Perturbation Training for Fall Prevention in Aging Adults

Overseen By Shamali Dusane, MPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Illinois at Chicago

Must not be taking: Sedatives, Narcotics, Opioids

Disqualifiers: Pain, Osteoporosis, Cognitive impairment, others

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

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests different types of balance training to help older adults prevent falls. Participants will practice recovering from slips, trips, or both (referred to as Combined slip+trip training) to determine which method best improves balance and stability. The goal is to develop an effective training program that could reduce the risk of falls and healthcare costs. Individuals who can walk independently and do not have major health issues, such as heart or neurological problems, may be suitable for this study. As an unphased trial, this study allows participants to contribute to innovative research that could significantly enhance fall prevention strategies for older adults.

Will I have to stop taking my current medications?

The trial requires that participants are not on any sedative drugs, osteoporosis medication, or narcotics/opioids. If you are taking these, you would need to stop before participating.

What prior data suggests that this perturbation training is safe for aging adults?

Research shows that balance training exercises, such as those simulating slipping or tripping, are generally safe for older adults. Studies have found that even a single session can improve balance and reduce the risk of falls, with no serious side effects reported. Whether focusing on slipping or tripping exercises alone, research supports these methods as effective and well-tolerated, with no major problems noted. Combining both slipping and tripping exercises also appears safe and effective. This approach helps the body prepare for different types of falls, enhancing overall balance and preventing accidents. Overall, these training methods are considered safe and focus on improving balance and reducing the risk of falls. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative training methods to prevent falls in aging adults, focusing on slip and trip perturbation training. Unlike traditional fall prevention strategies that might focus on environmental modifications or balance exercises, these techniques aim to enhance the body's natural response to slips and trips through repeated, controlled exposure. This could potentially lead to faster adaptation and improved reflexes, significantly reducing fall risk. By examining slip-only, trip-only, and combined slip+trip training, researchers hope to determine the most effective approach and provide a more targeted intervention for fall prevention.

What evidence suggests that this trial's treatments could be effective for fall prevention in aging adults?

Studies have shown that special training exercises can help reduce falls in older adults by improving balance and stability. In this trial, participants will join different training groups. For instance, the slip-only training group will practice recovering from slips, significantly lowering fall risk by enhancing reactions to balance loss. Similarly, the trip-only training group will focus on recovering from trips, reducing fall rates and improving stability by encouraging longer steps to regain balance. Another group will receive combined slip+trip training, which research suggests might offer even greater benefits by preparing the body to handle various types of falls. These findings indicate that such training methods can effectively lower the risk of falls in everyday life for older individuals. ^{1 2 3 4 6}

Who Is on the Research Team?

Tanvi Bhatt, PhD PT

Principal Investigator

University of Illinois at Chicago

Are You a Good Fit for This Trial?

This trial is for healthy older adults aged 60 to 90 who can walk independently for at least 8 meters, even with an assistive device. They should not have any acute or chronic neurological, cardiopulmonary, musculoskeletal or systemic conditions. Participants must not have had major surgery in the past six months or hospitalization in the last three months and should not be taking sedative drugs.

Inclusion Criteria

I do not have any ongoing heart, lung, muscle, nerve, or systemic diseases.

I am between 60 to 90 years old and can walk on my own with an assistive device for 8 meters.

I haven't had major surgery or been hospitalized in the last 6 and 3 months, respectively.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Baseline walking trials and initial assessment of participants' normal walking patterns and recovery responses

1 week

1 visit (in-person)

Training

Participants undergo perturbation training with slip and/or trip exposures, depending on group assignment

1 week

Multiple sessions (in-person)

Follow-up

Participants are monitored for stability and fall incidence over a 12-month period post-training

12 months

1 visit (in-person) at 12 months, ongoing monitoring

What Are the Treatments Tested in This Trial?

Interventions

• Combined slip+trip training
• Slip-only training
• Trip-only training

Trial Overview The study tests how different training programs (slip-only, trip-only, combined slip+trip) help prevent falls in aging adults. It's a randomized controlled trial that looks into improving stability control and limb support through exposure to slips and trips on a walkway. The goal is to see if combined training can better reduce fall risks than single-type perturbation training.

How Is the Trial Designed?

Group I: Trip-only training Experimental Treatment 1 Intervention

Trip specific training delivered in an identical sequence (mixed with non-trip trials) as the Group with slip only training.

Group II: Slip-only training Experimental Treatment 1 Intervention

Overground, slip specific perturbation training only delivered in a fixed sequence. After the baseline walking trials, subjects will walk for 30-35 trials, after which training will begin consisting of a first block of 8 repeated slips (S1-S8), a block of 3 regular (non-perturbed) walking trials (W1-W3), another block of 8 slips (S9-16), a second block of 3 regular walking trials (W4-W6), and a final block of 8 slips (S17-S24) mixed with 10 regular walking trials.

