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

Abstract

Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: “Principles and Mechanisms” and “Implementation in Practice”. In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson’s disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.

A Perspective on Using Virtual Reality to Incorporate the Affective Context of Everyday Falls Into Fall Prevention

“…Can replicate balance perturbation training techniques with visual perturbations [ 35 , 58 ] that improve balance recovery and reduce real-world falls [ 81 , 82 ].…”

“…Interventions improve performance on physical function tests related to fall risk[52,53,78], reduce fear of falling and depression[79,80], and reduce the incidence of falls in frail older adults[78] • Can replicate balance perturbation training techniques with visual perturbations[35,58] that improve balance recovery and reduce real-world falls[81,82].…”

Perturbation-based balance training

“…In the meantime, we recommend that studies on PBT collect and report prospective falls data as secondary outcomes to assist future meta-analyses. Template forms for collecting falls information following recommendations by Lamb et al (206) and Lord et al (207) can be downloaded at http://doi.org/10.17605/OSF.IO/HMJEF (208).…”

Measures of falls efficacy, balance confidence, or balance recovery confidence for perturbation-based balance training

“…Example 2: Large mechanical destabilizing perturbations to be delivered in such a way that insufficient or inadequate recovery reactions (i.e., reach-to-grasp or compensatory stepping) would result in a fall ( 1 ). This training aims to improve reactive change-in-support balance control, as shown in Figure 1 : Near-fall stage.…”

“…There is a growing interest in using perturbation-based balance training (PBT) to reduce falls ( 1 ). PBT is a skill training intervention that aims to improve reactive balance control in response to destabilizing perturbations in a safe and controlled environment ( 2 ).…”