Effect of a Perturbation-Based Balance Training Program on Compensatory Stepping and Grasping Reactions in Older Adults: A Randomized Controlled Trial

• Published in: Physical therapy Vol. 90; no. 4; pp. 476 - 491
• Main Authors: Mansfield, Avril, Peters, Amy L, Liu, Barbara A, Maki, Brian E
• Format: Journal Article
• Language: English
• Published: United States American Physical Therapy Association 01.04.2010; Oxford University Press
• Subjects: Accidental falls; Accidental Falls - prevention & control; Aged; Aged, 80 and over; Aging - physiology; Company business management; Double-Blind Method; Elderly; Equilibrium (Physiology); Falls (Accidents); Female; Health aspects; Humans; Male; Management; Middle Aged; Movement - physiology; Physical Therapy Modalities; Postural Balance - physiology; Posture - physiology; Prevention; Training; United States
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20090070

Compensatory stepping and grasping reactions are prevalent responses to sudden loss of balance and play a critical role in preventing falls. The ability to execute these reactions effectively is impaired in older adults. The purpose of this study was to evaluate a perturbation-based balance training program designed to target specific age-related impairments in compensatory stepping and grasping balance recovery reactions. This was a double-blind randomized controlled trial. The study was conducted at research laboratories in a large urban hospital. Thirty community-dwelling older adults (aged 64-80 years) with a recent history of falls or self-reported instability participated in the study. Participants were randomly assigned to receive either a 6-week perturbation-based (motion platform) balance training program or a 6-week control program involving flexibility and relaxation training. Features of balance reactions targeted by the perturbation-based program were: (1) multi-step reactions, (2) extra lateral steps following anteroposterior perturbations, (3) foot collisions following lateral perturbations, and (4) time to complete grasping reactions. The reactions were evoked during testing by highly unpredictable surface translation and cable pull perturbations, both of which differed from the perturbations used during training. /b> Compared with the control program, the perturbation-based training led to greater reductions in frequency of multi-step reactions and foot collisions that were statistically significant for surface translations but not cable pulls. The perturbation group also showed significantly greater reduction in handrail contact time compared with the control group for cable pulls and a possible trend in this direction for surface translations. Further work is needed to determine whether a maintenance program is needed to retain the training benefits and to assess whether these benefits reduce fall risk in daily life. Perturbation-based training shows promise as an effective intervention to improve the ability of older adults to prevent themselves from falling when they lose their balance.