n = 1, type 3: n = 3) or combined different types of training paradigms within their intervention (type 1 and 2: n = 2; all types: n = 2). The meta-analyses revealed significant overall effects of WS training on static steady-state balance outcomes including mediolateral (eyes open: Hedges' g = 0.82, CI: 0.43-1.21; eyes closed: g = 0.57, CI: 0.14-0.99) and anterior-posterior sway (eyes open: g = 0.55, CI: 0.01-1.10; eyes closed: g = 0.44, CI: 0.02-0.86). No effects on habitual gait speed were found in the meta-analysis ( g = -0.19, CI: -0.68 to 0.29). Two RCTs reported significant improvements for selected gait variables including single support time, and fast gait speed. One study identified effects on proactive balance (Alternate Step Test), but no effects were found for the Timed Up and Go test and the Berg Balance Scale. Two studies reported positive results on feasibility and usability. Only one study was performed in an unsupervised setting. Conclusion: This review provides evidence for a positive effect of WS training on static steady-state balance in studies with usual care controls and studies with conventional balance training controls. Specific gait parameters and proactive balance measures may also be improved by WS training, yet limited evidence is available. Heterogeneous training paradigms, small sample sizes, and short intervention durations limit the validity of our findings. Larger studies are required for estimating the true potential of WS technology. © 2017 S. Karger AG, Basel KeywordsInertial measurement unit · Force sensor · Postural balance · Gait · Biofeedback · Exergame · Systematic review Abstract Background: Wearable sensors (WS) can accurately measure body motion and provide interactive feedback for supporting motor learning. Objective: This review aims to summarize current evidence for the effectiveness of WS training for improving balance, gait and functional performance. Methods: A systematic literature search was performed in PubMed, Cochrane, Web of Science, and CINAHL. Randomized controlled trials (RCTs) using a WS exercise program were included. Study quality was examined by the PEDro scale. Metaanalyses were conducted to estimate the effects of WS balance training on the most frequently reported outcome parameters. Results: Eight RCTs were included (Parkinson n = 2, stroke n = 1, Parkinson/stroke n = 1, peripheral neuropathy n = 2, frail older adults n = 1, healthy older adults n = 1). The sample size ranged from n = 20 to 40. Three types of training paradigms were used: (1) static steady-state balance training, (2) dynamic steady-state balance training, which includes gait training, and (3) proactive balance training. RCTs either used one type of training paradigm (type 2:

Most falls occur after a loss of balance following an unexpected perturbation such as a slip or a trip. Greater understanding of how humans control and maintain stability during perturbed walking may help to develop appropriate fall prevention programs. The aim of this study was to examine changes in spatiotemporal gait and stability parameters in response to sudden mechanical perturbations in medio-lateral (ML) and anterior-posterior (AP) direction during treadmill walking. Moreover, we aimed to evaluate which parameters are most representative to quantify postural recovery responses. Ten healthy adults (mean = 26.4, SD = 4.1 years) walked on a treadmill that provided unexpected discrete ML and AP surface horizontal perturbations. Participants walked under no perturbation (normal walking), and under left, right, forward, and backward sudden mechanical perturbation conditions. Gait parameters were computed including stride length (SL), step width (SW), and cadence, as well as dynamic stability in AP- (MoS-AP) and ML- (MoS-ML) directions. Gait and stability parameters were quantified by means, variability, and extreme values. Overall, participants walked with a shorter stride length, a wider step width, and a higher cadence during perturbed walking, but despite this, the effect of perturbations on means of SW and MoS-ML was not statistically significant. These effects were found to be significantly greater when the perturbations were applied toward the ML-direction. Variabilities, as well as extremes of gait-related parameters, showed strong responses to the perturbations. The higher variability as a response to perturbations might be an indicator of instability and fall risk, on the same note, an adaptation strategy and beneficial to recover balance. Parameters identified in this study may represent useful indicators of locomotor adaptation to successfully compensate sudden mechanical perturbation during walking. The potential association of the extracted parameters with fall risk needs to be determined in fall-prone populations.

