Treadmill-Based Gait-Slip Training with Reduced Training Volume Could Still Prevent Slip-Related Falls (original) (raw)
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Journal of Biomechanics, 2018
The purpose of this pilot study was to establish the efficacy and feasibility of a single-session treadmill-based stance-slip perturbation program on preventing slip-related falls while walking over the ground among young adults. Two groups (training vs. control) of healthy young participants were respectively exposed to a treadmill-based stance-slip perturbation training protocol and a placebo training protocol. Post training, both groups experienced an unexpected overground gait-slip. Our results indicated that 28.6% of individuals in the training group and 55.0% of controls fell when responding to the overground slip. In comparison with the control group, the training group exhibited better control over the compensatory step and dynamic stability at the instant immediately prior to recovery touchdown. The improved dynamic stability control in the training group likely resulted from the enhanced capability of harnessing the slip kinematics of the base of support. Dynamic stability did not display any significant group-associated difference at slipping foot touchdown and recovery foot liftoff. This implies that a stance-slip perturbation training protocol with eight slips may not provide enough and very task-specific incentive to the Central Nervous System to form the capability of sufficiently modifying regular gait pattern after an unexpected gait slip. However, given its ease of use, stance-perturbation could be a practical option to train individuals in clinical settings as a simple push or pull could exert a perturbation to a standing individual. The findings from this study provide information for developing future studies based on large-scale samples.
BMJ Open, 2022
IntroductionFalls 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 analysis140 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 accelerati...
Effect of walking surface perturbation training on slip propensity and local dynamic stability
Work: A Journal of Prevention, Assessment and …, 2012
The objective of the current study was to evaluate the effect of walkway perturbation training on human dynamic walking stability and slip propensity. A new walkway perturbation training program was developed using an instrumented, split-belt treadmill. Walkway surface perturbation was composed of multiple, randomized perturbation pulses. Each pulse was created by sudden accelerating the treadmill belt underneath the dominant foot briefly. Five healthy older adults were involved in a laboratory study. An inertial measurement unit was attached to the subject's low back region to record 3D acceleration. Maximum Lyapunov exponent (maxLE) and transitional acceleration of whole body center of mass (TA_COM) were computed to quantify the local dynamic stability and slip propensity, respectively. The results indicated a significant training effect on both maxLE and TA_COM. It was concluded that the walkway perturbation training program significantly improved local dynamic stability and reduced slip propensity.
Effects of Moveable Platform Training in Preventing Slip-Induced Falls in Older Adults
Annals of Biomedical Engineering, 2012
Identifying effective interventions is vitalin preventing slip-induced fall accidents in older adults. The purpose of the current study was to evaluate the efficacy of moveable platform training in improving recovery reactions and reducing fall frequency in older adults. Twenty-four older adults were recruited and randomly assigned to two groups (training and control). Both groups underwent three sessions including baseline slip, training, and transfer of training on a slippery surface. Both groups experienced two slips on a slippery surface, one during the baseline and the other (after two weeks) during the transfer of training session. In the training session, the training group underwent twelve simulated slips using a moveable platform while the control group performed normal walking trials. Kinematic, kinetic, and EMG data were collected during all the sessions. Results indicated a reduced incidence of falls in the training group during the transfer of training trial as compared to the control group. The training group was able to transfer proactive and reactive control strategies learned during training to the second slip trial. The proactive adjustments include increased center-of-mass velocity and transitional acceleration after training. Reactive adjustments include reduction in muscle onset and time to peak activations of knee flexors and ankle plantarflexors, reduced ankle and knee coactivation, reduced slip displacement, and reduced time to peak knee flexion, trunk flexion, and hip flexion velocities. In general, the results indicated a beneficial effect of perturbation training in reducing slip severity and recovery kinematics in healthy older adults.
BMC Geriatrics
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 blockrandomization 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 perturbationbased treadmill training effects in a clinical setting towards improving daily life gait stability and reducing fall risk and falls.
