Balance assessment in cardio-respiratory conditions

Harrison, Samantha, Craig, Chesney and Trewartha, Grant (2024) Balance assessment in cardio-respiratory conditions. In: Gait, Balance and Mobility Analysis Theoretical, Technical, and Clinical Applications. Academic Press. ISBN 9780443214837 (ebk); 9780443214844 (pbk)

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Abstract

This chapter introduces the problem of poor balance in people with chronic obstructive pulmonary disease (COPD) which renders them at an increased risk of falling compared to healthy older adults of the same age (Huang et al., 2016; Oliveira et al., 2015; Roig et al., 2011). Considering COPD as a disease of accelerated ageing and drawing similarities with older frail adults and other chronic conditions, we outline the potential mechanisms underpinning balance impairment in people with COPD, including skeletal muscle dysfunction, altered proprioception, comorbidities, cognitive decline, and socioeconomic factors. Lab-based mobility assessments, including force platforms, vibration to interrupt proprioception, motion capture, the sensory organisation test (SOT) and tests of muscle strength and activation, have been applied in people with COPD, but the findings are not always clinically applicable, in part due to the variation in the outcome variables reported. Clinical guidelines for assessing balance and falls risk in older adults and people with COPD are summarised, and we offer a guide to selecting and interpreting the most appropriate clinical balance tests for assessing falls risk in people with COPD. The potential of wearable technology to assess balance and gait away from a hospital setting is discussed. We finish with recommendations for interventions to improve balance and reduce risk of falling in this population, namely balance training alongside pulmonary rehabilitation, perturbation-based balance training and a home falls risk assessment.