Unexpected Slip Research Articles

Ballet practice improves neuromuscular and biomechanical responses to an unexpected standing-slip in older adults.

Falls and fall-induced injuries are common and consequential in older adults. Ballet emphasizes full-body coordination, leg strength, and postural control. However, it remains unknown whether ballet can indeed reduce falls in older adults. This study examined biomechanical and neuromuscular responses of older recreational ballet dancers to an unexpected standing-slip. Twenty older ballet dancers (17 females, 3 males) and 23 age- and sex-matched nondancers (19 females, 4 males) were exposed to an unexpected slip during treadmill standing. The slip-faller rate was the primary outcome. The secondary outcomes were kinematic measurements, including dynamic gait stability, slip distance, and recovery stepping performance (step latency, duration, length, and speed). The tertiary outcome was the electromyography latency of leg muscles (bilateral tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris). Fewer dancers fell than nondancers after the standing-slip (45% vs. 83%, P = 0.005, d = 0.970). Dancers displayed better stability at recovery foot liftoff (P = 0.006) and touchdown (P = 0.012), a shorter step latency (P = 0.020), shorter step duration (P = 0.011), faster step speed (P = 0.032), and shorter slip distance (P = 0.015) than nondancers. They also exhibited shorter latencies than nondancers for the standing leg rectus femoris (P = 0.028) and tibialis anterior (P = 0.002), and the stepping leg biceps femoris (P = 0.031), tibialis anterior (P = 0.017), and medial gastrocnemius (P = 0.030). The results suggest that older ballet dancers experience a lower fall risk and are more stable than nondancers following an unexpected standing-slip. The greater stability among dancers could be attributed to more biomechanically effective recovery stepping, possibly associated with the ballet-induced neuromuscular benefit-an earlier leg muscle activation.NEW & NOTEWORTHY This is the first study to examine how older ballet dancers respond to an unexpected external slip perturbation while standing. The results suggest that older ballet dancers experience a reduced fall risk after the slip than their nondancer counterparts. The lower fall risk can be accounted for by dancers' quicker neuromuscular reactions to the slip that result in a more effective recovery step and thus higher stability against backward falls due to the slip.

The influence of occupational footwear on slip responses

This study investigated how walking in occupational footwear (OF) affects slip outcome and slip recovery strategies in response to an unexpected slip. Participants walked along a walkway while either barefoot (BF; n = 13) or in OF (n = 12). The first five walking trials consisted of the no-slip condition, where a high friction sheet was placed halfway down the walkway to ensure a low probability of a slip. Prior to the sixth walking trial and without the participant’s knowledge, the sheet was replaced with a low friction surface to induce an unexpected slip. Results obtained during the no-slip trials indicated that compared to the BF group, the OF group walked with a 15% smaller required coefficient of friction (p = 0.04), a 12° greater dorsiflexion at heel strike (p = 0.007) and a 7° more extended knee position at 100 ms following heel strike (p = 0.008). The OF group also demonstrated greater electromyographic (EMG) activity in the hamstrings of the stance limb and the gastrocnemius of the contralateral limb prior to and after heel strike. When the low friction surface was unexpectedly encountered, a slip was induced in both groups. But compared to the BF group, the OF group experienced a less severe slip, with the slip being 42% shorter (p = 0.004) and 75% slower (p < 0.001), and exhibited a 19–71% lesser EMG activation when responding to the slip. Although these results provide initial evidence for the benefits of wearing OF to minimise the consequence of a slip in the workplace, further research is needed to determine whether the altered walking patterns associated with wearing OF (e.g., greater dorsiflexion, reduced knee range of motion, etc.) may have contributed to the decrease in slip severity.

Intersegmental coordination in human slip perturbation responses

Intersegmental coordination (ISC) of lower limbs and planar covariation law (PCL) are important phenomena observed in biomechanics of human walking and other activities. Gait perturbations tend to cause deviation from the expected ISC pattern thus violating PCL. We used a data set of seven subjects, who experienced unexpected slips, to investigate and characterize the evolution of ISC during slip recoveries and falls. We have analyzed and presented the development of ISC patterns, encompassing the step preceding the slip initiation and duration of slip until it stops. The results show that the ISC patterns during slip recovery deviate considerably from the normal walking patterns. A newly proposed Euclidian distance-based metric (EDM) was used to quantify the deviation from the normal walking ISC pattern during four slip recoveries and three falls evaluated at gait events such as slip start, foot strike, and peak height of the swing foot. The timing of gait events after slip, pattern of EDM, placement of the feet after slip and temporal patterns of each limb angle have been presented. This initial investigation provides insight into the ISC during slip recovery which highlights the human natural recovery trajectories during such perturbations. The observed patterns of the ISC trajectories during slip can be used for the design of human-inspired controllers for exoskeleton devices that can provide external assistance to human subjects during balance recovery.

