Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling: protocol for the REACT randomized controlled trial (original) (raw)
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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...
BMC Geriatrics, 2016
Background: Falls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls. Methods: In a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions over 3 months that included unexpected perturbation of balance exercises during treadmill walking. The control group performed treadmill walking with no perturbations. The primary outcome measures were the voluntary step execution times, traditional postural sway parameters and Stabilogram-Diffusion Analysis. The secondary outcome measures were the fall efficacy Scale (FES), self-reported late life function (LLFDI), and Performance-Oriented Mobility Assessment (POMA). Results: Compared to control, participation in intervention program that includes unexpected loss of balance during walking led to faster Voluntary Step Execution Times under single (p = 0.002; effect size [ES] =0.75) and dual task (p = 0.003; [ES] = 0.89) conditions; intervention group subjects showed improvement in Short-term Effective diffusion coefficients in the mediolateral direction of the Stabilogram-Diffusion Analysis under eyes closed conditions (p = 0.012, [ES] = 0.92). Compared to control there were no significant changes in FES, LLFDI, and POMA. Conclusions: An intervention program that includes unexpected loss of balance during walking can improve voluntary stepping times and balance control, both previously reported as risk factors for falls. This however, did not transferred to a change self-reported function and FES. Trial registration: ClinicalTrials.gov Registration number: NCT01439451.
Physical exercise would improve postural stability, which is an essential factor in preventing accidental fall among the elderly population. The aim of this study is to examine the effectiveness of treadmill walking on balance improvement among the elderly people. A total of 30 community dwelling older adults with a Berg Balance Scale score of 36-48 and the ability to walk without aid were considered and divided into control (n=15) and experimental (n=15) groups. Individuals in the experimental group participated in 30 minutes of forward and backward treadmill training based on three times a week interval for a period of four weeks. Individuals in the control group were instructed to continue with their daily routine activity. Before and after training, gait speed was measured by six-minute walk test and balance ability was evaluated by Fullerton Advanced Balance Scale (FABS) and Berg Balance Scale (BBS) tests. Postural sway items such as the Center of Pressure (COP), average displacement and velocity were evaluated by using a force platform system. Data were collected in quiet standing, tandem position and standing on foam pads before and after intervention. After intervention, balance variables in the experimental group indicated a significant improvement in quiet standing on firm and foam surfaces, but no considerable improvement was shown in tandem position. A between-group comparison showed a significant reduction in COP velocity in the sagittal plane (P=0.030) during quiet standing and in the frontal plane (P=0.001) during standing on foam, whereas no significant reduction in COP parameters during tandem position was found. It is recommended that twelve sessions of forward and backward treadmill walk are effective in balance improvement in elderly people.
Physical therapy, 2014
Older adults and individuals with neurological conditions are at an increased risk for falls. While physical exercise can prevent falls, certain types of exercise may be more effective. Perturbation-based balance training is a novel intervention involving repeated postural perturbations aiming to improve control of rapid balance reactions. To estimate the effect of perturbation-based balance training on falls in daily life. Medline (1946-July 2014), EMBASE (1974-July 2014), PEDro (all dates), CENTRAL (1991-July 2014) and Google Scholar (all dates). Randomized controlled trials written in English were included if they focused on perturbation-based balance training among older adults or individuals with neurological conditions and collected falls data post-training. Two investigators extracted data independently. Study authors were contacted to obtain missing information. A PEDro score was obtained for each study. Primary outcomes were proportion of participants who reported one or mo...
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.7\_July2018/IJHSR\_Abstract.017.html, 2018
Background: Aging commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture due to the weakness of lower limb muscles. Fall prevention program has to be given to the patients which will mainly focus on the stimulation of primary muscle groups of lower limb. Aim: To evaluate the effect of perturbation based balance training along with strengthening and balance exercises in improving balance and to reduce risk of falls among older adults. Methodology: 40 elderly patients aged 65 to 80 years were randomized in two groups by using block randomization. Outcome variables measured were TUG & on force plate are maximum CoP excursion, minimum CoP excursion and stability score. To the group 1 treatment given was standardized OTAGO exercise program and group 2 was given PBBT along with OTAGO exercise program. The results were checked after two months. Treatment effect was checked within the group by using paired t test and between the groups by using unpaired t test. Results: The results showed significant difference in values of all outcome measures in all the four conditions which are NS EO, NS EC, PS EO & PS EC within the group. There was also a significant reduction in the values of TUG. Between groups analysis also show significant effect between both the groups. Conclusion: The PBBT is a useful program for fall prevention. It is also inexpensive and compact commercial perturbation-delivery system.
