Abstract
Falls in older adults are a major health and societal problem. It is thus imperative to develop highly effective training paradigms to reduce the likelihood of falls. Perturbation training is one such emerging paradigm known to induce shorter term fall reduction in healthy young as well as older adults. Its longer term benefits are not fully understood, however. The purpose of this study was to determine whether and to what degree older adults could retain their fall-resisting skills acquired from a single perturbation training session. Seventy-three community-dwelling older adults (≥65 years) received identical single-session perturbation training consisting of 24 slips. This was delivered through unannounced unlocking (and mixed with relocking) of low-friction movable sections of the walkway. A single retest was subsequently scheduled based on a three-stage sequential, pre-post-retest design. Outcome measurements, taken upon the first (novel) and the 24th (final) slips of the initial session and the retest slip, included fall-or-no-fall and stability (quantified by the shortest distance from relative motion state of the center-of-mass and the base-of-support to the limits of stability) at instants prior to (proactive) and after (reactive) the onset of the slip. The training boosted subjects' resilience against laboratory-induced falls demonstrated by a significant reduction from 42.5 % falls on the first slip to 0 % on the 24th slip. Rate of falls which occurred during the laboratory retest remained low in 6-month (0 %), 9-month (8.7 %), and 12-month retest (11.5 %), with no significant difference between the three time intervals. Such reduction of laboratory-induced falls and its retention were attributable to the significant training-induced improvement in the proactive and reactive control of stability. This unique pre-post-retest design enabled us to provide scientific basis for the feasibility of a single session of perturbation training to "inoculate" older adults and to reduce their annual risk of falls in everyday living.
Highlights
Increasing susceptibility to falls with age (Tinetti et al 1988) poses a health threat to older adults
Perturbation training significantly reduced the incidence of laboratory-induced falls: while 42.5 % of participants (31/73) fell upon exposure to the novel slip, none fell during their final slip exposure (p
Community-dwelling older adults displayed outstanding motor retention for as much as 12 months in this study. These results demonstrated that their central nervous system (CNS) can implicitly adapt and successfully develop proactive and reactive control strategies
Summary
Increasing susceptibility to falls with age (Tinetti et al 1988) poses a health threat to older adults. Perturbation training (an external factor that disrupts the regular falling-and-catching relations in locomotion between one’s center-of-mass (COM) and base-of-support (BOS)) can be employed to achieve similar objectives by inducing repeated slips that mimic life-threatening situations (Bhatt and Pai 2009a; Pai and Bhatt 2007). Such training can involve a destabilization process that disrupts the usual, predictable relations between one’s COM and the BOS through a sudden forward slip. The reduction of laboratoryinduced falls has been attributable to improved control of COM state (i.e., its position and velocity) stability
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