Perturbation Training for Stroke
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Medical University of South Carolina
Disqualifiers: Cerebellar damage, Cardiac arrhythmias, Neurological disorders, Legal blindness, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
Following a stroke, many individuals have a high risk of falls, which can negatively influence quality of life. Unfortunately, current treatments have not effectively addressed this problem. This study investigates whether two methods of delivering mechanical perturbations during walking have the potential to improve post-stroke walking balance and reduce real-world fall incidence.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Proactive Perturbations, Perturbation-Based Balance Training, PBT, Mechanical Perturbation Training, Reactive Perturbations, Perturbation-Based Balance Training, Reactive Balance Training, Mechanical Perturbation Training for stroke?
Is perturbation-based balance training safe for humans?
Perturbation-based balance training has been studied for its safety and effectiveness in improving balance and reducing falls, particularly in older adults and individuals with stroke. While it shows promise, some aspects of its safety and application need further investigation before widespread clinical use.12367
How is the treatment Perturbation-Based Balance Training different from other treatments for stroke?
Perturbation-Based Balance Training is unique because it focuses on improving reactive balance control by exposing patients to controlled destabilizing movements, which helps them practice and enhance their ability to recover from potential falls. This task-specific approach is different from traditional balance training, which may not specifically target the quick, reactive steps needed to prevent falls.12356
Eligibility Criteria
This trial is for individuals who had a stroke at least 6 months ago, have experienced falls or fear falling, can walk on a treadmill without support, and have a walking speed of at least 0.2 meters per second. It's not suitable for those with certain heart conditions, other neurological disorders or dementia, severe lower limb orthopedic issues, cerebellar damage, extremely high blood pressure, significant visual impairments, recent DVT/pulmonary embolism events or uncontrolled diabetes.Inclusion Criteria
I had a stroke more than 6 months ago.
I can walk at a speed of at least 0.2 meters per second.
I can walk on a treadmill without needing a cane or walker.
See 2 more
Exclusion Criteria
I have a history of serious heart conditions.
I have a leg or foot condition that affects how I walk.
I am legally blind or have severe trouble seeing.
See 5 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants undergo perturbation training to improve post-stroke walking balance and reduce fall incidence
8 weeks
Regular in-person sessions
Follow-up
Participants are monitored for safety and effectiveness after treatment
12 weeks
Monitoring through 2-week calendars
Treatment Details
Interventions
- Proactive Perturbations (Behavioural Intervention)
- Reactive Perturbations (Behavioural Intervention)
Trial OverviewThe study examines two types of mechanical perturbations during walking—proactive and reactive—to see if they improve balance and reduce the risk of falls in post-stroke patients. Participants will be subjected to these perturbations while walking to assess their effectiveness in enhancing stability.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: Reactive PerturbationsExperimental Treatment1 Intervention
Group II: Proactive PerturbationsExperimental Treatment1 Intervention
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Medical University of South CarolinaCharleston, SC
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Who Is Running the Clinical Trial?
Medical University of South CarolinaLead Sponsor
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)Collaborator
References
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.
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.
A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. [2023]Perturbation-based balance training has been proven effective to reduce falls in older adults. However, it remains inconclusive if this training paradigm reduces falls in the stroke population. This review sought to summarize the existing literature to assess the effects of perturbation-based balance training on falls and some common fall risk factors in people with stroke.
Toward improving the specificity of perturbation-based training through assessment of dynamic balancing responses: a series of N-of-1 studies in subacute stroke. [2023]Perturbation-based balance training (PBT) has been shown to improve reactive balancing abilities in chronic stroke. To inform future investigations in the subacute phase of stroke, the objective of this series of N-of-1 studies was to investigate the range of balancing responses to unexpected mechanical perturbations applied to the pelvis during walking on an instrumented treadmill before and after PBT training. Three subacute stroke subjects were assessed on each occasion with clinical tests and biomechanical measurements following perturbations applied in forward, backward, inward and outward directions. After 15 daily sessions of PBT, most clinical mobility outcomes showed improvements in all three subjects. Assessment of reactive balancing also showed improvements in all subjects when responding to perturbations in backward and inward directions whereas the changes following perturbations in forward and outward directions were subject-specific. The results suggest that PBT should be individually tailored to target balance deficiencies identified through a serial biomechanical assessment.
Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. [2023]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..
Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. [2023]Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.
The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial. [2023]Perturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling.