Relationship between stair ambulation with and without a handrail and centre of pressure velocities during stair ascent and descent

Introduction: Stair ambulation is one of the most challenging and hazardous types of locomotion for older adults and often requires the adoption of compensatory strategies such as increased handrail use to mitigate disability and increase stability. Centre of pressure velocity (VCOP) describes the neuromuscular response to shifts of the body's centre of mass and serves as an indicator of stability. Knowledge of VCOP may provide some understanding of strategies to improve measured and perceived stability during stair negotiation. The aim of this study was to compare VCOP during stair ascent and descent with and without a handrail in young, older and older adults with a fear of falling (FOF) populations. Methods: COP velocities of 23 young adults (23.7 +/- 3.0 yrs), 26 older adults (66.4 +/- 8.3 yrs), and 3 older adults with FOF (80.2 +/- 8.0 yrs) were analyzed while they ascended and descended a custom 4-step staircase. VCOP were obtained using a force plate mounted on concrete blocks centered on the second step of the staircase. Results: During stair ascent and descent with and without a handrail, the VCOP between young and older adults were comparable. The three adults with FOF demonstrated reduced VCOP during ascent and descent without the handrail and even slower VCOP when ascending and descending stairs with the handrail. These results suggest that handrail use does not increase biomechanical stability for healthy, older adults. However, in the presence of fear of falling the use of the handrail enhances dynamic stability, particularly during stair descent. Conclusions: This study provides the first detailed description of dynamic stability during stair ambulation with and without a handrail. Observations from those with FOF aid in understanding the nature of compensations to improve actual and perceived stability. (C) 2011 Elsevier B.V. All rights reserved.