Background: Falls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls. Methods: In a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions over 3 months that included unexpected perturbation of balance exercises during treadmill walking. The control group performed treadmill walking with no perturbations. The primary outcome measures were the voluntary step execution times, traditional postural sway parameters and Stabilogram-Diffusion Analysis. The secondary outcome measures were the fall efficacy Scale (FES), self-reported late life function (LLFDI), and Performance-Oriented Mobility Assessment (POMA). Results: Compared to control, participation in intervention program that includes unexpected loss of balance during walking led to faster Voluntary Step Execution Times under single (p = 0.002; effect size [ES] =0.75) and dual task (p = 0.003; [ES] = 0.89) conditions; intervention group subjects showed improvement in Short-term Effective diffusion coefficients in the mediolateral direction of the Stabilogram-Diffusion Analysis under eyes closed conditions (p = 0.012, [ES] = 0.92). Compared to control there were no significant changes in FES, LLFDI, and POMA. Conclusions: An intervention program that includes unexpected loss of balance during walking can improve voluntary stepping times and balance control, both previously reported as risk factors for falls. This however, did not transferred to a change self-reported function and FES. Trial registration: ClinicalTrials.gov Registration number: NCT01439451.
Bibliographical noteFunding Information:
This study was supported by a grant from the Israeli Ministry of Health (2011-056).
This study was supported by a grant from the Israeli Ministry of Health (2011-056), and partially supported by the Helmsley Charitable Trust through the Agricultural, Biological and Cognitive Robotics Initiative of Ben-Gurion University of the Negev. The authors thank the volunteers who participated in this study and the management of Beit Yona and Ganei Omer, Israel for allowing us to use its facilities.
probably decreases the reliance on feedback corrective mechanisms for successful recovery and builds an internal representations to improve its feedforward control while walking. Pai and Bahtt training  used forward slip practice, the training program, while in the present study the direction of the perturbation was highly unpredictable (forward, backward, right and left perturbations), the intervention group subjects were unable to predict the direction of perturbation during the training. Thus it is unlikely that the improvement was due to feedforward control. Our results support the notion that the central nervous system probably increased the reliance on feedback corrective mechanisms for successful recovery. This is supported by the results of the SDA.
© 2016 Kurz et al.
- Postural stability
- Step execution
- Unexpected perturbation of balance
ASJC Scopus subject areas
- Geriatrics and Gerontology