Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health



First Advisor

Dr. Graham D. Rowles


The problem of falls in old age is enormously costly and disruptive for the older individual, others, and society, and its severity is likely to intensify as our population ages. This dissertation takes a systems-oriented approach toward the falls problem and is presented in two parts. The first part critically develops a new approach to the problem of falls. The second part describes an empirical study that applies this new approach in a pragmatic manner.

Conventional fall prevention strategies employ a reductionist approach to the problem of falls. This approach is questioned because it corresponds poorly to the holistic nature of postural control. A systems-oriented conceptual framework explains postural instability in old age as the gradual decline of a postural control system’s ability to adapt.

Realizing that falls arise from a complex system of interacting components of various levels and domains makes it imperative to investigate interventions aimed toward systemically fostering robust postural control. A dynamic systems theoretical framework is outlined that views postural control to be the result of synergies which function to control myriad inherent degrees of freedom. Complexity-based measures of postural sway are suggested as indicators of postural control system robustness.

This new approach to the problem of falls is applied in an empirical study in which Tai Chi serves as a systems-oriented intervention. Using a dynamic systems perspective, motor imagery, along with other Tai Chi principles, are hypothesized to provide interacting physical and cognitive constraints on motor behavior that form synergies which enable robust postural stability into old age.

This hypothesis was tested in a quasi-experiment comparing effects of Tai Chi motor imagery in Tai Chi experts and non-experts. The expected significant effects on postural sway complexity were not found, but significant main effects and interactions on sway variability and ease of imagery were discovered with respect to expertise and imagery type. Findings, results, innovations, implications and future directions are presented, and discussed as they pertain to four specific aims, and to ameliorating the problem of falls in old age.

Digital Object Identifier (DOI)