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A Clinical Measure of Maximal and Rapid Stepping in Older Women

^a Mobility Research Center, Division of Geriatric Medicine, The University of Michigan, Ann Arbor
^b Ann Arbor Department of Veterans Affairs Medical Center Geriatric Research Education and Clinical Center, Michigan

Neil B. Alexander, Mobility Research Center, University of Michigan Geriatric Center, CCGCB Room 1111, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0926 E-mail: nalexand{at}umich.edu.

Decision Editor: John Morley, MB, BCh

Background. In older adults, clinical measures have been used to assess fall risk based on the ability to maintain stance or to complete a functional task. However, in an impending fall situation, a stepping response is often used when strategies to maintain stance are inadequate. We examined how maximal and rapid stepping performance might differ among healthy young, healthy older, and balance-impaired older adults, and how this stepping performance related to other measures of balance and fall risk.

Methods. Young (Y; n = 12; mean age, 21 years), unimpaired older (UO; n = 12; mean age, 69 years), and balance-impaired older women (IO; n = 10; mean age, 77 years) were tested in their ability to take a maximal step (Maximum Step Length or MSL) and in their ability to take rapid steps in three directions (front, side, and back), termed the Rapid Step Test (RST). Time to complete the RST and stepping errors occurring during the RST were noted.

Results. The IO group, compared with the Y and UO groups, demonstrated significantly poorer balance and higher fall risk, based on performance on tasks such as unipedal stance. Mean MSL was significantly higher (by 16%) in the Y than in the UO group and in the UO (by 30%) than in the IO group. Mean RST time was significantly faster in the Y group versus the UO group (by 24%) and in the UO group versus the IO group (by 15%). Mean RST errors tended to be higher in the UO than in the Y group, but were significantly higher only in the UO versus the IO group. Both MSL and RST time correlated strongly (0.5 to 0.8) with other measures of balance and fall risk including unipedal stance, tandem walk, leg strength, and the Activities-Specific Balance Confidence (ABC) scale.

Conclusions. We found substantial declines in the ability of both unimpaired and balance-impaired older adults to step maximally and to step rapidly. Stepping performance is closely related to other measures of balance and fall risk and might be considered in future studies as a predictor of falls and fall-related injuries.

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