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Nørgaard JE, Andersen S, Ryg J, Andreasen J, Oliveira ADSC, Stevenson AJT, Danielsen MBB, Jorgensen MG. 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. BMJ Open 2024; 14:e080550. [PMID: 39117404 DOI: 10.1136/bmjopen-2023-080550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
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.
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Affiliation(s)
- Jens Eg Nørgaard
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jane Andreasen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- Aalborg Health and Rehabilitation Center, Aalborg Municipality, Aalborg, Denmark
| | | | | | - Mathias Brix Brix Danielsen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
| | - Martin Gronbech Jorgensen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg Universitet, Aalborg, Denmark
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Hezel N, Brüll L, Arampatzis A, Schwenk M. Acceptability of Two Perturbation-Based Balance Training Paradigms: Perturbation Treadmill versus Dynamic Stability Training in the Presence of Perturbations. Gerontology 2024; 70:661-668. [PMID: 38565079 DOI: 10.1159/000538105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/18/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Perturbation-based balance training (PBT) is promising for fall prevention in older adults, mimicking real-life fall situations at a person's stability thresholds to improve reactive balance. Hence, it can be associated with anxiety, but knowledge about the acceptability of PBT is scarce. METHOD This is a secondary analysis of a randomized controlled trial comparing the effects of two different PBT paradigms that aims to evaluate and compare the acceptability of those training paradigms in fall-prone older adults. Participants (74.9 ± 5.7 years) who completed the training (6 weeks, 3x/week) on either a perturbation treadmill (PBTtreadmill: n = 22) or unstable surfaces in the presence of perturbations (PBTstability: n = 27) were surveyed on the acceptability of PBT using a 21-item questionnaire addressing seven domains (perceived effectiveness, tailoring, demand, safety, burden, devices, affective attitude), based on the theoretical framework of acceptability and context-specific factors. Relative scores (% of absolute maximum) for single items and domains were calculated. RESULTS Median domain scores of perceived effectiveness, tailoring, safety, devices, and affective attitude were all ≥70% for both paradigms. The highest scores were obtained for tailoring (both paradigms = 100% [interquartile range 80-100%]). Domain scores of demand and burden were in the medium range (40-45%) for both paradigms. No significant differences between paradigms were found for any domain score. Two single items of safety differed significantly, with PBTtreadmill perceived as needing less support (p = 0.015) and leading less often to balance loss (p = 0.026) than PBTstability. CONCLUSION PBT conducted on a perturbation treadmill or unstable surfaces is well accepted in this fall-prone older sample, even though it is conducted at individual stability thresholds. Tailoring may play a key role in achieving high levels of perceived effectiveness, appropriate levels of demand and burden, and a high sense of safety. PBT delivered on treadmills might be more appropriate for more anxious persons.
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Affiliation(s)
- Natalie Hezel
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany,
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany,
| | - Leon Brüll
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
- Department of Sport Science, Human Performance Research Center, University of Konstanz, Konstanz, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Rieger MM, Papegaaij S, Steenbrink F, van Dieën JH, Pijnappels M. Effects of Perturbation-Based Treadmill Training on Balance Performance, Daily Life Gait, and Falls in Older Adults: REACT Randomized Controlled Trial. Phys Ther 2024; 104:pzad136. [PMID: 37805994 PMCID: PMC10802992 DOI: 10.1093/ptj/pzad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/01/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of perturbation-based treadmill training on gait quality in daily life, a predictor of fall risk that was used as the primary outcome. An additional aim was to evaluate the effects on secondary outcomes, including balance, gait performance, self-efficacy, daily life physical activity, and falls. METHODS Seventy community-dwelling older adults (mean age = 74.73 [SD = 5.69] years; 46 women) at risk of falling were randomized and received 4 weeks of dual-task treadmill training, either with or without treadmill perturbations. Balance, gait performance, self-efficacy, and daily life trunk accelerometry at baseline, after intervention, and at a 6-month follow-up were assessed and compared within group over time and between groups for each time point, and their change rates between groups over time were also assessed. RESULTS Both groups improved in their balance, gait performance, and self-efficacy; the experimental group showed a significantly larger decrease in concern of falling and an increase in physical performance than the controls. These training effects did not translate into significant improvements in daily life gait quality or physical activity. However, the number of daily life falls and the percentage of fallers decreased significantly more in the experimental group. CONCLUSION A 4-week perturbation-based dual-task treadmill training program can improve self-efficacy, balance, and gait performance in a controlled setting and reduce daily life falls, although not through changes in quantity or quality of daily life gait. IMPACT Perturbation-based treadmill training is a safe and efficient way to train older adults' balance recovery and gait performance, increase self-efficacy, and prevent falls.
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Affiliation(s)
- Markus M Rieger
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Motek Medical B.V., Houten, Amsterdam, The Netherlands
| | | | | | - Jaap H van Dieën
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Whitten J, O’Leary B, Graham D, Grocke-Dewey M, Riley J, Harper D, Tarabochia D. The Acceptability of a Community-Based Perturbation-Based Balance Training to Older Adults and Healthcare Professionals. Gerontol Geriatr Med 2024; 10:23337214241246843. [PMID: 38628166 PMCID: PMC11020748 DOI: 10.1177/23337214241246843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Perturbation-based balance training (PBT) is a promising fall risk reduction method that involves inducing unexpected perturbations to balance to train participants reactive balance control. Due to the unpredictable nature of PBT, its acceptability to older adults could present a barrier to the implementation of PBT in the community. Aim/Purpose: The purpose of this study was to assess the perceived acceptability of a community-based PBT program to both older adults and healthcare professionals (HCPs). Methods: Nineteen older adults (aged 69.6 ± 6.6 years, 17 women, 2 men) and three HCPs participated in the qualitative study. Participants completed four PBT sessions facilitated in conjunction with HCPs. Interviews, based on the theoretical framework of acceptability, were conducted before and after PBT and analyzed using template analysis. Results: PBT was perceived as effective by older adults and HCPs. However, HCPs perceived the equipment cost as a substantial barrier to feasibility in the community.
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Affiliation(s)
- Justin Whitten
- Montana State University, Bozeman, USA
- Institute of Translational Health Sciences, Seattle, USA
- Griffith University, Gold Coast, Queensland, Australia
| | | | - David Graham
- Montana State University, Bozeman, USA
- Griffith University, Gold Coast, Queensland, Australia
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Pelicioni PHS, Lord SR, Menant JC, Chaplin C, Canning C, Brodie MA, Sturnieks DL, Okubo Y. Combined Reactive and Volitional Step Training Improves Balance Recovery and Stepping Reaction Time in People With Parkinson's Disease: A Randomised Controlled Trial. Neurorehabil Neural Repair 2023; 37:694-704. [PMID: 37864439 PMCID: PMC10666522 DOI: 10.1177/15459683231206743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND Falls are frequent and devastating events for people with Parkinson's disease (PD). Here, we investigated whether laboratory-based reactive step training combined with home-based volitional step training was effective in improving balance recovery and stepping ability in people with PD. METHODS Forty-four people with idiopathic PD were randomized into intervention or control groups. Intervention participants performed unsupervised volitional step training using home-based exergames (80+ minutes/week) for 12 weeks and attended reactive step training sessions in which they were exposed to slip and trip perturbations at 4 and 8 weeks. Control participants continued their usual activities. Primary outcomes were balance recovery following an induced-trip/slip and choice stepping reaction time (CSRT) at the 12-week reassessment. Secondary outcomes comprised sensorimotor, balance, cognitive, psychological, complex stepping (inhibitory CSRT and Stroop Stepping Test [SST]), gait measures, and falls experienced in everyday life. RESULTS At reassessment, the intervention group had significantly fewer total laboratory-induced falls and faster CSRT compared to the control group (P < .05). The intervention group also had significantly faster inhibitory CSRT and SST movement times and made fewer mistakes in the SST (P < .05). There were no significant differences in the rate of every day falls or other secondary outcome measures between the groups. CONCLUSION Combined volitional and reactive step training improved balance recovery from an induced-perturbation, voluntary stepping time, and stepping accuracy in cognitively challenging tests in people with PD. Further research is required to determine whether such combined step training can prevent daily-life falls in this population.
