Reactive Balance Training for Fall Prevention in Older Adults
Recruiting in Palo Alto (17 mi)
Overseen byTanvi Bhatt, PhD
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Illinois at Chicago
Must not be taking: Sedatives
Disqualifiers: Osteoporosis, Cognitive impairment, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The objective of this pilot study is to evaluate and compare the effect of three different perturbation based training devices on the reactive balance control among healthy young adults, healthy older adults, and neurologically impaired stroke individuals. Furthermore, the project aims to determine the feasibility and tolerability of 30-minutes of perturbation training using the SureFooted Trainer. Overall, the project directs to find out the long term effect of training on fall risk reduction and fall prevention.
This study investigates the effects of perturbation training (slip and trip) based on the principles of motor learning. Perturbations in the form of slips and trips induced by the three different types of perturbation devices will displace the center of mass outside the base of support and challenge the stability, thereby inducing a fall and demand compensatory strategies in order to prevent it. Such perturbation training would train the motor system to improve stability control and vertical limb support.
The project design aims to examine the ability of the central nervous system to mitigate the interference in stability control (if any) that is induced by opposing types of perturbations. The hypothesis of this study if supported by the results, will provide the difference in motor learning with training on three different perturbation devices. Furthermore, it would help to determine which of the three training devices is the most effective in developing defense mechanisms necessary to reduce fall-risk among community-living older adults and the neurological population.
Will I have to stop taking my current medications?
The trial does not specify if you need to stop taking your current medications, but you cannot be on any sedative drugs to participate.
What data supports the effectiveness of the treatment Reactive Balance Training for fall prevention in older adults?
Research shows that Reactive Balance Training (RBT) can help reduce the risk of falls in older adults by improving their ability to react to balance disturbances, like tripping or slipping. Studies have found that even a single session of RBT can lead to lasting improvements in balance control, making it a promising approach for fall prevention.
12345Is Reactive Balance Training safe for older adults?
Reactive Balance Training, also known as Perturbation Training, has been studied for its safety in older adults. Research indicates that it is generally safe, with no significant adverse events reported in studies focused on fall prevention.
24678How does Reactive Balance Training differ from other treatments for fall prevention in older adults?
Reactive Balance Training is unique because it focuses on improving the body's ability to respond to unexpected disturbances, like tripping or slipping, through exercises that simulate these situations. Unlike traditional balance exercises or strength training, this method specifically targets the reactive balance mechanisms, which are crucial for preventing falls.
123910Eligibility Criteria
This trial is for healthy young adults aged 18-55, and older adults aged 56-90 who can walk at least 10 meters with or without help. Participants should not have acute neurological, heart, muscle conditions or other systemic diseases, recent major surgery or hospitalization, and must not be taking sedatives.Inclusion Criteria
I am young and healthy.
I haven't had major surgery or been hospitalized in the last 6 and 3 months, respectively.
I am not taking any sedative medications.
+7 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Training
Participants undergo perturbation training using three different devices: ActiveStep treadmill, custom-designed over-ground walkway, and Surefooted Trainer. Training includes slip and trip perturbations under various conditions.
1 week
Multiple sessions (in-person)
Immediate Post-training Assessment
Assessment of changes in stability, limb support, and laboratory-induced falls immediately after training.
1 week
1 visit (in-person)
Follow-up
Participants are monitored for real-life falls and changes in physical activity over a long-term period.
12 months
Periodic check-ins (virtual or in-person)
Participant Groups
The study compares three types of balance training to prevent falls: overground training (walking on solid ground), treadmill training (walking on a moving surface), and Surefooted training (using a special device). It tests how these trainings improve balance in response to sudden slips or trips.
3Treatment groups
Experimental Treatment
Group I: Treadmill trainingExperimental Treatment1 Intervention
Subjects randomly assigned to the treadmill training, would undergo either a stance or walking perturbation training protocol. The stroke subjects and older adults would be assigned to either the stance or walking perturbation training protocol. All the participants would be asked to perform voluntary stepping, backward and forward with both limbs pre and post perturbation training. Also, all the participants would perform walking trials with head mounted virtual reality system under three conditions: ice, beach and crowd.
Group II: Surefooted trainingExperimental Treatment1 Intervention
Subjects randomly assigned to Surefooted (Surefooted LLC) would be donned a safety harness and instructed that "when you experience slip-like or trip-like movements, try to keep walking on the platform". Subjects would undergo 4-minute training block on each of the 6 different conditions. The first 3 training blocks would be unidirectional perturbation (either slip or trip) followed by 3 training blocks of mixed directional perturbations while the subjects are walking on the platform. 3 surface conditions- slippery (vinyl surface plate), normal friction with obstacles (surface plate with 6" tall structures embedded), and a foam surface with obstacles embedded would be used.
Group III: Overground trainingExperimental Treatment1 Intervention
Subjects randomly assigned to overground slip will be made to walk at their comfortable natural walking speeds either for 5-8 trials on the instrumented walkway (7 m 1.5 m) at their self-selected preferred speed. All the participants would perform walking trials with head mounted virtual reality system under three conditions: ice, beach and crowd. After establishing baseline walking ability, a slip will be introduced without warning which will comprise the baseline slip test followed by a trip in the form of the trip plate. This is followed by a block of 8 trials for slip training, block of 8 trials for trip training and then the mixed block consisting of slip and trip trials interspersed with walking trials. Slips and trips could be induced under either of the limbs.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of Illinois at ChicagoChicago, IL
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Who Is Running the Clinical Trial?
University of Illinois at ChicagoLead Sponsor
References
Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial. [2020]There is growing interest in using perturbation-based balance training to improve the reactive response to common perturbations (eg, tripping and slipping). The goal of this study was to compare the efficacy of treadmill-based reactive balance training versus Tai Chi performed at, and among independent residents of, older adult senior housing.
The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. [2023]Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events.
Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. [2023]Impaired reactive balance control can lead to increased falls in people with neurological impairments. Perturbation-based balance training (PBT), which involves repetitive exposure to destabilizing external perturbations, improves the ability to take reactive steps in older adults and individuals who have had a stroke.
Examining Different Motor Learning Paradigms for Improving Balance Recovery Abilities Among Older Adults, Random vs. Block Training-Study Protocol of a Randomized Non-inferiority Controlled Trial. [2021]Introduction: Falls are the leading cause of fatal and nonfatal injuries among older adults. Studies showed that older adults can reduce the risk of falls after participation in an unexpected perturbation-based balance training (PBBT), a relatively novel approach that challenged reactive balance control. This study aims to investigate the effect of the practice schedule (i.e., contextual interference) on reactive balance function and its transfer to proactive balance function (i.e., voluntary step execution test and Berg balance test). Our primary hypothesis is that improvements in reactive balance control following block PBBT will be not inferior to the improvements following random PBBT. Methods and Analysis: This is a double-blind randomized controlled trial. Fifty community-dwelling older adults (over 70 years) will be recruited and randomly allocated to a random PBBT group (n = 25) or a block PBBT group (n = 25). The random PBBT group will receive eight training sessions over 4 weeks that include unexpected machine-induced perturbations of balance during hands-free treadmill walking. The block PBBT group will be trained by the same perturbation treadmill system, but only one direction will be trained in each training session, and the direction of the external perturbations will be announced. Both PBBT groups (random PBBT and block PBBT) will receive a similar perturbation intensity during training (which will be customized to participant's abilities), the same training period, and the same concurrent cognitive tasks during training. The generalization and transfer of learning effects will be measured by assessing the reactive and proactive balance control during standing and walking before and after 1 month of PBBT, for example, step and multiple steps and fall thresholds, Berg balance test, and fear of falls. The dependent variable will be rank transformed prior to conducting the analysis of covariance (ANCOVA) to allow for nonparametric analysis. Discussion: This research will explore which of the balance retraining paradigms is more effective to improve reactive balance and proactive balance control in older adults (random PBBT vs. block PBBT) over 1 month. The research will address key issues concerning balance retraining: older adults' neuromotor capacities to optimize training responses and their applicability to real-life challenges. Clinical Trial Registration: Helsinki research ethics approval has been received (Soroka Medical Center approval #0396-16-SOR; MOH_2018-07-22_003536; www.ClinicalTrials.gov, NCT04455607).
Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. [2021]Falls risk poststroke is highest soon after discharge from rehabilitation. Reactive balance training (RBT) aims to improve control of reactions to prevent falling after a loss of balance. In healthy older adults, a single RBT session can lead to lasting improvements in reactive balance control and prevent falls in daily life. While increasing the dose of RBT does not appear to lead to additional benefit for healthy older adults, stroke survivors, who have more severely impaired balance control, may benefit from a higher RBT dose. Our long-term goal is to determine the optimal dose of RBT in people with subacute stroke. This assessor-blinded pilot randomised controlled trial aims to inform the design of a larger trial to address this long-term goal.
Feasibility, effectiveness and acceptability of two perturbation-based treadmill training protocols to improve reactive balance in fall-prone older adults (FEATURE): protocol for a pilot randomised controlled trial. [2023]Perturbation-based balance training (PBT) targets the mechanism of falls (eg, slipping, tripping) to specifically train the recovery actions needed to avoid a fall. This task-specific training has shown great promise as an effective and efficient intervention for fall prevention in older adults. However, knowledge about the dose-response relationship of PBT, as well as its feasibility and acceptability in older adults with increased risk of falling is still limited. Thus, the aim of this study is to compare the effectiveness of two different treadmill PBT protocols for improving reactive balance control in fall-prone older adults, and to evaluate the feasibility and acceptability of these protocols.
Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke? [2019]Although perturbation-based balance training (PBT) may be effective in improving reactive balance control and/or reducing fall risk in individuals with stroke, the characteristics of reactive balance responses that improve following PBT have not yet been identified. This study aimed to determine if reactive stepping characteristics and timing in response to support-surface perturbations improved to a greater extent following PBT, compared to traditional balance training.
A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. [2020]Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults.
Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training. [2021]Reactive balance training (RBT) is an emerging fall prevention exercise intervention for older adults. To better understand factors that influence improvements after RBT, the goal of this study was to identify key factors that strongly associate with training-induced improvements in reactive balance. This study is a secondary analysis of data from a prior study. Twenty-eight residents of senior housing facilities participated, including 14 RBT participants and 14 Tai Chi participants (controls). Before and one week after training, participants completed balance and mobility tests and a reactive balance test. Reactive balance was operationalized as the maximum trunk angle in response to standardized trip-like perturbations on a treadmill. Bivariate (Pearson) correlation was used to identify participant characteristics before RBT and measures of performance during RBT that associated with training-induced changes in maximum trunk angle. Maximum trunk angle before reactive balance training exhibited the strongest association with training-induced changes in maximum trunk angle among RBT participants (r2 = 0.84; p < .001), but not among Tai Chi participants (r2 = 0.17; p = .138). Measures of performance during RBT, based upon perturbation speed, also associated with RBT-induced improvements in maximum trunk angle. These results help clarify the characteristics of individuals who can benefit from RBT, and support the use of treadmill perturbation speed as a surrogate measure of training-induced improvements in trunk kinematics.
Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program. [2021]Both resistance training (RT) and perturbation-based training (PBT) have been proposed and applied as interventions to improve reactive balance performance in older adults. PBT is a promising approach but the adaptations in underlying balance-correcting mechanisms through which PBT improves reactive balance performance are not well-understood. Besides it is unclear whether PBT induces adaptations that generalize to movement tasks that were not part of the training and whether those potential improvements would be larger than improvements induced by RT. We performed two training interventions with two groups of healthy older adults: a traditional 12-week RT program and a 3-week PBT program consisting of support-surface perturbations of standing balance. Reactive balance performance during standing and walking as well as a set of neuro-muscular properties to quantify muscle strength, sensory and motor acuity, were assessed pre- and post-intervention. We found that both PBT and RT induced training specific improvements, i.e., standing PBT improved reactive balance during perturbed standing and RT increased strength, but neither intervention affected reactive balance performance during perturbed treadmill walking. Analysis of the reliance on different balance-correcting strategies indicated that specific improvements in the PBT group during reactive standing balance were due to adaptations in the stepping threshold. Our findings indicate that the strong specificity of PBT can present a challenge to transfer improvements to fall prevention and should be considered in the design of an intervention. Next, we found that lack of improvement in muscle strength did not limit improving reactive balance in healthy older adults. For improving our understanding of generalizability of specific PBT in future research, we suggest performing an analysis of the reliance on the different balance-correcting strategies during both the training and assessment tasks.