Predictive and Reactive Locomotor Adaptability in Healthy Elderly: A Systematic Review and Meta-Analysis

Böhm, Sebastian; Mademli, Lida; Mersmann, Falk; Arampatzis, Adamantios

doi:10.1007/s40279-015-0413-9

Cited by 69 publications

(66 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…19,23 The perturbations during PBT are unannounced in order to mimic the accidental and unexpected nature of falls in daily life, 21 and ensure that the task-specific approach of PBT is in concordance with the "specificity of learning" hypothesis. 24 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

207

151

View full text Add to dashboard Cite

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..

show abstract

Section: Introductionmentioning

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

207

151

View full text Add to dashboard Cite

show abstract

“…In daily-life, however, falls may be caused by different types of unexpected hazards. A recent systematic review of repeated perturbation training found that in 80% of the included studies insufficient washout walks were used between repeated exposure to a hazard (Bohm et al, 2015). Changes in the approach walk (slower gait speed, shorter step lengths and anticipatory postural adjustments) can reduce the intensity of the perturbation and therefore may have confounded the reported improvements in reactive balance recovery (Bohm et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Optimizing successful balance recovery from unexpected trips and slips

Brodie

Okubo

Sturnieks

et al. 2018

JBSE

View full text Add to dashboard Cite

Approximately one in three people over 65 years of age fall each year. The resulting physiological and psychological trauma can lead to physical deconditioning, social isolation and early mortality. Recent research has reported balance recovery can be trained in a single session resulting in dramatic reductions in fall rates. However, most previous research has used repeated exposures to a single hazard in a fixed location and not controlled for reductions in walking speed. It follows, that the biomechanical mechanisms important for reactive balance recovery (in the absence of anticipatory adjustments) are probably not well understood. Here, we investigated the biomechanics of successful reactive balance recovery following the first exposures to unexpected trip and slip hazards in different locations. Ten healthy adults (29.1±5.6 years) completed 32 walks at fixed speed, cadence and step length over a custom 10-meter walkway while being exposed to randomly presented and located slip and trip hazards. Balance recovery kinematics were assessed using a VICON motion analysis system. Repeated exposures to unexpected hazards induced significant reductions (p≤0.05) in anteroposterior (AP) trunk sway following the trips (26.7º to 14.3º; Cohen's d -1.24) and slips (32.7º to 19.0º; Cohen's d -0.93). During recovery from unexpected trips, reduced AP trunk sway was strongly correlated with a more posterior centre-of-mass position relative to the stepping foot (r=0.91) and a longer step length (r=-0.71). During recovery from unexpected slips, reduced AP trunk sway was moderately correlated with slower slipping speed (r=0.54) and a less posterior centre-of-mass position relative to the stance (slipping) foot (r=-0.39). The biomechanical mechanisms required for the successful reactive balance recovery from trips and slips were different. Future experimental protocols to optimize reactive balance recovery for fall prevention should therefore use progressive exposures to both slip and trip hazards using specialized equipment and determine if similar biomechanical mechanisms are observed in young and elderly people at risk of falls.

show abstract

“…Moreover, although many studies have reported significant improvements in reactive balance control following repeated perturbations [5–7, 9, 14–16], a recent systematic review found that 80% of the included studies did not control for the effect of predictive gait alterations (e.g. including sufficient washout walks) [4]. Anticipation of upcoming perturbations and related changes in the approach walk (slower gait speed, shorter step lengths and anticipatory postural adjustments) can diminish the perturbation magnitude and therefore possibly overestimate the improvements in reactive balance control reported [4].…”

Section: Introductionmentioning

confidence: 99%

“…including sufficient washout walks) [4]. Anticipation of upcoming perturbations and related changes in the approach walk (slower gait speed, shorter step lengths and anticipatory postural adjustments) can diminish the perturbation magnitude and therefore possibly overestimate the improvements in reactive balance control reported [4]. Thus, the evaluation of balance recovery responses during walking has proved to be a significant challenge because unpredictability and magnitude of postural perturbations are difficult to maintain over repeated trials…”

Section: Introductionmentioning

confidence: 99%

Exposure to unpredictable trips and slips while walking can improve balance recovery responses with minimum predictive gait alterations

Okubo

Brodie

Sturnieks

et al. 2018

Preprint

View full text Add to dashboard Cite

18INTRODUCTION: This study aimed to determine if repeated exposure to unpredictable trips 19 and slips while walking can improve balance recovery responses when predictive gait 20 alterations (e.g. slowing down) are minimised. 21 METHODS: Ten young adults walked on a 10-m walkway that induced slips and trips in fixed 22 and random locations. Participants were exposed to a total of 12 slips, 12 trips and 6 non-23 perturbed walks in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) 24 random leg and location. Kinematics during non-perturbed walks and previous and recovery 25 steps were analysed. 26 RESULTS: Throughout the three conditions, participants walked with similar gait speed, step 27 length and cadence(p>0.05). Participants' extrapolated centre of mass (XCoM) was anteriorly 28 shifted immediately before slips at the fixed location (p<0.01), but this predictive gait alteration 29 did not transfer to random perturbation locations. Improved balance recovery from trips in the 30 random location was indicated by increased margin of stability and step length during recovery 31 steps (p<0.05). Changes in balance recovery from slips in the random location was shown by 32 reduced backward XCoM displacement and reduced slip speed during recovery steps (p<0.05). 33 CONCLUSIONS: Even in the absence of most predictive gait alterations, balance recovery 34 responses to trips and slips were improved through exposure to repeated unpredictable 35 perturbations. A common predictive gait alteration to lean forward immediately before a slip 36 was not useful when the perturbation location was unpredictable. Training balance recovery 37 with unpredictable perturbations may be beneficial to fall avoidance in everyday life. 38 39

show abstract

Predictive and Reactive Locomotor Adaptability in Healthy Elderly: A Systematic Review and Meta-Analysis

Cited by 69 publications

References 106 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

Optimizing successful balance recovery from unexpected trips and slips

Exposure to unpredictable trips and slips while walking can improve balance recovery responses with minimum predictive gait alterations

Contact Info

Product

Resources

About