The relationships among fear of falling, conscious motor processing, balance ability and risk of falling in older adults: Implications for rehabilitation

Abstract

Walking is the most common fall-related activity in older adults (Lai et al., 2009). Healthy adults are mostly capable of walking and executing a wide range of movement skills automatically, but may use conscious motor processing to ensure the effectiveness of their movements when encountering difficulties. Owing to fear of falling or an awareness of movement difficulties, older adults may try to consciously monitor and control their movements during walking to ensure that the movements are performed correctly. Conscious motor processing utilizes knowledge and strategies that are explicitly processed in working memory (Baddeley, 1994). The process of switching from automatic motor processing to conscious explicit motor processing has been called “reinvestment” (Masters, 1992). Masters (1992) defined reinvestment as “an inward focus of attention in which an attempt is made to perform the skill by consciously processing explicit knowledge of how it works”. Masters et al. (2005) subsequently developed a Movement Specific Reinvestment Scale (MSRS), which measures an individual’s propensity for ‘reinvestment’. The scale assesses two separate factors (i) movement self-consciousness and (ii) conscious motor processing. Higher scores represent a greater propensity for conscious motor processing. Our research team initially found that high fear of falling in older adults was associated with poor balance and high propensity to reinvest (Wong & Masters, 2005). Subsequently, we discovered that older fallers have a higher propensity to consciously process their movements (i.e., reinvest) than age-matched non-fallers (Wong et al., 2008). Conscious control of movements by internal focus of attention may lead to movement disruption, possibly by constraining or interfering with automatic motor control mechanisms (Wulf et al., 2001; McNevin et al., 2003). Focusing internally may not only have the effect of disrupting natural motor coordination but may also reduce the allocation of or interfere with the attention to negotiating the environment, further increasing the risk of falling of the older adults. Additionally, older fallers were also found to have higher tendency to divide their attention between the external environment and internal mechanisms of their movements, especially under stress, while older non-fallers focus externally during walking (Wong et al., 2009). Efforts to attend both internal and external information by the older fallers may overload resources in the working memory (Baddeley, 1994) which may in return influence negatively on movement control. This talk summarizes the novel evidence of the relationships among fear of falling, conscious motor processing (i.e., reinvestment), balance ability and risk of falling in older adults. Potential practical implications and rehabilitation methods to ameliorate the predisposition to reinvest during gait training of the older fallers by Physiotherapists are discussed. The utilization of the theory of reinvestment in different disease groups for people with movement difficulties, for example Stroke and Parkinson’s diseases, are also reviewed.