Osteoporosis, Age, Parkinson’s decrease dynamic balance and increase fall risk

Motor abilities influence an individual’s success in the performance of certain motor skills (Magill & Anderson, 2013). A motor ability of interest is dynamic balance, or the ability to maintain stability while one is in motion, as there is a strong correlation between poor balance and falls (although it is not the only factor), which are a large health concern among many populations (Ünlüsoy et. al 2011). I have had many clients with various conditions, including age, Parkinson’s disease, and osteoporosis, who were unsteady during locomotion due to poor dynamic balance.

All three of these conditions, age, Parkinson’s disease, and osteoporosis, have a negative influence on the dynamic balance category of motor abilities (Paolucci et. al 2014; Ünlüsoy et. al 2011). Age-dependent change in the musculoskeletal, sensory, and neural systems decrease balance ability in older adults (Maki & Mcllroy, 1996). Parkinson’s disease occurs in the brain’s basal ganglia when there is a lack of dopamine production in the substantia nigra, and it causes bradykinesia, akinesia, tremor, and muscular rigidity (Magill & Anderson, 2013).  Paolucci et al. (2014) state that a “balance disorder is one of the most important impairments” in this population due to statistics showing substantially greater incidence of falls among those with PD (70% of individuals with PD fall once a year and 50% of them fall twice a year in comparison to only 30% of healthy adults over the age of 65 who fall once in a year). Osteoporosis is a bone disease where bones become increasingly fragile from microstructure impairments in the bone tissue and decreases in bone mass. Ünlüsoy et. al (2011) demonstrated that dynamic balance in osteoporotic women was significantly worse than in healthy individuals.

There are many factors influencing one’s ability for dynamic balance during locomotion including muscle strength, interpretation of vestibular and proprioceptive information, and visual feedback (Paolucci et. al 2014). In terms of defining dynamic balance or any type of balance as a motor ability, Magill and Anderson (2013) state balance is a “multidimensional ability that is specific to the task or skill in which balance is involved,” and the specificity of motor abilities hypothesis postulates that individual motor abilities are relatively independent of one another. Given these assumptions, it is challenging to articulate the specific balance ability or abilities influencing locomotion.

If a client or patient came to me requesting help with dynamic balance while walking, I would perform various tests to rule out (or in) factors that may contribute to difficulty walking. I would assess muscular strength and endurance, especially in the lower extremity, observe the patient’s normal walking gait for noticeable abnormalities, and inquire into the patient’s medical history to rule out diseases or conditions, including those previously discussed, that may impact dynamic balance. I would also question the patient about lifestyle factors (i.e., recent accident or trauma, change in medication, etc.) that may be contributing to the deficit. If the patient has good muscle strength in the lower extremity, adequate gait mechanics, and no red flags in his or her medical history, this would indicate a problem with the motor ability of dynamic balance.

Additional ideas of assessments for dynamic balance related to gait were reviewed in a study by Bloem et. al (2016). This study recommended clinical tests including the UPDRS-derived Postural Instability and Gait Difficulty score, Berg Balance Scale, Mini-BESTest, Dynamic Gait Index, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, Fear of Falling in the Elderly-Modified, 6-minute and 10-m walk tests, Timed Up-and-Go, and Functional Reach (Bloem et. al, 2016). Further research on my part is needed into these methods, but any would be reliable assessments of dynamic balance.

Motor abilities limit a person’s success in performing a motor skill. In the case discussed, dynamic balance is a motor ability that, if affected, can decrease one’s success at walking without falling. I believe it is important to note that while motor abilities may limit achievement in another skill, motor abilities themselves can be practiced, coached, and improved which would also benefit the motor skill performance. The most important part of treating a motor ability deficit is identifying and distinguishing it from other possible causes of poor motor skill performance.


Bloem, B. R., Marinus, J., Almeida, Q., Dibble, L., Nieuwboer, A., Post., B.,…Schrag, A. (2016). Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: Critique and recommendations (abstract only). Movement Disorders. doi:10.1002/mds.26572

Magill, R. A. & Anderson, D. I. (2013). Motor learning and control: Concepts and applications (10th ed.). New York, NY: McGraw Hill.

Maki, B. E. & Mcllroy, W. E. (1996). Postural control in the older adult (abstract only). Clinical Geriatric Medicine, 12(4), 635-58.

Nakano, W., Fukaya, T., Kobayashi, S., & Ohashi, Y. (2016).  Age effects on the control of dynamic balance during step adjustments under temporal constraints. Human Movement Science, 47, 29-37. doi:10.1016/j.humov.2016.01.015

Paolucci, T., Morone, G., Fusco, A., Giuliani, M., Rosati, E., Zangrando, F., & … Iosa, M. (2014). Effects of perceptive rehabilitation on balance control in patients with Parkinson’s disease. Neurorehabilitation, 34(1), 113-120. doi:10.3233/NRE-131024

Ünlüsoy, D., Aydoğ, E., Tuncay, R., Eryksel, R., Ünlüsoy, İ., & Çakcı, A. (2011). Postural Balance in Women with Osteoporosis and Effective Factors. Turkish Journal Of Osteoporosis / Turk Osteoporoz Dergisi, 17(2), 37-43.