Aquatic exercises are widely used for rehabilitation or preventive therapies in order to enable mobilization and muscle strengthening while minimizing joint loading of the lower limb. The load reducing effect of water due to buoyancy is a main advantage compared to exercises on land. However, also drag forces have to be considered that act opposite to the relative motion of the body segments and require higher muscle activity. Due to these opposing effects on joint loading, the load-reducing effect during aquatic exercises remains unknown. The aim of this study was to quantify the joint loads during various aquatic exercises and to determine the load reducing effect of water. Instrumented knee and hip implants with telemetric data transfer were used to measure the resultant joint contact forces in 12 elderly subjects (6x hip, 6x knee) in vivo. Different dynamic, weight-bearing and non-weight-bearing activities were performed by the subjects on land and in chest-high water. Non-weight-bearing hip and knee flexion/extension was performed at different velocities and with additional Aquafins. Joint forces during aquatic exercises ranged between 32 and 396% body weight (BW). Highest forces occurred during dynamic activities, followed by weight-bearing and slow non-weight-bearing activities. Compared to the same activities on land, joint forces were reduced by 36–55% in water with absolute reductions being greater than 100%BW during weight-bearing and dynamic activities. During non-weight-bearing activities, high movement velocities and additional Aquafins increased the joint forces by up to 59% and resulted in joint forces of up to 301%BW. This study confirms the load reducing effect of water during weight-bearing and dynamic exercises. Nevertheless, high drag forces result in increased joint contact forces and indicate greater muscle activity. By the choice of activity, movement velocity and additional resistive devices joint forces can be modulated individually in the course of rehabilitation or preventive therapies.

BackgroundWith the growing number of young-older adults (baby-boomers), there is an increasing demand for assessment tools specific for this population, which are able to detect subtle balance and mobility deficits. Various balance and mobility tests already exist, but suffer from ceiling effects in higher functioning older adults. A reliable and valid challenging balance and mobility test is critical to determine a young-older adult’s balance and mobility performance and to timely initiate preventive interventions. The aim was to evaluate the concurrent validity, inter- and intrarater reliability, internal consistency, and ceiling effects of a challenging balance and mobility scale, the Community Balance and Mobility Scale (CBM), in young-older adults aged 60 to 70 years.MethodsFifty-one participants aged 66.4 ± 2.7 years (range, 60–70 years) were assessed with the CBM. The Fullerton Advanced Balance scale (FAB), 3-Meter Tandem Walk (3MTW), 8-level balance scale, Timed-Up-and-Go (TUG), and 7-m habitual gait speed were used to estimate concurrent validity, examined by Spearman correlation coefficient (ρ). Inter- and intrarater reliability were calculated as Intra-class-correlations (ICC), and internal consistency by Cronbach alpha and item-total correlations (ρ). Ceiling effects were determined by obtaining the percentage of participants reaching the highest possible score.ResultsThe CBM significantly correlated with the FAB (ρ = 0.75; p < .001), 3MTW errors (ρ = − 0.61; p < .001), 3MTW time (ρ = − 0.35; p = .05), the 8-level balance scale (ρ = 0.35; p < .05), the TUG (ρ = − 0.42; p < .01), and 7-m habitual gait speed (ρ = 0.46, p < .001). Inter- (ICC2,k = 0.97), intrarater reliability (ICC3,k = 1.00) were excellent, and internal consistency (α = 0.88; ρ = 0.28–0.81) was good to satisfactory. The CBM did not show ceiling effects in contrast to other scales.ConclusionsConcurrent validity of the CBM was good when compared to the FAB and moderate to good when compared to other measures of balance and mobility. Based on this study, the CBM can be recommended to measure balance and mobility performance in the specific population of young-older adults.Trial registrationTrial number: ISRCTN37750605. (Registered on 21/04/2016).