Preparation for Future Care in Community-Dwelling Older Adults With Prefrailty and Frailty: Development and Pilot Test of a Digital Intervention.

Degenerative cervical myelopathy (DCM) is the most common cervical spine disorder encountered in the aging population []. Falls are disproportionately common among this group, thus accounting for a significant cost and resource burden to the healthcare system []. Individuals with DCM who experience falls are also at a greater risk of spinal cord injury and lifelong debilitation [,]. Due to progressive compression of the spinal cord, individuals with DCM present with neurological deterioration which commonly manifests as impaired gait [,]. Specifically, these individuals have reduced stride length, stride velocity, and prolonged stance phase duration compared to healthy controls [,]. Moreover, increased cervical kyphosis is a typical abnormal cervical alignment parameter observed in the setting of DCM []. Cervical kyphosis and spinal cord compression commonly co-exist and are rarely present independently [,]. Thus, the compounding effects of exaggerated head tilt as a result of cervical deformity may increase the risk of falling in individuals with DCM. Cervical deformity can be characterized by the degree of kyphosis (forward bending) or lordosis (backward bending) of the cervical spine []. The degree of kyphosis and lordosis has been correlated to overall health scores and myelopathy severity [–]. Additionally, patient-reported outcomes suggest that changes in cervical spine posture from values considered normal are associated with increased functional impairment and fall risk [,]. While perturbation-based balance training has been applied [], and perturbation-based assessments have characterized balance impairments in individuals with DCM [,], the effects of cervical posture on balance has yet to be objectively quantified, even in otherwise healthy individuals. Those with DCM often have comorbidities which can confound the relation between cervical posture and walking balance integrity. Thus, a critical first step that has yet to be taken is to study the effects of cervical posture on susceptibility to walking balance perturbations in healthy controls. Additionally, the influence of cervical immobilization itself on deformities is a longitudinal issue that can be challenging to observe and quantify in a well-controlled study. This becomes especially relevant in clinical practice where the only definitive treatment for DCM is surgery to decompress the spinal canal. Some studies have advocated for the restoration of cervical lordosis []. However, successful correction of cervical posture via surgical intervention is less definitive and a matter of controversy [,]. To this end, more objective data on cervical posture as it relates to walking balance is needed in order to guide clinical decision making.