Journal of Biomechanics, 2000
The purpose of the present study was to induce slips in healthy subjects as a means to determine if recovery from an induced slip is possible under conditions in which the displacements and velocities of the slipping foot exceed the generally accepted limits of 10 cm and 50 cm/s, respectively, and to determine if there are gait-related variables that predispose an individual to falling after a slip. Thirty-three young and barefoot adults, protected by an instrumented safety harness, were subjected to a single slipping trial following a series of unperturbed walking trials. The slip was induced when the bare foot contacted a vinyl sheet coated with mineral oil. Lower extremity kinematics were acquired using a video-based motion capture system. Fourteen and 12 subjects could be unambiguously categorized as having fallen or recovered, respectively. Four variables demonstrated signi"cant between-group di!erences and two were used to compute the probability of the slip outcome using logistic regression. The variables were the displacement of the foot during the slip and the angle of the shank relative to the ground at the instant of ground contact just prior to the slip. Separate univariate logistic regressions using each variable were signi"cant and correctly classi"ed about 70% of the slip outcomes. The results demonstrated that previously published values for the displacement and velocity of the slipping foot, 10 cm and 50 cm/s, respectively, may not accurately represent the upper limits beyond which recovery is not possible. The results also demonstrated that heel-strike angle, re#ective of stride length, exerts a signi"cant in#uence on the outcome of a slip.
Effects of age-related gait changes on the biomechanics of slips and falls
2003
A laboratory study was conducted to examine gait changes associated with aging and the effect of these changes on initiation of slips and frequency of falls utilizing newly defined biomechanical parameters of slips and falls. Twenty-eight participants from two age groups (young and old) walked around a circular track at a comfortable pace wearing a safety harness. A slippery floor surface was placed on the walking track over the force plate at random time intervals without the participants' awareness. Synchronized kinetic and kinematic measurements were obtained on both slippery and non-slippery walking surfaces. The results indicated that older participants' horizontal heel contact velocity was significantly faster, step length was significantly shorter, and transitional acceleration of the whole body centre-of-mass (COM) was significantly slower than younger participants. Older participants' initial friction demand, as measured by required coefficient of friction (RCOF), was not significantly different than their younger counterparts. Additionally, older participants slipped longer and faster, and fell more often than younger participants. A comparison of horizontal heel contact velocity for participants who fell with participants who did not fall indicated that, in general, fallers' horizontal heel contact velocity was faster than non-fallers. However, a comparison of RCOF for participants who fell with participants who did not fall suggested that RCOF was not a totally deterministic factor influencing actual fall events. These findings suggest that gait changes associated with aging (especially higher horizontal heel contact velocity and slower transition of the whole body COM) affect initiation of slip-induced falls.
International Journal of Kinesiology and Sport Science , 2019
Background: Slips and falls account for high rates of injury and mortality in multiple populations. The corrective responses during the slip perturbation have been well documented. However, when a fall results from a slip, it is unclear which of these responses were inadequate. Objective: The purpose of this study was to examine differences in lower extremity corrective responses of the slip recovery response between individuals who fall and those who recover. Methodology: Sixty-four participants completed this study (32 males & 32 females). Participant's gait kinematics and kinetics were collected during normal gait (NG) and an unexpected slip (US). A prediction equation for slip outcome and slip severity were created using a binary logistic regression model. Results: Our findings show an increased time to peak hip extension (OR = 1.006, CI: 1.000-1.011) and ankle dorsiflexion (OR = 1.005, CI: 1.001-1.009) moments increased the odds of falling, while the average ankle moment was negatively associated with falling (OR = 0.001, CI: 0.001-0.005). Conclusions: Rapid lower extremity corrective responses appear critical in arresting the slip and preventing a fall. While there are various strategies for slip recovery, our findings suggest that the primary recovery mechanism at the slipping hip may play a vital role in preventing the fall.
PloS one, 2018
The primary study aim was to determine if repeated exposure to trips and slips with increasing unpredictability while walking can improve balance recovery responses when predictive gait alterations (e.g. slowing down) are minimised. The secondary aim was to determine if predictive gait alterations acquired through exposure to perturbations at a fixed condition would transfer to highly unpredictable conditions. Ten young adults were instructed to step on stepping tiles adjusted to their usual step length and to a metronome adjusted to their usual cadence on a 10-m walkway. Participants were exposed to a total of 12 slips, 12 trips and 6 non-perturbed trials in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) random leg and location. Kinematics during non-perturbed trials and pre- and post-perturbation steps were analysed. Throughout the three conditions, participants walked with similar gait speed, step length and cadence(p>0.05). Participants' ...