Validation of the Wii Balance Board to assess static balance during dual-task activity in healthy subjects

Perturbation-based balance training of older adults and effects on physiological, cognitive and sociopsychological factors: a secondary analysis from a randomised controlled trial with 12-month follow-up

BACKGROUND

Perturbation-based balance training (PBT) has shown promising, although diverging, fall-preventive effects; however, the effects on important physical, cognitive and sociopsychological factors are currently unknown. The study aimed to evaluate these effects on PBT at three different time points (post-training, 6-months and 12-months) in community-dwelling older adults compared with regular treadmill walking.

METHODS

This was a preplanned secondary analysis from a randomised, controlled trial performed in Aalborg, Denmark, between March 2021 and November 2022. Community-dwelling older adults aged ≥65 were randomly assigned to participate in four sessions (lasting 20 min each) of either PBT (intervention) or regular treadmill walking (control). All participants were assigned to four testing sessions: pretraining, post-training, 6-month follow-up and 12-month follow-up. At these sessions, physical, cognitive and sociopsychological measures were assessed.

RESULTS

In total, 140 participants were randomly allocated to either the PBT or control group. Short-term (pretraining to post-training) between-group differences were seen for choice stepping reaction time (-49 ms, 95% CI -80 to -18), dual-task gait speed (0.05 m/s, 95% CI 0.01 to 0.09) favouring the PBT group. However, these improvements were not sustained at the 6-month and 12-month follow-up. No significant between-group differences were found in other physical, cognitive or sociopsychological factors.

CONCLUSIONS

This study showed that PBT, in the short term, improved choice stepping reaction time and dual-task gait speed among community-dwelling older adults. Yet, these improvements were not retained for 6- or 12-months. The healthy state of the study's population may have imposed a ceiling effect limiting the ability to show any clinically relevant effects of PBT.

TRIAL REGISTRATION NUMBER

NCT04733222.

Effects of treadmill slip and trip perturbation-based balance training on falls in community-dwelling older adults (STABILITY): study protocol for a randomised controlled trial

INTRODUCTION

Falls among older adults are most frequently caused by slips and trips and can have devastating consequences. Perturbation-based balance training (PBT) have recently shown promising fall preventive effects after even small training dosages. However, the fall preventive effects of PBT delivered on a treadmill are still unknown. Therefore, this parallel-group randomised controlled trial aims to quantify the effects of a four-session treadmill-PBT training intervention on falls compared with treadmill walking among community-dwelling older adults aged 65 years or more.

METHODS AND ANALYSIS

140 community-dwelling older adults will be recruited and randomised into either the treadmill-PBT or the treadmill walking group. Each group will undergo three initial training sessions within a week and an additional 'booster' session after 26 weeks. Participants in the treadmill-PBT group will receive 40 slip and/or trip perturbations induced by accurately timed treadmill belt accelerations at each training session. The primary outcome of interest is daily life fall rates collected using fall calendars for a follow-up period of 52 weeks. Secondary outcomes include physical, cognitive and social-psychological fall-related risk factors and will be collected at the pre-training and post-training test and the 26-week and 52-week follow-up tests. All outcomes will be analysed using the intention-to-treat approach by an external statistician. A Poisson's regressions with bootstrapping, to account for overdispersion, will be used to compare group differences in fall rates.

ETHICS AND DISSEMINATION

The study protocol has been approved by the North Denmark Region Committee on Health Research Ethics (N-20200089). The results will be disseminated in peer-reviewed journals and at international conferences.

TRIAL REGISTRATION NUMBER

NCT04733222.

The influence of cognitive load on static balance in chronic obstructive pulmonary disease patients

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) may demonstrate cognitive function and balance deterioration. These two phenomena are often realized simultaneously during daily living activities, where the risk of falling may be increased due to possible postural disturbance when focusing on a cognitive task during motion. Despite the high rate of falls in COPD, there is currently a lack of affordable clinical instruments to quantify the interaction between cognitive tasks and static balance in these patients. Therefore, this study aims to assess the balance perturbation induced by cognitive tasks using a new cost-effective protocol which can easily be implemented in clinical settings.

METHOD

A total of 21 COPD patients (Age: 64 ± 8 yrs, Forced Expiratory Volume in one second = 41 ± 17%, Women: 7) and 21 matched healthy controls participated in the study. They performed two cognitive tasks (counting backward by 3s and naming animals) with eyes open and with eyes closed. Each trial lasted 60 s, with balance-related parameters recorded and quantified using a Wii Balance Board. A three-way ANOVA (cognitive task, eyes action, and health status) for balance-related parameters derived from the center of pressure displacement was performed.

RESULTS

COPD, vision, and cognitive tasks altered the balance; no interaction between conditions was observed. There was no correlation between cognitive ability, respiratory function, and the balance-related parameters.

CONCLUSION

Compared to healthy controls, the COPD patients had impaired balance. Cognitive tasks altered postural control in both COPD and controls, where this alteration was more pronounced with eyes closed.