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Affiliation(s)
- Paulo H. S. Pelicioni
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
- School of Health Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
| | - Jasmine C. Menant
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Collen Canning
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Matthew A. Brodie
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, NSW, Australia
| | - Daina L. Sturnieks
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Biomedical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Yoshiro Okubo
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
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Hezel N, Sloot LH, Wanner P, Becker C, Bauer JM, Steib S, Werner C. Feasibility, effectiveness and acceptability of two perturbation-based treadmill training protocols to improve reactive balance in fall-prone older adults (FEATURE): protocol for a pilot randomised controlled trial. BMJ Open 2023; 13:e073135. [PMID: 37666555 PMCID: PMC10481747 DOI: 10.1136/bmjopen-2023-073135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Perturbation-based balance training (PBT) targets the mechanism of falls (eg, slipping, tripping) to specifically train the recovery actions needed to avoid a fall. This task-specific training has shown great promise as an effective and efficient intervention for fall prevention in older adults. However, knowledge about the dose-response relationship of PBT, as well as its feasibility and acceptability in older adults with increased risk of falling is still limited. Thus, the aim of this study is to compare the effectiveness of two different treadmill PBT protocols for improving reactive balance control in fall-prone older adults, and to evaluate the feasibility and acceptability of these protocols. METHODS AND ANALYSIS The study is designed as a pilot randomised controlled trial with a 6-week intervention and 6-week follow-up period. Thirty-six community-dwelling, fall-prone (Timed Up and Go >12 s, habitual gait speed <1.0 m/s and/or fall history) older adults will be randomised (1:1) to receive six (weeks 1-6) or two treadmill PBT sessions (weeks 1+6) plus four conventional treadmill training sessions (weeks 2-5). Training sessions are conducted 1×/week for 30 min. Each PBT will include 40 perturbations in anterior-posterior and mediolateral directions. Reactive balance after perturbations in standing (Stepping Threshold Test (STT)) and walking (Dynamic Stepping Threshold Test (DSTT)) will be assessed as the primary outcome for effectiveness. Secondary outcomes are spatiotemporal and kinematic parameters collected during STT, DSTT and PBT, maximum perturbation magnitude for each PBT session, static and dynamic balance, physical capacity, physical activity, concerns with falling and executive functions. Feasibility will be assessed via training adherence, drop-out rate, perturbations actually performed and adverse events; and acceptability via self-designed questionnaire and focus groups. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Medical Faculty Heidelberg (S-602/2022). Findings will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER DRKS00030805.
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Affiliation(s)
- Natalie Hezel
- Geriatric Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Lizeth H Sloot
- Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Philipp Wanner
- Institute for Sports and Sports Science, Heidelberg University, Heidelberg, Germany
| | - Clemens Becker
- Unit of Digital Geriatric Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Simon Steib
- Institute for Sports and Sports Science, Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- Geriatric Center, Heidelberg University Hospital, Heidelberg, Germany
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Pelicioni PH, Chan LL, Shi S, Wong K, Kark L, Okubo Y, Brodie MA. Impact of mobile phone use on accidental falls risk in young adult pedestrians. Heliyon 2023; 9:e18366. [PMID: 37701410 PMCID: PMC10493431 DOI: 10.1016/j.heliyon.2023.e18366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Mobile phone use is known to be a distraction to pedestrians, increasing their likelihood of crossing into oncoming traffic or colliding with other people. However, the effect of using a mobile phone to text while walking on gait stability and accidental falls in young adults remains inconclusive. This study uses a 70 cm low friction slip hazard and the threat of hazard to investigate the effects of texting while walking on gait stability, the ability to recover balance after a slip hazard and accidental falls. Methods Fifty healthy young adults performed six walking tasks, and one seated texting task in random order. The walks were conducted over a 10-m walkway. Four progressive hazard levels were used: 1) Seated; 2) Normal Walk (walking across the walkway with no threat of a slip); 3) Threat (walking with the threat of a slip); and 4) Slip (walking with an actual 70 cm slip hazard). The three walking conditions were repeated twice with and without the mobile phone texting dual-task. Gait kinematics and trunk posture were recorded using wearable sensors attached to the head, trunk, pelvis and feet. Study outcomes were analyzed using repeated measures analysis of variance with significance set to P≤.05. Results Mobile phone use significantly impaired postural balance recovery when slipping, as demonstrated by increased trunk sway. Mobile phone use negatively impacted gait stability as demonstrated by increased step time variability and decreased harmonic ratios. Increased hazard levels also led to reduced texting accuracy. Conclusions Using a mobile phone to text while walking may compete with locomotor tasks, threat assessment and postural balance control mechanisms, which leads to an increased risk of accidental falls in young adults. Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a "texting lock" on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist.
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Affiliation(s)
- Paulo H.S. Pelicioni
- School of Health Sciences, University of New South Wales, Kensington Campus, NSW 2052, Australia
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
| | - Lloyd L.Y. Chan
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, NSW, Australia
| | - Shuotong Shi
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Kenny Wong
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Yoshiro Okubo
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, NSW, Australia
| | - Matthew A. Brodie
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
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Gerards M, Marcellis R, Senden R, Poeze M, de Bie R, Meijer K, Lenssen A. The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial. BMC Geriatr 2023; 23:305. [PMID: 37198543 DOI: 10.1186/s12877-023-03988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/22/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Perturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling. METHODS Community-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill belt accelerations and decelerations and platform perturbations (shifts and tilts) were applied during standing and walking on the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV). This dual-belt treadmill embedded in a motion platform with 6 degrees of freedom is surrounded by a 180° screen on which virtual reality environments are projected. Duration and contents of the training were standardised, while training progression was individualised. Fear of falling (FES-I) and balance control (Mini-BESTest) were assessed at baseline and one week post-intervention. Primary analysis compared changes in outcome measures between groups using Mann-Whitney U tests. RESULTS Eighty-two participants were included (PBT group n = 39), with a median age of 73 years (IQR 8 years). Median Mini-BESTest scores did not clinically relevantly improve and were not significantly different between groups post-intervention (p = 0.87). FES-I scores did not change in either group. CONCLUSIONS Participation in a PBT program including multiple perturbation types and directions did not lead to different effects than usual care on clinical measures of balance control or fear of falling in community-dwelling older adults with a recent history of falls. More research is needed to explore how to modulate PBT training dose, and which clinical outcomes are most suitable to measure training effects on balance control. TRIAL REGISTRATION Nederlands Trial Register NL7680. Registered 17-04-2019 - retrospectively registered. https://www.trialregister.nl/trial/7680 .
