Provoking Artificial Slips and Trips towards Perturbation-Based Balance Training: A Narrative Review

Abstract

Humans’ balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients’ fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients’ reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT’s effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community.

The Impact of Induced Acceleration Perturbations in Selected Phases of the Gait Cycle on Kinematic and Kinetic Parameters

“…It is worth noting that reviews by Taylor, et al [15], as well as Ferreira, et al [11], have underscored that heel strike perturbations are prevalent. This study corroborates this finding, demonstrating that perturbations during the IC phase significantly impacted all examined parameters except torques related to dorsiflexion and hip extension.…”

“…This relationship is particularly visible in the area of [7-35.4]% of the gait cycle (Figure 6E). Significant changes also occur in the hip joint % and in the ankle joint [9][10][11][12][13][14][15][16][17]%, and [43][44][45][46][47][48]% in areas before the disturbance. The perturbation in the PS phase significantly affected all extreme kinematic values, except for the hip extension angle.…”

“…To date, many perturbation methods have been proposed in the literature. These include placing obstacles underfoot [11], using slippery or unstable surfaces [12], moving plates [13], and unexpected treadmill accelerations and decelerations [4,11,14]. The field of gait perturbation research, particularly involving both oneand dual-belt treadmill setups, is gaining increasing attention and is presently the most commonly used equipment in such studies [15].…”

Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review

“…To answer this question, scientists have simulated perturbations in laboratory conditions to analyze the compensatory protective step strategies [21][22][23][24], terms suggested by Tisserand et al [13]. In this sense, different instruments have been used to train balance [25] or generate falls such as the waist-pull [22], mobile platforms [26,27], slippery floor surfaces [28], release system [29,30] or new robotic devices [31]. Currently, there are also new devices that assess postural control during static and dynamic ways.…”

Effects of Acute Exposure to Virtually Generated Slip Hazards during Overground Walking

“…In general, biomechanical analyses of postural responses during slip-induced falls are performed during exposure to slip hazards during locomotion in both real-world and laboratory-based environments [11,[15][16][17]. With the growing popularity of virtual reality (VR), VR has been utilized as a means of assessment for postural control and stability and has been shown to be a promising tool for improving balance performance, especially among the elderly [18][19][20][21].…”