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Trunk Repositioning Errors Are Increased in Balance-Impaired Older Adults

¹ Institute of Gerontology, ² Department of Biomedical Engineering, and ³ Mobility Research Center, Division of Geriatric Medicine, Department of Internal Medicine, The University of Michigan, Ann Arbor.
⁴ VA Ann Arbor Health Care System Geriatric Research, Education and Clinical Center, Michigan.

Address correspondence to Allon Goldberg, PT, PhD, Department of Health Care Sciences, Program in Physical Therapy, Wayne State University, 259 Mack Ave., Detroit, MI 48201. E-mail: agoldberg{at}wayne.edu

Background. Controlling the flexing trunk is critical in recovering from a loss of balance and avoiding a fall. To investigate the relationship between trunk control and balance in older adults, we measured trunk repositioning accuracy in young and balance-impaired and unimpaired older adults.

Methods. Young adults (N = 8, mean age 24.3 years) and two groups of community-dwelling older adults defined by unipedal stance time (UST)—a balance-unimpaired group (UST > 30 seconds, N = 7, mean age 73.9 years) and a balance-impaired group (UST < 5 seconds, N = 8, mean age 79.6 years)—were tested in standing trunk control ability by reproducing a 30° trunk flexion angle under three visual-surface conditions: eyes opened and closed on the floor, and eyes opened on foam. Errors in reproducing the angle were defined as trunk repositioning errors (TREs). Clinical measures related to balance, trunk extensor strength, and self-reported disability were obtained.

Results. TREs were significantly greater in the balance-impaired group than in the other groups, even when controlling for trunk extensor strength and body mass. In older adults, there were significant correlations between TREs and three clinical measures of balance and fall risk, UST and maximum step length (–0.65 to –0.75), and Timed Up & Go score (0.55), and between TREs and age (0.63–0.76). In each group TREs were similar under the three visual-surface conditions. Test–retest reliability for TREs was good to excellent (intraclass correlation coefficients 0.74).

Conclusions. Older balance-impaired adults have larger TREs, and thus poorer trunk control, than do balance-unimpaired older individuals. TREs are reliable and valid measures of underlying balance impairment in older adults, and may eventually prove to be useful in predicting the ability to recover from losses of balance and to avoid falls.