A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease

Abstract

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Perturbation-based Balance Training: Principles, Mechanisms and Implementation in Clinical Practice

“…However, increasing intensity, frequency and duration of such protocols could also have disadvantages such as activity-induced fatigue and reduced participation, particularly in certain clinical populations with significant health issues and balance impairments (Romberg et al, 2004. Another alternative for those unable to tolerate a high dose within a single session is to provide more sessions with fewer training trials or minutes per session (McCrum et al, 2022). For example, studies have shown that a single slip exposure administered in separate, frequent sessions can induce lasting effects within the same environment (i.e., laboratory) Pai, 2009b, Liu et al, 2017).…”

“…However, there is also emerging evidence for the effectiveness of PBT in 'high risk' older adults (for example assisted living residents, or older adults with a history of falls or balance problems), and people with Parkinson's disease, stroke and multiple sclerosis (Shimada et al, 2004, Protas et al, 2005, Smania et al, 2010, Shen and Mak, 2015, Aviles et al, 2019, Bhatt et al, 2019, Handelzalts et al, 2019, Dusane and Bhatt, 2020, Mohamed Suhaimy et al, 2020, Dusane and Bhatt, 2021. PBT trials have also been conducted in people with chronic obstructive pulmonary disorder (McCrum et al, 2022) and incomplete spinal cord injury (Unger et al, 2021)), but due to limited findings will not be discussed in detail in this article. Previous reviews (Mansfield et al, 2015, Gerards et al, 2017 showed significant fall reductions in community-dwelling older adults, frail/high-risk older adults and people with Parkinson's disease and stroke following PBT.…”

Type II muscle fibre properties are not associated with balance recovery following large perturbations during walking in young and older adults

“…Following a break, the same fixed-speed walking trials were repeated and recorded. During another break, the data from these trials were used to calculate a stability-normalised walking speed for each participant individually for use in the subsequent walking perturbation trial, which was set for a margin of stability (MoS; see below; [68]) of 0.05m as described previously [69], ensuring a comparable baseline walking stability for all groups [70][71][72][73]. Next, participants completed the perturbation trial which started with three to four minutes of unperturbed walking at the stability-normalised walking speed, followed by 10 unannounced unilateral treadmill belt acceleration perturbations (every 30 to 90 seconds).…”

“…Foot touchdown and toe-off were detected using a combined method of force plate data (50 N threshold) and foot marker data [74], as described in detail previously [75]. The anteroposterior MoS at foot touchdown were calculated as the anteroposterior distance between the anterior boundary of the base of support (BoS) and the extrapolated centre of mass (XCoM) [68], adapted for our validated reduced kinematic model [76] and treadmill walking [77], in the same manner as our previous studies [69][70][71][72]. The MoS was calculated for the following steps: the mean MoS of the eleventh to second last step before each perturbation (Base); the final step before each perturbation (Pre); and the first eight recovery steps following each perturbation (Post1-8).…”

“…In order to determine the number of steps to recover to baseline stability (up to the eighth recovery step), two methods were used. The first, as used in our previous studies [71][72][73], used a 0.05m thresholdif the recovery step MoS value was within 0.05m of the Base MoS, this was heuristically considered not meaningfully different to unperturbed baseline walking. The second method, rather than using a standard value for all participants, used an individual threshold of three standard deviations of the 10 pre-perturbation steps used to calculate Base.…”