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Affiliation(s)
- Marissa Gerards
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Rik Marcellis
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Rachel Senden
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, division of Trauma Surgery, MUMC+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Rob de Bie
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Antoine Lenssen
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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10
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Brüll L, Hezel N, Arampatzis A, Schwenk M. Comparing the Effects of Two Perturbation-Based Balance Training Paradigms in Fall-Prone Older Adults: A Randomized Controlled Trial. Gerontology 2023; 69:910-922. [PMID: 36921581 DOI: 10.1159/000530167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION There is increasing evidence that perturbation-based balance training (PBT) is highly effective in preventing falls at older age. Different PBT paradigms have been presented so far, yet a systematic comparison of PBT approaches with respect to feasibility and effectiveness is missing. Two different paradigms of PBT seem to be promising for clinical implementation: (1) technology-supported training on a perturbation treadmill (PBTtreadmill); (2) training of dynamic stability mechanisms in the presence of perturbations induced by unstable surfaces (PBTstability). This study aimed to compare both program's feasibility and effectiveness in fall-prone older adults. METHODS In this three-armed randomized controlled trial, seventy-one older adults (74.9 ± 6.0 years) with a verified fall risk were randomly assigned into three groups: PBTtreadmill on a motorized treadmill, PBTstability using unstable conditions such as balance pads, and a passive control group (CG). In both intervention groups, participants conducted a 6-week intervention with 3 sessions per week. Effects were assessed in fall risk (Brief-BEST), balance ability (Stepping Threshold Test, center of pressure, limits of stability), leg strength capacity, functional performance (Timed Up and Go Test, Chair-Stand), gait (preferred walking speed), and fear of falling (Short FES-I). RESULTS Fifty-one participants completed the study. Training adherence was 91% for PBTtreadmill and 87% for PBTstability, while no severe adverse events occurred. An analysis of covariance with an intention-to-treat approach revealed statistically significant group effects in favor of PBTstability in the Brief-BEST (p = 0.009, η2 = 0.131) and the limits of stability (p = 0.020, η2 = 0.110) and in favor of PBTtreadmill in the Stepping Threshold Test (p < 0.001, η2 = 0.395). The other outcomes demonstrated no significant group effects. CONCLUSION Both training paradigms demonstrated high feasibility and were effective in improving specific motor performances in the fall-prone population and these effects were task specific. PBTtreadmill showed higher improvements in reactive balance, which might have been promoted by the unpredictable nature of the included perturbations and the similarity to the tested surface perturbation paradigm. PBTstability showed more wide-ranging effects on balance ability. Consequently, both paradigms improved fall risk-associated measures. The advantages of both formats should be evaluated in light of individual needs and preferences. Larger studies are needed to investigate the effects of these paradigms on real-life fall rates.
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Affiliation(s)
- Leon Brüll
- Network Aging Research, Heidelberg University, Heidelberg, Germany,
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany,
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany,
| | - Natalie Hezel
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
- Department of Sport Science, Human Performance Research Center, University of Konstanz, Konstanz, Germany
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11
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Okubo Y, Mohamed Suhaimy MSB, Hoang P, Chaplin C, Hicks C, Sturnieks D, Lord S. Training reactive balance using trips and slips in people with multiple sclerosis: a blinded randomised controlled trial. Mult Scler Relat Disord 2023; 73:104607. [PMID: 37004274 DOI: 10.1016/j.msard.2023.104607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND This study examined the feasibility and efficacy of reactive balance training for improving stepping performance and reducing laboratory-induced falls in people with multiple sclerosis (MS). METHODS Thirty people diagnosed with MS (18-70 years) participated in a blinded randomized controlled trial (ACTRN12618001436268). The intervention group (n = 14) underwent two 50-minute sessions (total 100 min) that exposed them to a total of 24 trips and 24 slips in mixed order, over one week. The control group (n = 16) received sham training (stepping over foam obstacles) with equivalent dosage. The primary outcome was falls into the harness (defined as >30% body weight) when exposed to trips and slips that were unpredictable in timing, location and type at post-assessment. Physical and psychological measures were also assessed at baseline and post assessments. RESULTS The intervention and control groups completed 86% and 95% of the training protocols respectively. Incidence rate ratios (95% confidence intervals) of the intervention group relative to the control group were 0.57 (0.25, 1.26) for all falls, 0.80 (0.30, 2.11) for slip falls and 0.20 (0.04, 0.96) for trip falls in the laboratory. Kinematic analyses indicated the intervention participants improved dynamic stability, with higher centre of mass position and reduced trunk sway during recovery steps following a trip, compared to control. There were no significant differences between the intervention and control participants at post-assessment for other secondary outcome measures. CONCLUSIONS Reactive balance training improved trip-induced dynamic stability, limb support, trunk control and reduced falls in people with MS. More research is required to optimise the training protocol and determine whether the beneficial effects of reactive balance training can be retained long term and generalize to fewer daily-life falls.
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12
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Devasahayam AJ, Farwell K, Lim B, Morton A, Fleming N, Jagroop D, Aryan R, Saumur TM, Mansfield A. The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. Phys Ther 2022; 103:pzac154. [PMID: 37651698 DOI: 10.1093/ptj/pzac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/11/2022] [Accepted: 08/19/2022] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events. METHODS Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of RBT were included. The literature search was limited to the English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. RESULTS Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to RBT groups were less likely to fall compared with control groups (fall risk ratio = 0.76; 95% CI = 0.63-0.92; I2 = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45-0.83; I2 = 81%). Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%). CONCLUSION RBT reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in RBT than control groups. IMPACT Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training. LAY SUMMARY If you are an older adult and/or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life.
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Affiliation(s)
| | - Kyle Farwell
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Bohyung Lim
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Abigail Morton
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Fleming
- École de Readaptation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- École de Kinésiologie et de Loisir, Université de Moncton, Moncton, New Brunswick, Canada
| | - David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Raabeae Aryan
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Mitchell Saumur
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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13
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Jagroop D, Houvardas S, Danells CJ, Kochanowski J, French E, Salbach NM, Musselman K, Inness EL, Mansfield A. Rehabilitation clinicians' perspectives of reactive balance training. Disabil Rehabil 2022; 44:7967-7973. [PMID: 34812700 DOI: 10.1080/09638288.2021.2004246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Reactive balance training (RBT) aims to improve reactive balance control. However, because RBT involves clients losing balance, clinicians may view that it is unsafe or not feasible for some clients. We aimed to explore how clinicians implement RBT to treat balance and mobility issues. MATERIALS AND METHODS Physiotherapists and kinesiologists across Canada who reported that they include RBT in their practices were invited to complete telephone interviews about their experiences with RBT. Interviews were transcribed verbatim, and analysed using a deductive thematic analysis. RESULTS Ten participants completed telephone interviews, which lasted between 30-60 min. Participants primarily worked in a hospital setting (inpatient rehabilitation (n = 3); outpatient rehabilitation (n = 2)), and were treated clients with neurological conditions (n = 5). Four main themes were identified: 1) there is variability in RBT approaches; 2) knowledge can be a barrier and facilitator to RBT; 3) reactive balance control is viewed as an advanced skill; and 4) RBT experience builds confidence. CONCLUSIONS Our findings suggest a need for resources to make clinical implementation of RBT more feasible.Implications for rehabilitationTrust between the therapist and client improves self-efficacy and feelings of apprehension/fear when conducting reactive balance training.Being creative and improvising with equipment that is readily available in clinics enables reactive balance training, without the need for high-tech equipment.Clinicians should consider using standardized tools with reactive balance control components, such as the Balance Evaluation Systems Test or Performance Oriented Mobility Assessment, to assess balance control.