How Fault‐Normal and Shear‐Parallel Stiffness Influence Frictional Sliding Behavior

AbstractThe potential of faults to show earthquake‐generating slip instabilities depends not only on the intrinsic frictional properties of the fault zone, but also on the elasticity of the surrounding material. A velocity‐weakening fault is expected to show increasingly unstable frictional behavior with decreasing local elastic stiffness around the fault zone. Fault zone roughness can cause slip in the shear direction to be accompanied by fault‐normal movement, modulated by fault‐normal elastic properties, however these effects are poorly understood. Here, we systematically vary the stiffness surrounding the fault in both the shear‐parallel and fault‐normal directions, to investigate the origin of slip instabilities and changes in friction constitutive properties. We confirm the transition from stable sliding through slow slip to stick‐slip due to reduced fault‐parallel stiffness, and that the occurrence of different types of slip events can be explained by the ratio between shear and critical stiffness. In contrast, reducing the fault‐normal stiffness produces stick‐slip instabilities under conditions where the conventional critical stiffness criterion predicts stable sliding, and does not produce transitional slow slip events. Our data suggest that: (a) the stability criterion for frictional slip should be modified to incorporate fault‐normal stiffness, and (b) the unexpected slip instabilities may represent wrinkle‐like slip pulses, possibly due to a stiffness asymmetry introduced by lowering the fault normal stiffness on one side of the fault. This implies that earthquakes may occur when the fault‐normal stiffness, or bulk modulus for natural faults, is decreased and/or asymmetric across the fault zone, both of which may be common in nature.

Knee Exoskeleton-Enabled Balance Control of Human Walking Gait With Unexpected Foot Slip

Knee Exoskeleton-Enabled Balance Control of Human Walking Gait With Unexpected Foot Slip

Reactive responses of the arms increase the Margins of Stability and decrease center of mass dynamics during a slip perturbation

Although reactive arm motions are important in recovering from a slip event, the biomechanical influences of upper extremity motions during slipping are not clear. The purpose of the current study was to determine whether reactive arm motions during slip recovery leads to increased margins of stability (MoS), and decreased center of mass (CoM) velocity and excursion. Thirty-two participants were randomized into 2 conditions: arms free and arms constrained. Participants traversed a 10-meter walkway and were exposed to an unexpected slip while wearing a protective harness. Anterior-posterior and medial–lateral MoS, as well as the CoM excursion and velocity during the slip perturbation was quantified using a three-dimensional motion capture system. In the frontal plane, individuals with their arms unconstrained demonstrated greater MoS (0.06 ± 0.03 vs −0.01 ± 0.02 m, p < 0.01), decreased CoM excursion (0.05 ± 0.02 vs 0.08 ± 0.01 m, p = 0.015), and a reduced CoM velocity (0.07 ± 0.03 vs. 0.14 ± 0.02 m/s, p < 0.01) compared to individuals with their arms constrained. In the sagittal plane, individuals with their arms unconstrained demonstrated, decreased CoM excursion (0.83 ± 0.13 vs 1.14 ± 0.20 m, p < 0.01) reduced CoM velocity (1.71 ± 0.08 vs. 1.79 ± 0.07 m/s, p = 0.02), but no differences in margins of stability (0.89 ± 0.13 vs 0.94 ± 0.10 m, p = 0.32). Our findings demonstrate that arm motions during a slip perturbation act to restore balance by minimizing displacement and velocity of the body CoM during a slip event in the frontal plane.

