A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing

Madigan, Michael L.; Aviles, Jessica; Allin, Leigh J.; Nussbaum, Maury A.; Alexander, Neil B.

doi:10.1093/gerona/gly077

Cited by 11 publications

(11 citation statements)

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“…For example, averting a fall after a trip or trip-like perturbation requires arresting trunk motion, maintaining adequate hip height to allow continued stepping, and stepping to expand the base of support (33,35,36). The reactive balance rating provides a clinical analogue to these measures (29), which, together with maximum trunk angle, improved with RBT. Moreover, as evidence of the specificity of RBT, these reactive measures did not change with Tai Chi.…”

Section: Discussionmentioning

confidence: 99%

“…Each testing session included a reactive balance test (29). Briefly, participants stood on a modified treadmill (Freemotion 800, Freemotion Fitness, Logan, UT) with the treadmill belt speed at zero, and facing forward.…”

Section: Reactive Balance Testsmentioning

confidence: 99%

“…Participant inability to complete treadmill trials at 2.4 mph, or unwillingness to continue, resulted in a large percentage of missing data describing stepping characteristic (ranging from 31% of liftoff time to 69% of maximum trunk angle values), and thus these measures were not determined for trials at 2.4 mph. A reactive balance rating score was also determined (29). This score, which was not an a priori outcome measure developed before the start of this trial, is based upon group-blinded investigators viewing video recordings of each perturbation during reactive balance tests, and rating them on a three-level scale in terms of both the quality of the stepping response and the amount of support provided by the fall prevention harness and/or spotters standing next to the participant (see Supplementary Material for additional details).…”

Section: Reactive Balance Testsmentioning

confidence: 99%

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Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial

Aviles

Allin

Alexander

et al. 2018

The Journals of Gerontology: Series A

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Background There is growing interest in using perturbation-based balance training to improve the reactive response to common perturbations (eg, tripping and slipping). The goal of this study was to compare the efficacy of treadmill-based reactive balance training versus Tai Chi performed at, and among independent residents of, older adult senior housing. Methods Thirty-five residents from five senior housing facilities were allocated to either treadmill-based reactive balance training or Tai Chi training. Both interventions were performed three times per week for 4 weeks, with each session lasting approximately 30 minutes. A battery of balance tests was performed at baseline, and again 1 week, 1 month, 3 months, and 6 months post-training. The battery included six standard clinical tests of balance and mobility, and a test of reactive balance performance. Results At baseline, no significant between-group differences were found for any balance tests. After training, reactive balance training participants had better reactive balance than Tai Chi participants. Maximum trunk angle was 13.5° smaller among reactive balance training participants 1 week after training (p = .01), and a reactive balance rating was 24%–31% higher among reactive balance training participants 1 week to 6 months after training (p < .03). Clinical tests showed minimal differences between groups at any time point after training. Conclusion Trip-like reactive balance training performed at senior housing facilities resulted in better rapid balance responses compared with Tai Chi training.

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Section: Discussionmentioning

confidence: 99%

Section: Reactive Balance Testsmentioning

confidence: 99%

Section: Reactive Balance Testsmentioning

confidence: 99%

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Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial

Aviles

Allin

Alexander

et al. 2018

The Journals of Gerontology: Series A

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“…Phase 1 – Rapid Stepping targets the need to quickly step anteriorly to extend the base of support ( 27 , 33 , 34 ). It involves volitional stepping exercises from bilateral standing during which the participant starts to tip and fall forward by rotating about their ankles, and then takes quick steps to recover balance.…”

Section: Methodsmentioning

confidence: 99%

A proposed methodology for trip recovery training without a specialized treadmill

Lee

Alexander

Madigan

2022

Front. Sports Act. Living

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Falls are the leading cause of accidental injuries among adults aged 65 years and older. Perturbation-based balance training is a novel exercise-based fall prevention intervention that has shown promise in reducing falls. Trip recovery training is a form of perturbation-based balance training that targets trip-induced falls. Trip recovery training typically requires the use of a specialized treadmill, the cost of which may present a barrier for use in some settings. The goal of this paper is to present a methodology for trip recovery training that does not require a specialized treadmill. A trial is planned in the near future to evaluate its effectiveness. If effective, non-treadmill trip recovery training could provide a lower cost method of perturbation-based balance training, and facilitate greater implementation outside of the research environment.