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Affiliation(s)
- David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Esmé French
- Northwestern Ontario Regional Stroke Network, Thunder Bay, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Faculty of Kinesiology, University of Toronto, Toronto, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
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14
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Ferreira RN, Ribeiro NF, Figueiredo J, Santos CP. Provoking Artificial Slips and Trips towards Perturbation-Based Balance Training: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9254. [PMID: 36501958 PMCID: PMC9740792 DOI: 10.3390/s22239254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/29/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Humans' balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients' fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients' reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT's effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community.
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Affiliation(s)
- Rafael N. Ferreira
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
| | - Nuno Ferrete Ribeiro
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
- MIT Portugal Program, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal
| | - Joana Figueiredo
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
| | - Cristina P. Santos
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
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15
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Lee Y, Alexander NB, Madigan ML. A proposed methodology for trip recovery training without a specialized treadmill. Front Sports Act Living 2022; 4:1003813. [PMID: 36479551 PMCID: PMC9719936 DOI: 10.3389/fspor.2022.1003813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
Falls are the leading cause of accidental injuries among adults aged 65 years and older. Perturbation-based balance training is a novel exercise-based fall prevention intervention that has shown promise in reducing falls. Trip recovery training is a form of perturbation-based balance training that targets trip-induced falls. Trip recovery training typically requires the use of a specialized treadmill, the cost of which may present a barrier for use in some settings. The goal of this paper is to present a methodology for trip recovery training that does not require a specialized treadmill. A trial is planned in the near future to evaluate its effectiveness. If effective, non-treadmill trip recovery training could provide a lower cost method of perturbation-based balance training, and facilitate greater implementation outside of the research environment.
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Affiliation(s)
- Youngjae Lee
- Grado Department of Industrial and Systems Engineering (0118), Virginia Tech, Blacksburg, VA, United States
| | - Neil B. Alexander
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States
| | - Michael L. Madigan
- Grado Department of Industrial and Systems Engineering (0118), Virginia Tech, Blacksburg, VA, United States
- Department of Biomedical Engineering and Mechanics (0298), Virginia Tech, Blacksburg, VA, United States
- *Correspondence: Michael L. Madigan
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16
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McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, Okubo Y. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living 2022; 4:1015394. [PMID: 36275443 PMCID: PMC9583884 DOI: 10.3389/fspor.2022.1015394] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tanvi S. Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Marissa H. G. Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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17
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Kaewmanee T, Liang H, Madrid KC, Aruin AS. Older adults utilize less efficient postural adaptations when they are uncertain about the magnitude of a perturbation. Hum Mov Sci 2022; 85:102996. [PMID: 36049269 DOI: 10.1016/j.humov.2022.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/04/2022]
Abstract
People frequently experience perturbations while standing or walking in crowded areas or when interacting with external objects. Balance maintenance in response to a perturbation is affected by the predictability of the magnitude of a body disturbance. The aim of this quasi-experimental study was to investigate the role of aging in maintenance of standing balance in response to perturbations of varying magnitudes. Twelve older adults and twelve young adults received a series of frontal perturbations of small or large magnitudes induced to their upper body by a pendulum impact while standing. The perturbation sequence included 10 trials of small, 15 trials of large, and 10 more trials of small magnitudes. The participants were exposed to either repetitive perturbations of known (predictable) magnitude or perturbations of unknown (unpredictable) magnitude as they were not told which of the perturbation magnitude (small, large) to expect. Electromyographic activity of six leg and trunk muscles and displacements of the center of pressure were recorded and analyzed during anticipatory (APAs) and compensatory (CPAs) phases of postural control. When exposed to both, repetitive perturbations of known magnitude and perturbations of unpredictable magnitude, older adults, compared to young adults, demonstrated delayed and smaller anticipatory and compensatory postural adaptations. Older adults also required more trials to modify postural adjustments, as compared to young adults. The findings imply that the ability to predict magnitudes of frontal perturbations is declined in older adults.
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Affiliation(s)
- Tippawan Kaewmanee
- PhD Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, USA
| | - Huaqing Liang
- School of Physical Therapy, Marshall University, Huntington, WV, USA
| | - Katya Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexander S Aruin
- PhD Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.
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18
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Okubo Y, Duran L, Delbaere K, Sturnieks DL, Richardson JK, Pijnappels M, Lord SR. Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study. J Geriatr Phys Ther 2022; 45:160-166. [PMID: 34320534 DOI: 10.1519/jpt.0000000000000312] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips. METHODS Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls. RESULTS Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls. CONCLUSION Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
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Affiliation(s)
- Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - Lionne Duran
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
- UNSW Medicine, Sydney, New South Wales, Australia
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19
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Betelli MT, de Oliveira JÁ, Coelho DB, Teixeira LA. Judokas Show Increased Resilience to Unpredictable Stance Perturbations. Percept Mot Skills 2022; 129:513-527. [PMID: 35379021 DOI: 10.1177/00315125221087581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Combat sports are characterized by frequent large-scale stance perturbations that may lead to falls. In the present investigation, we compared compensatory arm and leg movements in response to unpredictable stance perturbations between judokas and other athletes whose sports present reduced balance demand, relative to combat sports. Specifically, we tested judokas (n = 9), and a group of swimmers and runners (n = 11, controls) in sudden support base displacements in the mediolateral direction, generated by a movable electronic platform, in the following modes: (a) rotation, (b) translation, and (c) combined rotation-translation. The platform was displaced to either side, in three peak velocities (cm/second or o/second) of 20 (low), 30 (moderate), or 40 (high), resulting in 18 distinct perturbations. We evaluated postural responses with a scale for analyzing the stability of compensatory arm and leg movements (CALM). Results showed that, in the most challenging perturbations, judokas had higher stability scores (arm, leg, and global) than did the comparison group. Higher scores for judokas reflected their increased rate of motionless arm and leg responses and absence of near-falls, compared to 30% falls in the most challenging perturbations for the swimmers and runners. As a practical application, judo training may help achieve stable compensatory limb movements in a way that parallels the benefits obtained from perturbation-based balance training in laboratory settings.