Validation of a portable shoe tread scanner to predict slip risk

Problem: Worn shoes are an important contributor to occupational slip and fall injuries. Tools to assess worn tread are emerging; imaging tools offer the potential to assist. The aim of this study was to develop a shoe tread scanner and evaluate its effectiveness to predict slip risk. Methods: This study analyzed data from two previous studies in which worn or new slip-resistant shoes were donned during an unexpected slip condition. The shoe tread for each shoe was scanned using a portable scanner that utilized frustrated total internal reflection (FTIR) technology. The shoe tread parameters of the worn region size (WRS) for worn shoes and total contact area for new shoes were measured. These parameters were then used to predict slip risk from the unexpected slip conditions. Results: The WRS was able to accurately predict slip risk, but the contact area was not. Discussion: These findings support that increased WRS on the shoe outsole is associated with worse slip outcomes. Furthermore, the tool was able to offer robust feedback across a wide range of tread designs, but the results of this study show that the tool may be more applicable for slip-resistant shoes that are worn compared to their new counterparts. Summary: This study shows that FTIR technology utilized in this tool may be a useful and portable method for determining slip risk for worn shoes. Practical Applications: This tool has the potential to be an efficient, objective, end-user tool that improves timely replacement of shoes and prevention of injuries.

Recovering from Laboratory-Induced slips and trips causes high levels of lumbar muscle activity and spine loading.

Slips, trips, and falls are some of the most substantial and prevalent causes of occupational injuries and fatalities, and these events may contribute to low-back problems. We quantified lumbar kinematics (i.e., lumbar angles relative to pelvis) and kinetics during unexpected slip and trip perturbations, and during normal walking, among 12 participants (6F, 6M). Individual anthropometry, lumbar muscle geometry, and lumbar angles, along with electromyography from 14 lumbar muscles were used as input to a 3D, dynamic, EMG-based model of the lumbar spine. Results indicated that, in comparison with values during normal walking, lumbar range of motion, lumbosacral (L5/S1) loads, and lumbar muscle activations were all significantly higher during the slip and trip events. Maximum L5/S1 compression forces exceeded 2700N during slip and trip events, compared with∼1100N during normal walking. Mean values of L5/S1 anteroposterior (930N), and lateral (800N) shear forces were also substantially larger than the shear force during the normal walking (230N). These observed levels of L5/S1 reaction forces, along with high levels of bilateral lumbar muscle activities, suggest the potential for overexertion injuries and tissue damage during unexpected slip and trip events, which could contribute to low back injuries. Outcomes of this study may facilitate the identification and control of specific mechanisms involved with low back disorders consequent to slips or trips.

Constraining the arms during a slip perturbation results in a higher fall frequency in young adults

Slip and fall incidents are a major health concern. Although studies have reported the mechanical benefits of upper extremity responses during a slip to regain balance, it is not currently known if reactive arm motions aid in the recovery of a slip event. Sixty-four healthy young adults were randomized into 4 gait conditions: arms free, both arms constrained, contralateral arm to the slipping foot constrained and ipsilateral arm to the slipping foot constrained. While wearing a protective harness, participants traversed a 10-m walkway and were exposed to an unexpected slip. The group with their arms constrained exhibited a higher proportion of falls compared to the group with the arms free (62.5% vs 18.8%). In addition, individuals assigned to the contralateral arm constraint group exhibited a significantly higher proportion of falls compared to the group in which the ipsilateral arm was constrained (68.8% vs. 31.2%). Our findings suggest that arm motions aid in the recovery of balance during a slip perturbation. Motion of the arm contralateral to the slipping foot appears to be most important. Training upper extremity reactive responses training the arms may be a useful adjunct to fall prevention programs fall prevention.

Identification of balance recovery patterns after slips using hierarchical cluster analysis

Accidental falls often result from loss of balance initiated by slips. People may adopt different balance recovery patterns after slips which could affect recovery outcomes. The present study aimed to identify balance recovery patterns after slips and to determine whether these balance recovery patterns could be associated with different levels of slip-induced fall likelihood. Sixty young (age 24.2 ± 2.1 years) participants were involved in an experimental study. They were instructed to walk on a linear walkway, where unexpected slips were induced when stepping onto a removable vinyl tile sheet covered with water-detergent mixture. One hundred and fifty slip trials were obtained, including 85 successful balance recovery trials and 65 failed balance recovery trials (i.e., fall trials). Hierarchical cluster analysis was used to classify balance recovery patterns based on the kinematic measures of both feet over the period from 100 to 300 ms after heel contact of the slipping foot. Three balance recovery patterns were identified, and these balance recovery patterns were found to be associated with different levels of slip-induced fall likelihood. Findings from the present study can contribute to better understanding of balance recovery mechanisms associated with slips, and guide developing and evaluating fall prevention interventions.

Gait Slip-Induced Fall-Type Assessment Based on Regular Gait Characteristics in Older Adults.

