistical analy-

sis there was no signi cant difference was being seen

between the different age groups of healthy population,

therefore the research hypothesis is being rejected.

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