Reactive Balance Training for Fall Prevention in Older Adults

Overseen By Shamali Dusane, MPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Illinois at Chicago

Must not be taking: Sedatives

Disqualifiers: Osteoporosis, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

90 Participants Needed

Trial Summary

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. ^{1 2 3 4 5}

Is 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. ^{1 4 6 7 8}

How 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. ^{3 4 5 9 10}

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.

Research Team

Tanvi Bhatt, PhD

Principal Investigator

University of Illinois at Chicago

Eligibility 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.

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)

Treatment Details

Interventions

• Reactive Balance Training

Trial Overview 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.

Participant Groups

Group I: Treadmill training Experimental Treatment 1 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 training Experimental Treatment 1 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 training Experimental Treatment 1 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.

Who Is Running the Clinical Trial?

University of Illinois at Chicago

Lead Sponsor

Trials

653

Recruited

1,574,000+

Findings from Research

This study will evaluate the effectiveness of two different training schedules (random vs. block) in improving balance control among 50 older adults (over 70 years) through a 1-month perturbation-based balance training (PBBT) program.

The research aims to determine which training method better enhances both reactive and proactive balance functions, potentially reducing the risk of falls in older adults, a leading cause of injury in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Nachmani, H., Paran, I., Salti, M., et al.[2021]

This pilot randomized controlled trial involves 36 stroke survivors to evaluate the effects of different doses of reactive balance training (RBT) on balance control and confidence, aiming to inform a larger study on optimal RBT dosage.

Participants will be assessed at multiple time points, including 6 months post-discharge, to track falls and physical activity, which will help determine the feasibility and necessary sample size for future trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. Mansfield, A., Inness, EL., Danells, CJ., et al.[2021]

In a study involving 35 older adults over 4 weeks, treadmill-based reactive balance training significantly improved rapid balance responses compared to Tai Chi, with participants showing a 13.5° smaller maximum trunk angle and a 24%-31% higher reactive balance rating after training.

While both training methods were effective, treadmill-based training was more effective in enhancing the ability to respond to trips and slips, indicating it may be a better option for improving balance in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Aviles, J., Allin, LJ., Alexander, NB., et al.[2020]

Reactive balance training (RBT) significantly reduces the likelihood of falls in daily life for older adults and individuals with balance impairments, with a fall risk ratio of 0.76 compared to control groups.

While RBT is effective in decreasing falls, it is associated with a higher prevalence of adverse events (29% in RBT vs. 20% in control), indicating that while it is beneficial, caution is needed regarding potential risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. Devasahayam, AJ., Farwell, K., Lim, B., et al.[2023]

This study investigates the effectiveness of perturbation-based balance training (PBT) compared to conventional intensive balance training (CIBT) in improving reactive stepping ability in 24 adults with chronic incomplete spinal cord injury over 8 weeks.

The primary outcome measures the ability to recover balance using a single step, which will help determine which training method is more effective for enhancing balance control and reducing fall risk in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. Unger, J., Chan, K., Scovil, CY., et al.[2023]

Perturbation-based balance training (PBT) significantly improved reactive balance control in individuals with chronic stroke, as evidenced by a decrease in the frequency of extra steps taken in response to support-surface perturbations after 6 weeks of training.

In contrast, traditional balance training did not show similar improvements, highlighting the effectiveness of PBT in rehabilitation programs aimed at reducing fall risk in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke? Schinkel-Ivy, A., Huntley, AH., Aqui, A., et al.[2019]

This pilot randomized controlled trial will evaluate the effectiveness of two different perturbation-based balance training (PBT) protocols over a 6-week period in 36 older adults at risk of falling, focusing on improving their reactive balance control.

The study will also assess the feasibility and acceptability of these training protocols, measuring factors like adherence, drop-out rates, and any adverse events, which are crucial for understanding how well these interventions can be implemented in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Hezel, N., Sloot, LH., Wanner, P., et al.[2023]

A systematic review of nine studies involving healthy older adults found that various gait perturbation methods, such as moveable floor platforms and treadmill adjustments, can effectively improve reactive recovery responses during walking.

Eight out of the nine studies reported enhancements in recovery responses, and some showed a reduction in falls, indicating that training with gait perturbations may be a promising strategy for preventing falls in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. McCrum, C., Gerards, MHG., Karamanidis, K., et al.[2020]

Reactive balance training (RBT) significantly improves balance in older adults, with the maximum trunk angle before training being a strong predictor of improvement, as shown in a study of 28 participants.

The speed of treadmill perturbations during RBT is also associated with better training outcomes, suggesting that these factors can help identify individuals who will benefit most from RBT interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training. Aviles, J., Wright, DL., Allin, LJ., et al.[2021]

A 12-week resistance training (RT) program and a 3-week perturbation-based training (PBT) program were tested on healthy older adults, showing that both interventions improved specific aspects of reactive balance, but did not enhance performance during perturbed treadmill walking.

The PBT specifically improved reactive balance during standing due to adaptations in stepping strategies, highlighting that while PBT is effective, its benefits may not generalize to all movement tasks, which is important for designing effective fall prevention interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program. Van Wouwe, T., Afschrift, M., Dalle, S., et al.[2021]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

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]

2. England pubmed.ncbi.nlm.nih.gov

Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

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]

4. United States pubmed.ncbi.nlm.nih.gov

The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke? [2019]

7. England pubmed.ncbi.nlm.nih.gov

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]

8. Germany pubmed.ncbi.nlm.nih.gov

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training. [2021]

10. Switzerland pubmed.ncbi.nlm.nih.gov

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]