Barefoot walking is more stable in the gait of balance recovery in older adults
BMC Geriatrics, 2022
Background: Perturbation-based balance training on a treadmill is an emerging method of gait stability training with a characteristic task nature that has had positive and sustained effects on balance recovery strategies and fall reduction. Little is known about the effects produced by shod and barefoot walking. We aimed to investigate which is more appropriate, shod or barefoot walking, for perturbation-based balance training in older adults. Methods: Fourteen healthy older adults (age: 68.29 ± 3.41 years; body height: 1.76 ± 0.10 m; body mass: 81.14 ± 14.52 kg) performed normal and trip-like perturbed walking trials, shod and barefoot, on a treadmill of the Gait Real-time Analysis Interactive Lab. The marker trajectories data were processed by Human Body Model software embedded in the Gait Offline Analysis Tool. The outcomes of stride length variability, stride time variability, step width variability, and swing time variability were computed and statistically analyzed by a two-way repeated-measures analysis of variance (ANOVA) based on gait pattern (normal gait versus perturbed recovery gait) and footwear condition (shod versus barefoot). Results: Footwear condition effect (p = 0.0310) and gait pattern by footwear condition interaction effect (p = 0.0055) were only observed in swing time variability. Gait pattern effects were detected in all four outcomes of gait variability. Conclusions: Swing time variability, independent of gait speed, could be a valid indicator to differentiate between footwear conditions. The lower swing time variability in perturbed recovery gait suggests that barefoot walking may be superior to shod walking for perturbation-based balance training in older adults.
Archives of Medical Science, 2009
Introduction: The purpose of the present study was to compare stationary balance between a group of elderly women and young adult women using stabilometric parameters. Material and methods: Sixty elderly women with an average age of 67.6 ±4.7 years and 60 young adult women with an average age of 25.1 ±2.2 years participated in the study. A Medicapteurs quartz/piezoelectric force platform (Loran Engineering™) was used for data collection, with the sampling frequency set at 50 Hz. The experimental protocol consisted of the analysis of individuals in bipedal support, with their feet on the platform in an orthostatic position and the upper limbs in extension alongside the body. The data collection time was standardized as 20 s. Data were exported to the Microcal/Origin (version 6.0) environment for processing and interpretation. The following variables were analyzed by means of this software program: i) Center of Pressure Displacement Velocity (P) and ii) Radial Displacement of Center o...
Balance perturbation system to improve balance compensatory responses during walking in old persons
Journal of NeuroEngineering and Rehabilitation, 2010
Ageing commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture. This can lead to increased risk of falling in old adults (65 years old and over). Therefore, improving compensatory postural responses during walking is one of the goals in fall prevention programs. Training is often used to achieve this goal. Most fall prevention programs are usually directed towards improving voluntary postural control. Since compensatory postural responses triggered by a slip or a trip are not under direct volitional control these exercises are less expected to improve compensatory postural responses due to lack of training specificity. Thus, there is a need to investigate the use balance perturbations during walking to train more effectively compensatory postural reactions during walking.This paper describes the Balance Measure & Perturbation System (BaMPer System) a system that provides small, controlled and unpredictable perturbations during treadmill walking providing valuable perturbation, which allows training compensatory postural responses during walking which thus hypothesize to improve compensatory postural responses in older adults.
BMC Geriatrics, 2013
Background: Walking requires gait adjustments in order to walk safely in continually changing environments. Gait adaptability is reduced in older adults, and (near) falls, fall-related hip fractures and fear of falling are common in this population. Most falls occur due to inaccurate foot placement relative to environmental hazards, such as obstacles. The C-Mill is an innovative, instrumented treadmill on which visual context (e.g., obstacles) is projected. The C-Mill is well suited to train foot positioning relative to environmental properties while concurrently utilizing the high-intensity practice benefits associated with conventional treadmill training. The present protocol was designed to examine the efficacy of C-Mill gait adaptability treadmill training for improving walking ability and reducing fall incidence and fear of falling relative to conventional treadmill training and usual care. We hypothesize that C-Mill gait adaptability treadmill training and conventional treadmill training result in better walking ability than usual care due to the enhanced training intensity, with superior effects for C-Mill gait adaptability treadmill training on gait adaptability aspects of walking given the concurrent focus on practicing step adjustments.
Gait & Posture, 2018
BACKGROUND: Treadmill-based gait-slip training shows to be effective in reducing the risk of slip-related falls. In previous relevant studies, the number of repeated slip perturbations ranged from 12 to 30. RESEARCH QUESTION: It is unclear if a reduced number of treadmill-slips can still yield adaptive strategies to lower the likelihood of falls after a slip over ground. This study examined if eight repeated slips on a treadmill reduced the risk of falls among young adults when they were exposed to a novel overground slip. METHODS: Forty-three healthy young adults were randomized into either training or control group. The training group underwent an 8-slip perturbation training procedure on a treadmill while the control group received the same number of normal walking trials on the same treadmill. Following the training, both groups were exposed to an unrehearsed slip during overground walking. Their body's reactions to the novel overground slip were collected by a motion capture system. RESULTS: The training group exhibited significantly better reactions to the slip than did the control group, evidenced by the lower fall proportion and improved dynamic stability at recovery foot touchdown during the overground slip. No improvement in dynamic stability was detected in the training group at the slipping foot touchdown and recovery foot liftoff. SIGNIFICANCE: The results suggested that the shortened perturbation training program may be efficacious in improving responses to a novel overground slip but may not be as effective as protocols using greater number of slips. This study could provide guidance for selecting the number of slips for future perturbation-based training protocols.