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Affiliation(s)
- Marina T Betelli
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
| | - Julia Á de Oliveira
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
| | - Daniel B Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil.,Center for Engineering, Modeling and Applied Social Sciences (CECS), 74362Federal University of ABC, São Paulo, Brazil
| | - Luis A Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
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20
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Borrelli J, Creath R, Westlake K, Rogers MW. Test-retest reliability of the FALL FIT system for assessing and training protective arm reactions in response to a forward fall. MethodsX 2022; 9:101702. [PMID: 35518921 PMCID: PMC9062354 DOI: 10.1016/j.mex.2022.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
The use of the hands and arms is an important protective mechanism in avoiding fall-related injury. The aim of this study was to evaluate the test-retest reliability of fall dynamics and evokd protective arm response kinematics and kinetics in forward falls simulated using the FALL simulator For Injury prevention Training and assessment system (FALL FIT). Fall FIT allows experimental control of the fall height and acceleration of the body during a forward fall. Two falls were simulated starting from 4 initial lean angles in Experiment 1 and with 4 different fall accelerations in Experiment 2. Fourteen younger adults (25.1±3.5 years) and 13 older adults (71.3±3.7 years) participated in Experiment 1 and 13 younger adults (31.8±5.7 years) participated in Experiment 2. Intraclass correlation coefficients (ICC) were used to the evaluate absolute agreement of single measures at each condition and averages across conditions. Average measures of fall dynamics and evoked kinematics and kinetics exhibited excellent reliability (ICC(A,4)>0.86). The reliability of single measures (ICC(A,1) > 0.59) was good to excellent, although 18% of single measures had a reliability (ICC(A,1)) between 0.00 and 0.57. The FALL FIT was shown to have good to excellent reliability for most measures. FALL FIT can produce a wide range of fall dynamics through modulation of initial lean angle and body acceleration. Additionally, the range of fall velocities and evoked kinematics and kinetics are consistent with previous fall research.The FALL FIT can be used to gain further insight into the control of protective arm reactions and may provide a therapeutic tool to assess and train protective arm reactions.
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21
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Nørgaard JE, Andersen S, Ryg J, Stevenson AJT, Andreasen J, Danielsen MB, Oliveira ADSC, Jørgensen MG. 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. BMJ Open 2022; 12:e052492. [PMID: 35131823 PMCID: PMC8823198 DOI: 10.1136/bmjopen-2021-052492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Jens Eg Nørgaard
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
| | | | - Jane Andreasen
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
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22
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Borrelli J, Creath R, Westlake K, Rogers MW. Age-related changes in protective arm reaction kinematics, kinetics, and neuromuscular activation during evoked forward falls. Hum Mov Sci 2022; 81:102914. [PMID: 34923206 PMCID: PMC8895474 DOI: 10.1016/j.humov.2021.102914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Fall related injuries in older adults are a major healthcare concern. During a fall, the hands and arms play an important role in minimizing trauma from ground impact. Although older adults are able to orient the hands and arms into a protective orientation after falling and prior to ground impact, an inability to avoid increased body impact occurs with age. Previous investigations have generally studied rapid arm movements in the pre-impact phase or absorbing energy in the post-impact phase. There are no known studies that have directly examined both the pre-impact and post-impact phase in sequence in a forward fall. The aim of this study was to identify age-related biomechanical and neuromuscular changes in evoked arm reactions in response to forward falls that may increase fall injury risk. Fourteen younger and 15 older adults participated. Falls were simulated while standing with torso and legs restrained via a moving pendulum system from 4 different initial lean angles. While there was not a significant age-related difference in the amount of energy absorbed post-impact (p = 0.68), older adults exhibited an 11% smaller maximum vertical ground reaction force when normalized to body weight (p = 0.031), and 8 degrees less elbow extension at impact (p = 0.045). A significant interaction between age and initial lean angle (p = 0.024), indicated that older adults required 54%, 54%, 41%, and 57% greater elbow angular displacement after impact at the low, medium, medium-high, and high initial lean angles compared to younger adults. These results suggested older adults may be at greater risk of increased body impact due to increased elbow flexion angular displacement after impact when the hands and arms are able to contact the ground first. Both groups exhibited robust modulation to the initial lean angle with no observed age-related differences in the initial onset timing or amplitude of muscle activation levels. There were no significant age-related differences in the EMG timing, amplitude or co-activation of muscle activation preceding impact or following impact indicating comparable neuromotor response patterns between older and younger adults. These results suggest that aging changes in muscular elements may be more implicated in the observed differences than changes in neuromuscular capacity. Future work is needed to test the efficacy of different modalities (e.g. instruction, strength, power, perturbation training, fall landing techniques) aimed at reducing fall injury risk.
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Affiliation(s)
- James Borrelli
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA.
| | - Robert Creath
- Lebanon Valley College, Exercise Science Department, Annville, PA, USA
| | - Kelly Westlake
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
| | - Mark W Rogers
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Sciences, Baltimore, MD, USA
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23
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Kim Y, Vakula MN, Bolton DAE, Dakin CJ, Thompson BJ, Slocum TA, Teramoto M, Bressel E. Which Exercise Interventions Can Most Effectively Improve Reactive Balance in Older Adults? A Systematic Review and Network Meta-Analysis. Front Aging Neurosci 2022; 13:764826. [PMID: 35115917 PMCID: PMC8804322 DOI: 10.3389/fnagi.2021.764826] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/24/2021] [Indexed: 01/07/2023] Open
Abstract
BackgroundReactive balance is the last line of defense to prevent a fall when the body loses stability, and beneficial effects of various exercise-based interventions on reactive balance in older adults have been reported. However, their pooled evidence on the relative effects has yet to be described.ObjectiveTo review and evaluate the comparative effectiveness of various exercise-based interventions on reactive balance in older adults.MethodsNine electronic databases and reference lists were searched from inception to August 2021. Eligibility criteria according to PICOS criteria were as follows: (1) population: older adults with the mean age of 65 years or above; (2) intervention and comparison: at least two distinct exercise interventions or one exercise intervention with a no-exercise controlled intervention (NE) compared in each trial; (3) outcome: at least one measure of reactive balance; (4) study: randomized controlled trial. The main network meta-analysis was performed on data from the entire older adult population, involving all clinical conditions as well as healthy older adults. Subgroup analyses stratified by characteristics of participants (healthy only) and reactive balance outcomes (simulated slip or trip while walking, simulated forward falls, being pushed or pulled, and movable platform) were also conducted.ResultsThirty-nine RCTs (n = 1388) investigating 17 different types of exercise interventions were included in the network meta-analysis. Reactive balance training as a single intervention presented the highest probability (surface under the cumulative ranking (SUCRA) score) of being the best intervention for improving reactive balance and the greatest relative effects vs. NE in the entire sample involving all clinical conditions [SUCRA = 0.9; mean difference (95% Credible Interval): 2.7 (1.0 to 4.3)]. The results were not affected by characteristics of participants (i.e., healthy older adults only) or reactive balance outcomes.Summary/ConclusionThe findings from the NMA suggest that a task-specific reactive balance exercise could be the optimal intervention for improving reactive balance in older adults, and power training can be considered as a secondary training exercise.
