Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial

Abstract

Background: Falls are the leading cause of injuries among older adults. Perturbation-based balance training (PBT) is an innovative approach to fall prevention that aims to improve the reactive balance response following perturbations such as slipping and tripping. Many of these PBT studies have targeted reactive balance after slipping or tripping, despite both contributing to a large proportion of older adult falls. The goal of this randomized controlled trial was to evaluate the effects of PBT targeting slipping and tripping on laboratory-induced slips and trips. To build upon prior work, the present study included: 1) a control group; 2) separate training and assessment sessions; 3) PBT methods potentially more amenable for use outside the lab compared to methods employed elsewhere, and 4) individualized training for older adult participants. Methods: Thirty-four community-dwelling, healthy older adults (61-75 years) were assigned to PBT or a control intervention using minimization. Using a parallel design, reactive balance (primary outcome) and fall incidence were assessed before and after four sessions of BRT or a control intervention involving general balance exercises. Assessments involved exposing participants to an unexpected laboratory-induced slip or trip. Reactive balance and fall incidence were compared between three mutually-exclusive groups: 1) baseline participants who experienced a slip (or trip) before either intervention, 2) postcontrol participants who experienced a slip (or trip) after the control intervention, and 3) post-PBT participants who experienced a slip (or trip) after PBT. Neither the participants nor investigators were blinded to group assignment. Results: All 34 participants completed all four sessions of their assigned intervention, and all 34 participants were analyzed. Regarding slips, several measures of reactive balance were improved among post-PBT participants when compared to baseline participants or post-control participants, and fall incidence among post-PBT participants (18%) was lower than among baseline participants (80%). Regarding trips, neither reactive balance nor fall incidence differed between groups. Conclusions: PBT targeting slipping and tripping improved reactive balance and fall incidence after laboratory-induced slips. Improvements were not observed after laboratory-induced trips. The disparity in efficacy between slips and trip may have resulted from differences in dosage and specificity between slip and trip training.

Falls in young adults: The effect of sex, physical activity, and prescription medications

“…These findings support the continued development of perturbation training where people are trained to recover from falls by safely exposing them to slips and trips (e.g. [30]). Furthermore, the training may have benefit not only for balance-compromised populations, but also young healthy adults, since they regularly experience slips and trips and these perturbations are the most common cause of falls.…”

Promoting Generalized Learning in Balance Recovery Interventions

“… Individualized baseline. The baseline assessment is a critical stage to determine the specific needs for a given individual [ 9 , 80 , 81 , 82 ]. In some cases, training may need to start very simple to develop a component skill in isolation before advancing to a more difficult task (e.g., practicing a step response when nudged by a therapist).…”

The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial

“…However, the participants in these studies were older adults ( 51 – 53 ), individuals with Parkinson's disease ( 26 ), and individuals who had experienced a stroke ( 27 ); none of whom had damage to their spinal cord. To our knowledge, the FES-I has only been evaluated following PBT in one study of older adults, where it was found to be unaffected by the training ( 54 ). This finding is also in conflict with our results, which showed a decrease in fall concern following both balance training programs.…”