Older adults could experience split falls or feet-forward falls following an unexpected slip in gait due to different neuromuscular vulnerabilities, and different intervention strategies would be required for each type of faller. Thus, this study aimed to investigate the key factors affecting the fall types based on regular gait pattern. A total of 105 healthy older adults who experienced a laboratory-induced slip and fall were included. Their natural walking trial immediately prior to the novel slip trial was analyzed. To identify the factors related to fall type, gait characteristics and demographic factors were determined using univariate logistic regression, and then stepwise logistic regression was conducted to assess the slip-induced fall type based on these factors. The best fall-type prediction model involves gait speed and recovery foot angular velocity, which could predict 70.5% of feet-forward falls and 86.9% of split falls. Body mass index was also a crucial fall-type prediction with an overall prediction accuracy of 70.5%. Along with gait parameters, 84.1% of feet-forward falls and 78.7% of split falls could be predicted. The findings in this study revealed the determinators related to fall types, which enhances our knowledge of the mechanism associated to slip-induced fall and would be helpful for the development of tailored interventions for slip-induced fall prevention.

Learning from the Physical Consequences of Our Actions Improves Motor Memory.

Actions have consequences. Motor learning involves correcting actions that lead to movement errors and remembering these actions for future behavior. In most laboratory situations, movement errors have no physical consequences and simply indicate the progress of learning. Here, we asked how experiencing a physical consequence when making a movement error affects motor learning. Two groups of participants adapted to a new, prism-induced mapping between visual input and motor output while performing a precision walking task. Importantly, one group experienced an unexpected slip perturbation when making foot-placement errors during adaptation. Because of our innate drive for safety, and the fact that balance is fundamental to movement, we hypothesized that this experience would enhance motor memory. Learning generalized to different walking tasks to a greater extent in the group who experienced the adverse physical consequence. This group also showed faster relearning one week later despite exposure to a competing mapping during initial learning, evidence of greater memory consolidation. The group differences in generalization and consolidation occurred although they both experienced similar magnitude foot-placement errors and adapted at similar rates. Our results suggest the brain considers the potential physical consequences of movement error when learning and that balance-threatening consequences serve to enhance this process.

Near-Fall Detection in Unexpected Slips during Over-Ground Locomotion with Body-Worn Sensors among Older Adults.

Slip-induced falls are a growing health concern for older adults, and near-fall events are associated with an increased risk of falling. To detect older adults at a high risk of slip-related falls, this study aimed to develop models for near-fall event detection based on accelerometry data collected by body-fixed sensors. Thirty-four healthy older adults who experienced 24 laboratory-induced slips were included. The slip outcomes were first identified as loss of balance (LOB) and no LOB (NLOB), and then the kinematic measures were compared between these two outcomes. Next, all the slip trials were split into a training set (90%) and a test set (10%) at sample level. The training set was used to train both machine learning models (n = 2) and deep learning models (n = 2), and the test set was used to evaluate the performance of each model. Our results indicated that the deep learning models showed higher accuracy for both LOB (>64%) and NLOB (>90%) classifications than the machine learning models. Among all the models, the Inception model showed the highest classification accuracy (87.5%) and the largest area under the receiver operating characteristic curve (AUC), indicating that the model is an effective method for near-fall (LOB) detection. Our approach can be helpful in identifying individuals at the risk of slip-related falls before they experience an actual fall.

Molecular kinetic modelling of nanoscale slip flow using a continuum approach

One major challenge for a continuum model to describe nanoscale confined fluid flows is the lack of a boundary condition that can capture molecular-scale slip behaviours. In this work, we propose a molecular-kinetic boundary condition to model the fluid–surface and fluid–fluid molecular interactions using the Lennard–Jones type potentials, and add a mean-field force to the momentum equation. This new boundary condition is then applied to investigate the nanoscale Couette and Poiseuille flows using the generalised hydrodynamic model developed by Guo et al. (Phys. Fluids, volume 18, issue 6, 2006a, 067107). The accuracy of our model is validated by molecular dynamics simulations and other models for a broad range of parameters including density, shear rate, wettability and channel width. Our simulation results reveal some unexpected and unintuitive slip behaviours at the nanoscale, including the epitaxial layering structure of fluids and the slip length minimum. The slip length minimum, which is analogous to the Knudsen minimum, can be explained by competing fluid–solid and fluid–fluid molecular interactions as density varies. A new scaling law is proposed for the slip length to account for not only the competing effect between the fluid–solid and fluid–fluid molecular interactions, but also many other physical mechanisms including the competition between the fluid internal potential energy and kinetic energy, and the confinement effect. While the slip length is nearly constant at the low shear rates, it increases rapidly at the high shear rates due to friction reduction. These molecular-scale slip behaviours are caused by energy corrugations at the fluid–solid interface where strong fluid–solid and fluid–fluid molecular interactions interplay.