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Affiliation(s)
- Youngwook Kim
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
- *Correspondence: Youngwook Kim
| | - Michael N. Vakula
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Christopher J. Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Brennan J. Thompson
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Timothy A. Slocum
- Department of Special Education and Rehabilitation Counseling, Utah State University, Logan, UT, United States
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Eadric Bressel
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
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24
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Mohamed Suhaimy MSB, Lord SR, Hoang PD, Nieto A, Sturnieks DL, Okubo Y. Reactive balance responses to a trip and slip during gait in people with multiple sclerosis. Clin Biomech (Bristol, Avon) 2021; 90:105511. [PMID: 34710843 DOI: 10.1016/j.clinbiomech.2021.105511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To examine reactive balance responses to a trip and slip during gait in people with multiple sclerosis (MS). METHODS This cross-sectional laboratory study involved 29 participants with MS (50.6 ± 13.4 years) and 29 gender-and-aged-matched healthy controls (50.9 ± 19.2 years). Falls following an induced trip and slip along a 10 m walkway, approach (e.g. gait speed, step length, foot contact angle) and recovery strategies (e.g. response time, extrapolated centre of mass position, margin of stability) were compared between the two groups. FINDINGS The rate of falls was significantly higher in the participants with MS relative to healthy controls (rate ratio=2.82, 95% confidence interval [CI]=1.42, 5.61). Participants with MS also experienced more trip falls (odds ratio [OR]=3.90, 95% CI=1.16, 13.08) and more slip falls (OR=6.27, 95% CI=1.95, 20.22) than the heathy controls. Participants with MS had significantly slower gait speed, step length, cadence, and foot contact angle during approach (P < 0.05). Following slips, participants with MS had significantly greater stance limb knee flexion (P < 0.05), suggesting inadequate lower limb support to recover balance post-slip. Following trips, participants with MS had significantly delayed response initiation, lower toe clearance, shorter step length, and greater trunk sway (P < 0.05). Fewer participants with MS showed a hopping response to clear the obstacle (P < 0.05). INTERPRETATION Multiple sclerosis impairs reactive balance responses to a trip and slip associated with reduced lower limb function and delayed postural responses. Neurorehabilitation targeting reactive balance may facilitate fall prevention in people with multiple sclerosis.
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Affiliation(s)
| | - Stephen R Lord
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Phu D Hoang
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Alex Nieto
- Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA 01609, United States
| | - Daina L Sturnieks
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Yoshiro Okubo
- Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Sydney, NSW 2052, Australia; Falls, Balance, and Injury Research Centre, Neuroscience Research, 139 Barker Street, Randwick, NSW 2031, Australia.
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25
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Grabiner MD, Kaufman KR. Developing and Establishing Biomechanical Variables as Risk Biomarkers for Preventable Gait-Related Falls and Assessment of Intervention Effectiveness. Front Sports Act Living 2021; 3:722363. [PMID: 34632378 PMCID: PMC8492908 DOI: 10.3389/fspor.2021.722363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023] Open
Abstract
The purpose of this review is to position the emerging clinical promise of validating and implementing biomechanical biomarkers of falls in fall prevention interventions. The review is framed in the desirability of blunting the effects of the rapidly growing population of older adults with regard to the number of falls, their related injuries, and health care costs. We propose that biomechanical risk biomarkers may be derived from systematic study of the responses to treadmill-delivered perturbations to both identify individuals with a risk of specific types of falls, such as trips and slips as well as quantifying the effectiveness of interventions designed to reduce that risk. The review follows the evidence derived using a specific public health approach and the published biomedical literature that supports trunk kinematics as a biomarker as having met many of the criteria for a biomarker for trip-specific falls. Whereas, the efficacy of perturbation training to reduce slip-related falls by older adults appears to have been confirmed, its effectiveness presently remains an open and important question. There is a dearth of data related to the efficacy and effectiveness of perturbation training to reduce falls to the side falls by older adults. At present, efforts to characterize the extent to which perturbation training can reduce falls and translate the approaches to the clinic represents an important research opportunity.
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Affiliation(s)
- Mark D Grabiner
- Biomechanics and Clinical Biomechanics Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - K R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
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26
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Soh SLH, Tan CW, Thomas JI, Tan G, Xu T, Ng YL, Lane J. Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls. J Frailty Sarcopenia Falls 2021; 6:131-138. [PMID: 34557612 PMCID: PMC8419849 DOI: 10.22540/jfsf-06-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Abstract
Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual’s perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.
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Affiliation(s)
- Shawn Leng-Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.,Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
| | - Chee-Wee Tan
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Janet I Thomas
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
| | - Gideon Tan
- Department of Sport and Exercise Science, School of Sports, Health and Leisure, Republic Polytechnic, Singapore
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Yoke Leng Ng
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.,Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Judith Lane
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, United Kingdom
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27
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Song PYH, Sturnieks DL, Davis MK, Lord SR, Okubo Y. Perturbation-Based Balance Training Using Repeated Trips on a Walkway vs. Belt Accelerations on a Treadmill: A Cross-Over Randomised Controlled Trial in Community-Dwelling Older Adults. Front Sports Act Living 2021; 3:702320. [PMID: 34490425 PMCID: PMC8417700 DOI: 10.3389/fspor.2021.702320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway. Method: Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip. Results: No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks (P < 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT (P < 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed (P < 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip. Conclusions: This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.
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Affiliation(s)
- Patrick Y H Song
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Michael K Davis
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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28
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Gill-Body KM, Hedman LD, Plummer L, Wolf L, Hanke T, Quinn L, Riley N, Kaufman R, Verma A, Quiben M, Scheets P. Movement System Diagnoses for Balance Dysfunction: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force. Phys Ther 2021; 101:6307337. [PMID: 34160028 DOI: 10.1093/ptj/pzab153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
UNLABELLED The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. IMPACT The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention.
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Affiliation(s)
| | - Lois D Hedman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Plummer
- Physical Therapy Department, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Leslie Wolf
- Outpatient Neurologic Rehabilitation, OhioHealth, Columbus, Ohio, USA
| | - Timothy Hanke
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Nora Riley
- Physical Therapy Department, St. Ambrose University, Davenport, Iowa, USA
| | - Regina Kaufman
- Department of Physical Therapy, Springfield College, Springfield, Massachusetts, USA
| | - Akanshka Verma
- Inpatient Rehabilitation Unit & Acute Neurology Service, New York- Presbyterian Hospital, New York, New York, USA
| | - Myla Quiben
- Department of Physical Therapy, School of Health Professions, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Patricia Scheets
- Quality & Clinical Outcomes, Infinity Rehab, Wilsonville, Oregon, USA
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29
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Koppelaar H, Kordestani-Moghadam P, Kouhkani S, Irandoust F, Segers G, de Haas L, Bantje T, van Warmerdam M. Proof of Concept of Novel Visuo-Spatial-Motor Fall Prevention Training for Old People. Geriatrics (Basel) 2021; 6:66. [PMID: 34210015 PMCID: PMC8293049 DOI: 10.3390/geriatrics6030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Falls in the geriatric population are one of the most important causes of disabilities in this age group. Its consequences impose a great deal of economic burden on health and insurance systems. This study was conducted by a multidisciplinary team with the aim of evaluating the effect of visuo-spatial-motor training for the prevention of falls in older adults. The subjects consisted of 31 volunteers aged 60 to 92 years who were studied in three groups: (1) A group under standard physical training, (2) a group under visuo-spatial-motor interventions, and (3) a control group (without any intervention). The results of the study showed that visual-spatial motor exercises significantly reduced the risk of falls of the subjects.
