Individual, task, and environmental influences on balance recovery: a narrative review of the literature and implications for preventing occupational falls. Issue 2 (3rd April 2019) - Komisar, Vicki
OCCUPATIONAL APPLICATIONS: Balance recovery is a complex, multi-factorial task. When examining occupational environments for fall safety hazards, practitioners must be aware of how a worker's ability to recover from balance loss and avoid a fall depends on their unique individual characteristics, the task they are performing, and their work environment. Balance recovery can be negatively affected by factors related to the individual (e.g., aging, obesity, arthritis, low back pain, fatigue, and peripheral neuropathies); the task (e.g., holding objects or performing multiple tasks); and the environment (e.g., slopes or stairs). Conversely, balance recovery can be enhanced by exposure to balance disturbances in the context of perturbation training, and by environmental design (e.g., appropriately-designed handrails). By understanding how individual, task, and environmental factors influence balance recovery and overall fall risk, occupational health and safety practitioners will be in a stronger position to design and implement safety controls to prevent occupational slips, trips, and falls. TECHNICAL ABSTRACT Rationale: Falls are a leading cause of injuries in occupational environments. Several factors related to the individual, the work task, and the work environment can influence a person's ability to recover from balance loss and avoid a fall. Understanding how individual, task, and environmental factors affect balance recovery is important for ergonomic practitioners, engineers, managers and researchers, when developing appropriate solutions for preventing falls and improving the safety of the workplace. Purpose: This paper aims to provide a comprehensive, critical review of the individual, task, and environmental factors that influence balance recovery, and their implications for preventing falls in occupational environments. Methods: In this narrative review, we outline physical characteristics of balance recovery reactions, and describe how balance recovery depends on individual, task, and environmental factors. Results: Balance recovery can be negatively affected by individual (e.g., aging; obesity; musculoskeletal disorders; fatigue; peripheral neuropathies), task (e.g., holding small objects), and environmental (e.g., slopes; stairs) factors. Balance recovery can be enhanced by exposure to perturbations (in the context of perturbation training), and by environmental design (e.g., appropriately-designed handrails). Discussion: Several individual, task, and environmental factors must be considered when examining occupational fall risk. This risk can be mitigated through design, including installing appropriate handrails. Perturbation training shows promise as a fall prevention tool with clinical populations, but requires validation with healthy populations. As most of the published balance recovery literature involves laboratory studies of healthy (and mostly young) adults, future studies should examine balance recovery more directly in occupational contexts, particularly with subsets of the population who are under-represented in this literature.