Temperature-dependent cyclic deformation behavior of CoCrFeMnNi high-entropy alloy

We compare the low-cycle fatigue behavior of a CoCrFeMnNi high-entropy alloy at room-temperature (RT) and 550 °C. The cyclic response at 550 °C manifests no cyclic softening, presence of serrated flow and reduced fatigue life compared to that at RT. Microstructural investigations show that distinctly from the dominating wavy slip at RT, dislocations planar slip complements wavy slip at 550 °C. The unexpected planar slip at 550 °C is ascribed to the increase of stacking fault width, likely due to Suzuki segregation. Furthermore, dislocation slip mode evolution with both strain amplitude and cycle number at 550 °C is revealed.

Quantification of reactive arm responses to a slip perturbation

The purpose of this study was two-fold: 1) characterize bilateral upper extremity responses during a slip event in both the sagittal and frontal planes, and 2) to examine the utility of using slip onset as the measurement reference for behavioral responses of the upper extremities using EMG latency. Sixteen healthy young adults were exposed to an unexpected slip during walking. Three-dimensional arm kinematics (excursions) and electromyographic onset latencies (bilateral deltoids) were quantified. Thirteen of the 16 participants recovered their balance following the slip perturbation. Of those who recovered, multi-planar arm responses were observed bilaterally. The arm contralateral to the slipping foot demonstrated significantly greater excursion in the frontal plane than the ipsilateral arm (p < 0.001), whereas excursions in the sagittal plane did not differ between arms (p = 0.75). Further, the frontal plane excursion of the contralateral arm was greater than sagittal plane excursion (p < 0.001). The electromyographic onset of deltoid activity was equivalent in both arms (57–76 ms), despite the differences in kinematics. Multi-plane arm motion occurs in response to a slip perturbation. Specifically, frontal plane motion of the arm contralateral to the slipping foot exhibited the greatest amount of excursion.

Investigating proactive balance control in individuals with incomplete spinal cord injury while walking on a known slippery surface

BackgroundUp to 83 % of individuals with incomplete spinal cord injury (iSCI) experience ≥ 1 fall/year. Individuals with iSCI employ more cautious walking strategies than able-bodied (AB) individuals during normal walking. Whether individuals with iSCI can use proactive balance strategies to adapt to expected slip perturbations/reduce slip severity while walking has not been previously assessed. Methods19 individuals with iSCI (AIS D; 14 males; 61 ± 18 years) and 17 AB individuals (13 males; 61 ± 18 years) completed 3 walking conditions: normal walking trials, an unexpected slip trial, and expected slip trials. Steel rollers induced a slip in the antero-posterior (AP) direction. Outcome variables included step length, center of mass velocity, foot-floor angle, AP margin of stability, and maximum post-slip velocity (PSV). ResultsThe iSCI group used a greater magnitude of cautious strategies (i.e. walking slower with shorter, flatter steps) than AB individuals in all conditions. However, the lack of significant interaction effects indicate that the proactive adaptations compared to normal walking (i.e. walking slower with shorter, flatter steps, and a more anterior xCOM-position) were similar between the two groups (AB & iSCI). Both groups showed a similar rate of adaptation (after just 1 slip) and these feedforward changes were maintained throughout the remaining slip trials which was effective at reducing maximum PSV. ConclusionsIndividuals with iSCI use proactive balance strategies to adapt to a known slippery surface in a similar manner to AB individuals both in terms of the proportion and timing of adaptation.

Kinematic synergies in over-ground slip recovery outcomes: Distinct strategies or a single strategy?

