Older adults can improve compensatory stepping with repeated postural perturbations

Dijkstra, Bauke W.; Horak, Fay B.; Kamsma, Y.P.T.; Peterson, Daniel S.

doi:10.3389/fnagi.2015.00201

Cited by 64 publications

(78 citation statements)

References 23 publications

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“…Another study applied only perturbations leading to a forward loss of balance,32 whereas three studies applied perturbations in both directions 34, 35, 36. Although the impact of perturbation direction on falls incidence or types of falls experienced is not known, there is evidence to suggest that adaptation to perturbations in one direction might not transfer and benefit reactive balance control in another direction 27, 38. Perturbations in the mediolateral directions should also be considered when applying PBT in clinical settings, because of the reduced mediolateral stability seen in older adults 51.…”

Section: Resultsmentioning

confidence: 99%

“…Despite the diminished reactive gait stability seen in older adults in response to a novel perturbation compared with young adults,25 reactive locomotor adaptation potential (the ability to adapt and improve reactive gait adjustments in a feedback‐driven manner) does not appear to decline with age,26, 27 nor does it appear to be specific to one mode (stance, sit‐to‐stand or gait) of locomotion 28. By capitalizing on older adults’ potential for improvement by providing sufficient and specific stimuli (i.e.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

206

151

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Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation‐based balance training (PBT) is an emerging task‐specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill‐based systems and therapist‐applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long‐term follow‐up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294–2303..

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

206

151

View full text Add to dashboard Cite

show abstract

“…Overall, the findings indicated that although reduced stability at first foot contact could be a determinant of taking additional steps, stepping responses could also be attributable to the COM motion state as early as first step lift-off, preceding foot contact. Since perturbation training has been reported to improve the reactive control of balance stability (Barrett et al, 2012; Dijkstra et al, 2015; Kurz et al, 2016; Mansfield et al, 2015; Pai et al, 2014; Rosenblatt et al, 2013), which increased balance stability at the instant of step lift-off (Lee et al, 2016; Liu et al, 2016), perturbation-based training interventions aimed at improving the reactive control of stability would reduce initial balance instability at first step lift-off and possibly the consequent need for multiple steps in response to balance perturbations.…”

Section: Discussionmentioning

confidence: 99%

Single and multiple step balance recovery responses can be different at first step lift-off following lateral waist-pull perturbations in older adults

Fujimoto

Bair

Rogers

2017

Journal of Biomechanics

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An inability to recover lateral balance with a single step is predictive of future falls in older adults. This study investigated if balance stability at first step lift-off (FSLO) would be different between multiple and single stepping responses to lateral perturbations. 54 healthy older adults received left and right waist-pulls at 5 different intensities (levels 1–5). Crossover stepping responses at and above intensity level 3 that induced both single and multiple steps were analyzed. Whole-body center of mass (COM) and center of pressure (COP) positions in the medio-lateral direction with respect to the base of support were calculated. An inverted pendulum model was used to define the lateral stability boundary, which was also adjusted using the COP position at FSLO (functional boundary). No significant differences were detected in the COP positions between the responses at FSLO (p ≥ 0.075), indicating no difference in the functional boundaries between the responses. Significantly smaller stability margins were observed at first step landing for multiple steps at all levels (p ≤ 0.024), while stability margins were also significantly smaller at FSLO for level 3 and 4 (p ≤0.048). These findings indicate that although reduced stability at first foot contact would be associated with taking additional steps, stepping responses could also be attributable to the COM motion state as early as first step lift-off, preceding foot contact. Perturbation-based training interventions aimed at improving the reactive control of stability would reduce initial balance instability at first step lift-off and possibly the consequent need for multiple steps in response to balance perturbations.

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“…HO participants were similar with respect to age, Montreal Cognitive Assessment, and MiniBESTest to the PD participants (Table 1). Data from HO subjects have been compared to younger adults previously [9]. All participants provided informed consent, and the research protocol was approved by the OHSU institutional review board.…”

Section: Methodsmentioning

confidence: 99%

“…This protocol has been described previously [9]. Briefly, participants completed two visits on consecutive days.…”

Section: Methodsmentioning

confidence: 99%

Postural motor learning in people with Parkinson’s disease

2016

Self Cite

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Protective postural responses to external perturbations are hypokinetic in people with Parkinson’s disease (PD) and improving these responses may reduce falls. However, the ability of people with PD to improve postural responses with practice is poorly understood. Our objective was to determine whether people with PD can improve protective postural responses similarly to healthy adults through repeated perturbations, and whether improvements are retained or generalize to untrained perturbations. Twelve healthy adults and 15 people with PD underwent 25 forward and 25 backward translations of the support surface, eliciting backward and forward protective steps, respectively. We assessed whether: 1) performance improved over one day of practice, 2) changes were retained 24 hours later, and 3) improvements generalized to untrained (lateral) postural responses. People with PD and healthy adults improved postural response characteristics including center of mass displacement after perturbations (p<0.001), margin of stability at first foot-fall (p=0.001), step latency (p=0.044), and number of steps (p=0.001). However, unlike controls, improvements in people with PD occurred primarily in the first block of trials. Improvements were more pronounced during backward protective stepping than forward, and with the exception of step latency, were retained 24 hours later. Improvements in forward-backward stepping did not generalize to lateral protective stepping. People with PD can improve protective stepping over the course of one day of perturbation practice. Improvements were generally similar to healthy adults, and were retained in both groups. Perturbation practice may represent a promising approach to improving protective postural responses in people with PD, however additional research is needed to understand how to enhance generalization.

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Older adults can improve compensatory stepping with repeated postural perturbations

Cited by 64 publications

References 23 publications

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Single and multiple step balance recovery responses can be different at first step lift-off following lateral waist-pull perturbations in older adults

Postural motor learning in people with Parkinson’s disease

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