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Affiliation(s)
- Henk Koppelaar
- Faculty of Electric and Electronic Engineering, Mathematics and Computer Science, Delft University of Technology, 2628 CD Delft, The Netherlands
| | | | - Sareh Kouhkani
- Department of Mathematics, Islamic University Shabestar Branch, Shabestar, Iran;
| | - Farnoosh Irandoust
- Department of Ophtalmology, Lorestan University of Medical Sciences, Korramabad, Iran;
| | - Gijs Segers
- Gymi Sports & Visual Performance, 4907 BC Oosterhout, The Netherlands;
| | - Lonneke de Haas
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
| | - Thijmen Bantje
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
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30
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Soh SLH, Lane J, Gleeson N, Xu T, Bte Abdul Rahman F, Yeh TT, Soon B, Tan CW. Validation of a new patient-reported outcome measure of balance recovery confidence (BRC) for community-dwelling older adults: a study protocol. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1938867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shawn Leng-Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Judith Lane
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Nigel Gleeson
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | | | - Ting-Ting Yeh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Benjamin Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Chee-Wee Tan
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK
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Mumba MN, Nacarrow AF, Cody S, Key BA, Wang H, Robb M, Jurczyk A, Ford C, Kelley MA, Allen RS. Intensity and type of physical activity predicts depression in older adults. Aging Ment Health 2021; 25:664-671. [PMID: 31948269 DOI: 10.1080/13607863.2020.1711861] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
UNLABELLED This study examined whether various levels of physical activity among older adults predicted levels of depression and whether there were racial differences in the levels and types of physical activities engaged in by adults aged 50 and older. METHOD Data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed for 2,474 adults aged 50 years and older. Variables of focus were demographics, physical activity and depression, assessed using the Physical Activity Questionnaire and the Mental Health - Depression Screener. RESULTS There was a significant positive relationship between income and depression; individuals with higher income had lower levels of depression. Simple linear regression revealed income significantly predicted depression scores, b = -.20, F(1, 2296) = 96.35, p < .001, explaining 4% of the variance, R2 = .04. As age increased, all levels of physical activity declined, regardless of the category. Vigorous recreation-related activity and moderate recreation-related activity each made significant, unique contributions to depression scores. CONCLUSION Findings from the current study suggest that physical activity interventions should be culturally appropriate and tailored to the needs and abilities of individual older adults to maximize benefits and minimize adverse events, particularly among community dwelling older adults.
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Affiliation(s)
- Mercy Ngosa Mumba
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Alexandra F Nacarrow
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA.,Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shameka Cody
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Betty A Key
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Hui Wang
- Institute for Rural Health Research, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - MacKenzie Robb
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Abigail Jurczyk
- Department of Biology, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Cassandra Ford
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Mary Ann Kelley
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Rebecca S Allen
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Okubo Y, Schoene D, Caetano MJD, Pliner EM, Osuka Y, Toson B, Lord SR. Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests. Ageing Res Rev 2021; 66:101238. [PMID: 33352293 DOI: 10.1016/j.arr.2020.101238] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
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Rogers MW, Creath RA, Gray V, Abarro J, McCombe Waller S, Beamer BA, Sorkin JD. Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 76:e194-e202. [PMID: 33491052 DOI: 10.1093/gerona/glab017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. METHODS Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. RESULTS Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07-0.90], IST 0.44 [0.18-1.08], and HST 0.30 (0.10-0.91). CONCLUSIONS Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%-74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.
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Affiliation(s)
- Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US.,Department of Exercise Science, Lebanon Valley College, Annville, Pennsylvania, US
| | - Vicki Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Janice Abarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Brock A Beamer
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
| | - John D Sorkin
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
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Lee A, Bhatt T, Liu X, Wang Y, Wang S, Pai YCC. Can Treadmill Slip-Perturbation Training Reduce Longer-Term Fall Risk Upon Overground Slip Exposure? J Appl Biomech 2020; 36:298-306. [PMID: 32843581 PMCID: PMC8344091 DOI: 10.1123/jab.2019-0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 04/23/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
The purpose was to examine and compare the longer-term generalization between 2 different practice dosages for a single-session treadmill slip-perturbation training when reexposed to an overground slip 6 months later. A total of 45 older adults were conveniently assigned to either 24 or 40 slip-like treadmill perturbation trials or a third control group. Overground slips were given immediately after initial training, and at 6 months after initial training in order to examine immediate and longer-term effects. The performance (center of mass stability and vertical limb support) and fall percentage from the laboratory-induced overground slips (at initial posttraining and at 6 mo) were measured and compared between groups. Both treadmill slip-perturbation groups showed immediate generalization at the initial posttraining test and longer-term generalization at the 6-month retest. The higher-practice-dosage group performed significantly better than the control group (P < .05), with no difference between the lower-practice-dosage and the control groups at the 6-month retest (P > .05). A single session of treadmill slip-perturbation training showed a positive effect for reducing older adults' fall risk for laboratory-induced overground slips. A higher-practice dosage of treadmill slip perturbations could be more beneficial for further reducing fall risk.
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Affiliation(s)
- Anna Lee
- University of Illinois at Chicago
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Elkarif V, Kandel L, Rand D, Schwartz I, Greenberg A, Portnoy S. Kinematics following gait perturbation in adults with knee osteoarthritis: Scheduled versus not scheduled for knee arthroplasty. Gait Posture 2020; 81:144-152. [PMID: 32888553 DOI: 10.1016/j.gaitpost.2020.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare recovery kinematics following trip-simulated perturbation during gait between three groups: adults without knee Osteoarthritis (OA) and adults with OA, scheduled and not scheduled for Total Knee Replacement (TKR). METHODS People with OA scheduled for TKR (TKR group; N = 19) and not scheduled (NTKR group; N = 17) were age-matched with People without OA (N = 19). Outcome measures included: joint range of motion (ROM), Timed Up and Go (TUG), joint pain levels, Oxford score, Instrumental Activities of Daily Living Questionnaire, and the Activities-specific Balance Confidence Scale. Also, spatiotemporal gait parameters and joint kinematics were recorded during perturbed and unperturbed gait. The perturbed gait data were normalized by unperturbed gait data. RESULTS There were no differences between the two OA groups in the four questionnaire scores and joint ROM. The TUG score of the TKR group was higher than that of the NTKR group. There were no statistically significant between-group differences in the normalized spatiotemporal parameters. The OA groups showed statistically significant lower anterior pelvic tilt ranges and higher maximal hip adduction of the contralateral limb compared to the Non-OA group. When the contralateral limb was perturbed, the TKR group showed significantly lower pelvic rotation range compared to the NTKR and Non-OA groups. When the OA limb was perturbed, the maximal hip flexion of the injured limb was significantly lower and the maximal knee flexion higher in the OA groups compared with the Non-OA group. CONCLUSION The recovery strategy from trip-simulated perturbation of individuals with OA differs from that of individuals without OA. This may emphasize the importance of devising a treatment plan that focuses on improving balance and reactions to gait perturbation.