BackgroundAfter experiencing an unexpected slip perturbation, individuals’ behavioral performance can be classified into three categories: recovery, feet-forward fall, and split fall. Researchers are uncertain whether these differences in slip outcomes are due to distinct strategies or part of a single strategy. Research questionWhether older adults with different behavioral outcomes during their novel slip have different kinematic synergies? MethodsThe kinematic synergies were extracted from segment angles in 87 participants using principal component analysis (PCA). The first two principal components (PC1 and PC2) in pre-slip, early-reactive, and late-reactive phases were compared across different slip outcomes. ResultsResults showed that the kinematic synergies in pre-slip and early-reactive phases are highly consistent among the three outcomes (recovery, split fall, and feet-forward fall). For the late-reactive phase, both split falls and feet-forward falls showed different kinematics synergies from recoveries. SignificanceOur findings indicated that a single strategy might be used for different slip outcomes in the pre-slip and early-reactive phases, while distinct strategies were used by fallers compared to recovered individuals. Specifically, larger trunk flexion in pre-slip phase, larger knee flexion and plantar flexion of the slipping limb in both early-reactive and late-reactive phase, and larger knee extension of the recovery limb in late-reactive phase would lower the fall risk. This study would help to assess the vulnerabilities in control strategy, according to which individualized treatment could be provided to reduce predisposition to specific types of falls.

Reactive balance responses to an unexpected slip perturbation in individuals with incomplete spinal cord injury

BackgroundFrequent falls while walking among individuals with incomplete spinal cord injury may suggest impairments in reactive balance control; however, reactive balance control during walking has not been studied in this population. The objective was to compare reactive balance control with respect to changes in margin of stability, onset of arm and heel responses, and onset and magnitude of muscle activity following an unexpected slip perturbation in individuals with incomplete spinal cord injury and able-bodied individuals. MethodsKinematic and electromyography data were obtained during normal walking and one unexpected slip. Changes in margin of stability following a compensatory or aborted step, onset of arms and trail heel responses, and onset and magnitude of activation of the tibialis anterior, soleus and gluteus medius were calculated. Multivariate analyses compared responses between incomplete spinal cord injury and able-bodied groups. FindingsData from 16 participants with incomplete spinal cord injury (all American Spinal Injury Association Impairment Scale Grade D, 8 with tetraplegia) and 13 age-and-sex matched able-bodied individuals were included. Individuals with incomplete spinal cord injury demonstrated limited ability to increase margin of stability in the lateral direction during a compensatory or aborted step, and a smaller magnitude of soleus activity compared to able-bodied individuals. InterpretationThere are limitations in reactive balance control of individuals with incomplete spinal cord injury, which may be a reason for the high frequency of falls in this population. Reactive balance assessment should be included as a component of routine balance assessment and fall avoidance strategies in this population.

Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial

BackgroundFalls are the leading cause of injuries among older adults. Perturbation-based balance training (PBT) is an innovative approach to fall prevention that aims to improve the reactive balance response following perturbations such as slipping and tripping. Many of these PBT studies have targeted reactive balance after slipping or tripping, despite both contributing to a large proportion of older adult falls. The goal of this randomized controlled trial was to evaluate the effects of PBT targeting slipping and tripping on laboratory-induced slips and trips. To build upon prior work, the present study included: 1) a control group; 2) separate training and assessment sessions; 3) PBT methods potentially more amenable for use outside the lab compared to methods employed elsewhere, and 4) individualized training for older adult participants.MethodsThirty-four community-dwelling, healthy older adults (61–75 years) were assigned to PBT or a control intervention using minimization. Using a parallel design, reactive balance (primary outcome) and fall incidence were assessed before and after four sessions of BRT or a control intervention involving general balance exercises. Assessments involved exposing participants to an unexpected laboratory-induced slip or trip. Reactive balance and fall incidence were compared between three mutually-exclusive groups: 1) baseline participants who experienced a slip (or trip) before either intervention, 2) post-control participants who experienced a slip (or trip) after the control intervention, and 3) post-PBT participants who experienced a slip (or trip) after PBT. Neither the participants nor investigators were blinded to group assignment.ResultsAll 34 participants completed all four sessions of their assigned intervention, and all 34 participants were analyzed. Regarding slips, several measures of reactive balance were improved among post-PBT participants when compared to baseline participants or post-control participants, and fall incidence among post-PBT participants (18%) was lower than among baseline participants (80%). Regarding trips, neither reactive balance nor fall incidence differed between groups.ConclusionsPBT targeting slipping and tripping improved reactive balance and fall incidence after laboratory-induced slips. Improvements were not observed after laboratory-induced trips. The disparity in efficacy between slips and trip may have resulted from differences in dosage and specificity between slip and trip training.Trial registrationName of Clinical Trial Registry:clinicaltrials.govTrial Registration number: NCT04308239.Date of Registration: March 13, 2020 (retrospectively registered).