Group III: Combined slip+trip training Experimental Treatment 1 Intervention

Training consisting of repeated exposure to both slips and trips.

Group IV: Control Active Control 1 Intervention

Walk for about 70-75 trials at the preferred walking pace to match the total trials the other groups receive before the test perturbations.

Who Is Running the Clinical Trial?

University of Illinois at Chicago

Lead Sponsor

Trials

653

Recruited

1,574,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

A study involving 82 older adults (average age 73) found that a perturbation-based balance training (PBT) program did not significantly improve balance control or reduce fear of falling compared to usual care alone after three weeks of training.

Despite using advanced technology and a structured training approach, the PBT did not yield clinically relevant improvements in balance, indicating a need for further research to optimize training methods and outcome measures for older adults at risk of falls.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial. Gerards, M., Marcellis, R., Senden, R., et al.[2023]

Perturbation-based balance training, specifically trip recovery training, is a promising method to reduce falls among older adults, who are at high risk for such accidents.

This paper proposes a cost-effective methodology for trip recovery training that does not require specialized equipment, potentially increasing accessibility and implementation in various settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A proposed methodology for trip recovery training without a specialized treadmill. Lee, Y., Alexander, NB., Madigan, ML.[2023]

Perturbation-based balance training (PBT) significantly improved reactive balance and reduced fall incidence in older adults after laboratory-induced slips, with only 18% of participants falling post-training compared to 80% at baseline.

However, the training did not show improvements in reactive balance or fall incidence after trips, suggesting that the effectiveness of PBT may vary based on the type of perturbation experienced.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial. Allin, LJ., Brolinson, PG., Beach, BM., et al.[2023]

Perturbation-based balance training is emerging as a promising method for preventing falls in older adults, focusing on task-specific training that may lead to better adaptation and retention of balance skills.

While the approach shows potential efficacy, further research is needed to address safety concerns and practical implementation issues before it can be widely adopted in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. McCrum, C., Bhatt, TS., Gerards, MHG., et al.[2023]

Trip-specific perturbation training has been shown to effectively reduce trip-related falls both in controlled laboratory settings and in real-world community environments.

The study suggests that combining this specialized training with traditional exercise programs could enhance the overall effectiveness of fall prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise-based fall prevention: can you be a bit more specific? Grabiner, MD., Crenshaw, JR., Hurt, CP., et al.[2014]

In a study involving 169 healthy older adults, slip-perturbation training improved proactive balance measures, such as margin of stability (MOS) and step length, but may increase the risk of falls when encountering unexpected trip perturbations.

Trip-perturbation training enhanced toe clearance during walking, which could reduce the effectiveness of reactive responses to slips, yet both training groups maintained similar reactive balance control and fall risk compared to the control group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention. Bhatt, T., Wang, Y., Wang, S., et al.[2021]

A review of nine studies involving 364 participants found insufficient evidence that perturbation-based balance training effectively reduces falls in individuals with stroke.

The training protocols varied widely among studies, leading to inconsistent results regarding the impact of this training on common fall risk factors, highlighting the need for more high-quality research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. Brown, D., Simpkins, C., Yang, F.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT03199729

Aging and Mixed Perturbation Training to Reduce Falls in ... Slips and trips combined account for more than 50% of the outdoor falls in community-dwelling older adults. These environmental perturbations are opposing in ...

2. cmbrl.ahs.uic.edu cmbrl.ahs.uic.edu/research-studies/aging-and-mixed-perturbation-training/

Aging and Mixed Perturbation Training The aim of this project is to investigate the underlying mechanism of perturbation training, the scope of its generalization and retention in real-life fall ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0268003325000427

Meta-analysis on effects of trip-based perturbation training ... Trip-based perturbation training significantly reduces the fall rate and enhances postural stability, as evidenced by improvements in the recovery step length.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10119738/

Effect of Treadmill Perturbation-Based Balance Training on ... This randomized clinical trial evaluates the effect of a perturbation-based balance training treadmill intervention vs standard treadmill walking on 12-month ...

5. bmjopen.bmj.com bmjopen.bmj.com/content/12/2/e052492

Effects of treadmill slip and trip perturbation-based balance ... This study aims to determine the effects of treadmill-based balance training on falls in older adults, comparing it to treadmill walking. The primary outcome ...

6. frontiersin.org frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2021.697169/full

Perturbation Training for Fall-Risk Reduction in Healthy ... This study examined the effects of perturbation training on the contextual interference and generalization of encountering a novel opposing perturbation.