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Standing subjects were unexpectedly pulled forward to identify a threshold boundary that evokes stepping in terms of the size of the pull relative to the base of support (BoS). Performances in a range of sensorimotor tests were correlated with the threshold boundary parameters. Younger and older subjects were studied to identify age-related changes in stepping and the threshold boundaries. The threshold boundary had a forward limit (TL) that, when crossed, always made subjects step no matter how slowly they were pulled. As velocity increased, the threshold position that produced a step shifted nearer to the ankles. Eventually a pull velocity was reached above which velocity had no further effect and a position threshold (TH) was identified behind which subjects never stepped. Thus the position threshold boundary for stepping is a posterior-going sigmoidal function of perturbation velocity. Older subjects stepped more than the young (69% vs. 40% of trials). For the older subjects, TL (91% vs. 107% BoS) and TH (59% vs. 72% BoS) were closer to the ankles, and the transition between TL and TH occurred at lower velocities (96% vs. 121% BoS.s–1). Across the entire study population many sensorimotor factors were associated with TL and TH. However, these associations were not present when age was removed as a factor. Thus, although the older subjects use protective stepping more often, this cannot be attributed directly to the sensorimotor factors tested here. It can be explained by stepping as a triggered response to the perturbation event rather than later sensory input about body movement.

Human stepping is a commonly executed control strategy for maintaining standing balance in the natural environment. Aging changes in the initiation triggering of both voluntary (longer latency) and perturbation-induced (shorter latency) stepping are associated with falling, and are a complex function of altered sensorimotor, neuromuscular, and cognitive system factors. The aim of this study was to determine the effect of contextual uncertainty about balance stability on the triggering of protective stepping in young and older individuals. Subjects initiated forward stepping during simple reaction time and waist-pull perturbation conditions with and without contextual uncertainty about balance stability. The results showed that, regardless of age, the initiation timing for triggering both voluntary and induced stepping was delayed substantially (100-300 ms) by the presence of balance uncertainty, and that age-associated timing differences were exacerbated with contextual uncertainty. The initiation timing of the first step liftoff for perturbation-induced stepping did not reflect entirely an immediate necessity or last resort strategy to balance instability determined directly by specific sensory input, but rather a decision to step. Moreover, the time to liftoff onset for perturbation-induced stepping was similar for the old and young with contextual certainty, and occurred 130 ms earlier for the old than for the young when balance stability was uncertain. Overall, we concluded that older individuals can retain a residual capacity to sustain stationary standing stability as a function of the prevailing task conditions, and that the reduced timing threshold with age may involve a pre-selected strategy triggered earlier by non-specific event-related sensory input rather than specific movement-related information.

Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days.

Johnson ME, Mille M-L, Martinez KM, Crombie G, Rogers MW. Age-related changes in hip abductor and adductor joint torques. Arch Phys Med Rehabil 2004;85:593–7. Objective To test the hypothesis that older age significantly affects hip abduction and adduction joint torque-time generating capability in women. Design Cross-sectional study, wherein subjects were tested in a supported standing position. Setting University human performance laboratory. Participants Seventy-six healthy, adult women (38 young; 38 old). Interventions Not applicable. Main outcome measures The dependent variables were peak isometric torque and its corresponding torque rate and average peak isokinetic torque. Age group differences were assessed by analysis of variance. Results Isometric peak torques were significantly lower in older women (P≤.001) for hip abduction (34%) and adduction (24%). Decreases with age were also significant for isometric rates of torque for both muscle groups (P≤.001). Average isokinetic peak torque of hip abduction and adduction showed even greater declines in older women versus the young (P≤.001) with losses of 44% and 56%, respectively. Conclusions The hip abductor and adductor torques showed relatively marked age-related changes. To enhance balance assessment and treatment, and to reduce the risk of falls and related injuries in older women, greater focus should be placed on understanding the role of joint torque-time changes on frontal plane balance control.

Background. Falls related to balance dysfunction are among the major problems of older individuals. The timing characteristics of protective voluntary stepping are critically related to effective balance recovery and are often delayed and slowed with age. This study investigated the influence of step training on the timing characteristics of voluntary step initiation in younger and older adults. Methods. Voluntary reaction time stepping was evaluated before and after training in 12 younger adults and 8 healthy community-dwelling older adults who performed a 3-week regimen of either twice weekly induced step training (destabilizing large waist pulls) or voluntary step practice to a somatosensory reaction stimulus cue (nondestabilizing small waist pulls). Results. Overall, the first step initiation times were slower for the older than for the younger subjects for both the somatosensory reaction stimulus cue task and an auditory transfer cue task. Step completion time was completed earlier for the young posttraining subjects, and older subjects generally had a longer step length. Training resulted in significant reductions in step initiation timing for the old (17%) and young (15%) subjects. Across age groups, the induced training group showed greater reductions in step initiation time than the voluntary practice group for the auditory transfer cue task. Conclusions. A 3-week period of either voluntary or waist-pull-induced step training reduced step initiation time in older and younger adults. Moreover, compared with voluntary step practice, induced step training resulted in a significantly greater improvement in reaction time stepping for an auditory transfer cue task. At least in the short term, such step training has the potential to help older adults perform more like younger adults in their step initiation timing.