Unexpected perturbations training improves balance control and voluntary stepping times in older adults - a double blind randomized control trial.

Ilan Kurz,Amir Shapiro,Ronen Debi,Yoram Snir,Yoav Gimmon,Itshak Melzer

doi:10.1186/s12877-016-0223-4

Ilan Kurz, Amir Shapiro + Show 4 more

Open Access

https://doi.org/10.1186/s12877-016-0223-4

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Abstract

BackgroundFalls 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.MethodsIn 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).ResultsCompared 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.ConclusionsAn 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 registrationClinicalTrials.gov Registration number: NCT01439451.

Highlights

Falls are common among elderly, most of them occur while slipping or tripping during walking
Motivated by the above perturbations training studies and trying to accommodate for some of the issues mentioned above, we aimed to explore whether unexpected multidirectional perturbation training while walking on a treadmill [21] can reduce risks of falls in independent older adults
The Stabilogram-Diffusion Analysis plots (SDA) method has been adopted by our research group, we found that SDA parameters (e.g., Critical Displacement (Cd), and Short-term Effective diffusion coefficients (Ds) were able to predict falls [26] and injury from fall [27]

Summary

Introduction

Falls are common among elderly, most of them occur while slipping or tripping during walking. Falls are a major problem among elderly population; they are the leading cause of injury above the age of 65 [1] Of those who fall in the U.S, 20 to 30 % suffer moderate to severe injuries that reduce mobility and independence, and Walking is the major activity in which large proportion of falls in older adults occurs [3]. A better way to improve balance, improve stepping and reduce risk of falls may be to direct preventive efforts towards older adults who have not yet fallen. Until recently these balance recovery responses were considered hardwired postural reflexes that could not be influenced by training. [8,9,10] it was showed that older adults were able to adapt in a reactive manner after participation in a perturbation exercises that challenged the mechanisms responsible for dynamic stability (i.e., increase in base of support and counter-rotating segments around the center of mass)

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