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Affiliation(s)
- Vicktoria Elkarif
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Kandel
- Department of Orthopaedics Department, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isabella Schwartz
- Department of Physical and Medicine Rehabilitation, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Alexander Greenberg
- Department of Orthopaedics Department, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Sigal Portnoy
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hicks GE. Addressing Balance, Mobility, and Falls: Are We Moving the Needle on Fall Prevention? J Gerontol A Biol Sci Med Sci 2020; 74:1487-1488. [PMID: 30892593 DOI: 10.1093/gerona/glz064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark
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Mohamed Suhaimy MSB, Okubo Y, Hoang PD, Lord SR. Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2020; 34:675-685. [PMID: 32507036 DOI: 10.1177/1545968320929681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P < .0001, I2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P < .0001, I2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times (P < .001) and training effects on response times could be retained for 24 hours (P < .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.
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Affiliation(s)
| | - Yoshiro Okubo
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Phu D Hoang
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Stephen R Lord
- University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia, Sydney, New South Wales, Australia
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Rieger MM, Papegaaij S, Steenbrink F, van Dieën JH, Pijnappels M. Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling: protocol for the REACT randomized controlled trial. BMC Geriatr 2020; 20:167. [PMID: 32380950 PMCID: PMC7203817 DOI: 10.1186/s12877-020-01566-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/22/2020] [Indexed: 01/02/2023] Open
Abstract
Background The European population is rapidly ageing. There is an urgent need for innovative solutions to reduce fall risk in older adults. Perturbation-based gait training is a promising new method to improve reactive balance responses. Whereas positive effects on task-specific dynamic balance recovery during gait have been shown in clinical or laboratory settings, translation of these effects to daily life gait function and fall risk is limited. We aim to evaluate the effect of a 4-week perturbation-based treadmill training on daily-life dynamic gait stability, assessed with inertial sensor data. Secondary outcomes are balance recovery performance, clinical balance and gait assessment scores, the amount of physical activity in daily life and falls incidence during 6 months follow-up. Methods The study is a monocenter assessor-blinded randomized controlled trial. The target study sample consists of 70 older adults of 65 years and older, living in the community and with an elevated risk of falling. A block-randomization to avoid seasonal effects will be used to allocate the participants into two groups. The experimental group receives a 4-week, two times per week perturbation-based gait training programme on a treadmill, with simulated slips and trips, in combination with cognitive dual tasks. The control group receives a 4-week, two times per week treadmill training programme under cognitive dual-task conditions without perturbations. Participants will be assessed at baseline and after the 4-weeks intervention period on their daily-life gait stability by wearing an inertial sensor on the lower back for seven consecutive days. In addition, clinical balance and gait assessments as well as questionnaires on falls- and gait-efficacy will be taken. Daily life falls will be followed up over 6 months by a fall calendar. Discussion Whereas perturbation-based training has shown positive effects in improving balance recovery strategies and in reducing laboratory falls, this study will contribute to investigate the translation of perturbation-based treadmill training effects in a clinical setting towards improving daily life gait stability and reducing fall risk and falls. Trial registration NTR7703 / NL66322.028.18, Registered: January 8, 2019; Enrolment of the first participant April 8, 2019.
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Affiliation(s)
- Markus M Rieger
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.,Motek Medical BV, Hogehilweg 18C, 1101 CD, Amsterdam, The Netherlands
| | - Selma Papegaaij
- Motek Medical BV, Hogehilweg 18C, 1101 CD, Amsterdam, The Netherlands
| | - Frans Steenbrink
- Motek Medical BV, Hogehilweg 18C, 1101 CD, Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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High contextual interference in perturbation-based balance training leads to persistent and generalizable stability gains of compensatory limb movements. Exp Brain Res 2020; 238:1249-1263. [PMID: 32303810 DOI: 10.1007/s00221-020-05806-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/07/2020] [Indexed: 01/03/2023]
Abstract
Reactive responses to balance perturbations have been shown to be improved by training. This investigation aimed to compare the effects of block and random training perturbation schedules on stability gains of compensatory arm and leg movements in response to unpredictable large-magnitude balance perturbations. Perturbations were produced by means of sudden displacements of the support base, associating mode (rotation, translation, combined), direction, and velocity of platform motion. Healthy young participants were assigned to one of three groups: random, block, and control. For the random group, perturbation sequence was unpredictable. For the block group, each balance perturbation was repeated over blocks of four trials. Controls were tested only, serving as reference of first trial responses in the post-test. Evaluation was made through a scale rating stability of compensatory arm and leg movements (CALM). We probed immediate and persistence gains (1-week retention), in addition to generalizability to perturbations of higher velocity and to dual-tasking (mental subtraction). In the post-test both the block and random groups achieved higher leg and global scores in comparison with controls in the most challenging perturbations. In retention and transfer tests, results for the global score indicated higher values for the random than for the block and control groups. These results support the conclusion that high but not low contextual interference in perturbation-based balance training leads to enduring and generalizable increased stability gains of compensatory limb movements in response to unpredictable balance perturbations.
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König M, Epro G, Seeley J, Potthast W, Karamanidis K. Retention and generalizability of balance recovery response adaptations from trip perturbations across the adult life span. J Neurophysiol 2019; 122:1884-1893. [DOI: 10.1152/jn.00380.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
For human locomotion, varying environments require adjustments of the motor system. We asked whether age affects gait balance recovery adaptation, its retention over months, and the transfer of adaptation to an untrained reactive balance task. Healthy adults (26 young, 27 middle-aged, and 25 older; average ages 24, 52, and 72 yr, respectively) completed two tasks. The primary task involved treadmill walking: either unperturbed (control; n = 39) or subject to unexpected trip perturbations (training; n = 39). A single trip perturbation was repeated after a 14-wk retention period. The secondary transfer task, before and after treadmill walking, involved sudden loss of balance in a lean-and-release protocol. For both tasks, the anteroposterior margin of stability (MoS) was calculated at foot touchdown. For the first (i.e., novel) trip, older adults required one more recovery step ( P = 0.03) to regain positive MoS compared with younger, but not middle-aged, adults. However, over several trip perturbations, all age groups increased their MoS for the first recovery step to a similar extent (up to 70%) and retained improvements over 14 wk, although a decay over time was found for older adults ( P = 0.002; middle-aged showing a tendency for decay: P = 0.076). Thus, although adaptability in reactive gait stability control remains effective across the adult life span, retention of adaptations over time appears diminished with aging. Despite these robust adaptations, the perturbation training group did not show superior improvements in the transfer task compared with age-matched controls (no differences in MoS changes), suggesting that generalizability of acquired fall-resisting skills from gait-perturbation training may be limited. NEW & NOTEWORTHY The human neuromotor system preserves its adaptability across the adult life span. However, although adaptability in reactive gait stability control remains effective as age increases, retention of recovery response adaptations over time appears to be reduced with aging. Furthermore, acquired fall-resisting skills from single-session perturbation training seem task specific, which may limit the generalizability of such training to the variety of real-life falls.
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Affiliation(s)
- Matthias König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - John Seeley
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
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Karamanidis K, Epro G, McCrum C, König M. Improving Trip- and Slip-Resisting Skills in Older People: Perturbation Dose Matters. Exerc Sport Sci Rev 2019; 48:40-47. [DOI: 10.1249/jes.0000000000000210] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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