Unexpected perturbations training improves balance control and voluntary stepping times in older adults - a double blind randomized control trial

Abstract

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 .

Figures

Fig. 1

Study flow chart

Fig. 2

The perturbation treadmill system used a Photo of the perturbation system during balance training. The system is compose of a motor-driven treadmill, mounted on a moving platform, motion controller, safety harness and an operator station; b the perturbations velocity control diagram during training delivered unpredictably in forward, backward, left, and right directions. Note those are actual measurements taken during perturbation training. c Example of the perturbation applied during the treadmill walking training (c1–c12). The perturbation applied unpredictably (c5) by horizontal movement of the platform towards the left side during the right foot initial contact-loading response phases of gait cycle. The participant right foot was slipped unpredictably to the left while walking in the center of the platform. The participants performed a cross over stepping response by his left foot (c6–c9), than additional side step was performed by the right foot stepping outside the treadmill (c10–c12)