Use of a physiological profile to document motor impairment in ageing and in clinical groups

• Published in: The Journal of physiology 2016-08, Vol.594 (16), p.4513-4523
• Main Authors: Lord, S. R., Delbaere, K., Gandevia, S. C.
• Format: Article
• Language: English
• Subjects: Accidental Falls; Aged; Aging; Aging - physiology; Aging and Degeneration; Cognitive and Behavioural Neuroscience; Exercise Physiology; Geriatric Assessment - methods; Humans; Mortality; Physiology; Risk; Symposium Review
• ISSN: 0022-3751; 1469-7793
• DOI: 10.1113/JP271108

Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall ‘score’ which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan. Physiological profile for an individual older person showing performance scores expressed in z‐score units in relation to the population aged 65 years and older. The profile indicates near average performances for proprioception, knee extension strength and reaction time and below average performances for visual contrast sensitivity and the standing and leaning balance tests. This information can be used to guide fall prevention strategies.