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“…In the scientific setting, several approaches have been developed, e.g., perturbations by cable pull (Hilliard et al, 2008), sudden cable release of tethered lean (Carty et al, 2015), and platform motions (Maki and McIlroy, 2006;Madigan et al, 2018;Aviles et al, 2019). Emerging technologies enable the computerized application of perturbations in various directions, intensities, time intervals, and under controlled, safe conditions (Shapiro and Melzer, 2010).…”

Section: Introductionmentioning

confidence: 99%

The Stepping Threshold Test for Reactive Balance: Validation of Two Observer-Based Evaluation Strategies to Assess Stepping Behavior in Fall-Prone Older Adults

Adams

Brüll

Lohkamp

et al. 2021

Front. Sports Act. Living

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Introduction: Measurement of reactive balance is critical for fall prevention but is severely underrepresented in the clinical setting due to the lack of valid assessments. The Stepping Threshold Test (STT) is a newly developed instrumented test for reactive balance on a movable platform, however, it has not yet been validated for fall-prone older adults. Furthermore, different schemes of observer-based evaluation seem possible. The aim of this study was to investigate validity with respect to fall risk, interpretability, and feasibility of the STT using two different evaluation strategies.Methods: This study involved 71 fall-prone older adults (aged ≥ 65) who underwent progressively increasing perturbations in four directions for the STT. Single and multiple-step thresholds for each perturbation direction were determined via two observer-based evaluation schemes, which are the 1) consideration of all steps (all-step-count evaluation, ACE) and 2) consideration of those steps that extend the base of support in the direction of perturbation (direction-sensitive evaluation, DSE). Established balance measures including global (Brief Balance Evaluations Systems Test, BriefBEST), proactive (Timed Up and Go, TUG), and static balance (8-level balance scale, 8LBS), as well as fear of falling (Short Falls Efficacy Scale—International, FES-I) and fall occurrence in the past year, served as reference measurements.Results: The sum scores of STT correlated moderately with the BriefBEST (ACE: r = 0.413; DSE: r = 0.388) and TUG (ACE: r = −0.379; DSE: r = −0.435) and low with the 8LBS (ACE: r = 0.173; DSE: r = 0.246) and Short FES-I (ACE: r = −0.108; DSE: r = −0.104). The sum scores did not distinguish between fallers and non-fallers. No floor/ceiling effects occurred for the STT sum score, but these effects occurred for specific STT thresholds for both ACE (mean floor effect = 13.04%, SD = 19.35%; mean ceiling effect = 4.29%, SD = 7.75%) and DSE (mean floor effect = 7.86%, SD = 15.23%; mean ceiling effect = 21.07%, SD = 26.08). No severe adverse events occurred.Discussion: Correlations between the STT and other balance tests were in the expected magnitude, indicating convergent validity. However, the STT could not distinguish between fallers and non-fallers, referring to a need for further studies and prospective surveys of falls to validate the STT. Current results did not allow a definitive judgment on the advantage of using ACE or DSE. Study results represented a step toward a reactive balance assessment application in a clinical setting.

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A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing

Abstract: The reactive balance rating method may provide a low-tech, valid measure of reactive balance kinematics, and an indicator of fall risk, after trip-like postural perturbations.

Cited by 11 publications

References 38 publications

Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial

Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial

A proposed methodology for trip recovery training without a specialized treadmill

The Stepping Threshold Test for Reactive Balance: Validation of Two Observer-Based Evaluation Strategies to Assess Stepping Behavior in Fall-Prone Older Adults

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