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

600 Participants Needed

Trial Summary

What is the purpose of this trial?

The long-term objective of this research is to develop an efficacious training paradigm to enhance older adults' defense mechanisms against falls and possibility reduce healthcare cost. The Centers for Disease Control and Prevention estimates the direct medical cost for fall related injuries to be $30 billion annually. Slips and trips combined account for more than 50% of the outdoor falls in community-dwelling older adults. These environmental perturbations are opposing in nature, with slips mainly resulting in backward falls and trips in forward falls. This project explores perturbation training through both slip and trip exposure based on the principles of motor learning. The project design consists of a randomized controlled trial 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. It also introduces a novel combined slip and trip perturbation training paradigm to enhance one's ability to retain and generalize the acquired fall-prevention skills to both types of falls. Slips and trips induced on an over ground walkway will be used to prepare the motor system to improve stability control and vertical limb support to resist falls. The longer-term benefits of such combined perturbation training over exclusive slip-only or trip-only perturbation training in reducing both laboratory-induced and real life falls will also be assessed. The hypothesis of this study if supported by the results will provide an evidence-supported training protocol to reduce the fall-risk among community-dwelling 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 data supports the effectiveness of the treatment Perturbation Training for Fall Prevention in Aging Adults?

Research shows that perturbation-based balance training, which includes exercises to improve balance after slips and trips, is effective in reducing falls among older adults. This type of training helps improve the body's ability to react to sudden balance disturbances, making it a promising approach for fall prevention. ^{1 2 3 4 5}

Is perturbation-based balance training safe for humans?

Perturbation-based balance training, which includes exercises to prevent falls by improving balance after slips and trips, is generally considered safe for older adults. However, more research is needed to fully understand its safety in different clinical settings and populations. ^{1 2 3 4 5}

How is perturbation training for fall prevention different from other treatments?

Perturbation training is unique because it specifically targets improving balance reactions to unexpected slips and trips, which are common causes of falls in older adults. Unlike traditional exercise programs, this training focuses on real-life scenarios to enhance the body's ability to recover from sudden balance disturbances. ^{1 2 3 6 7}

Research Team

Tanvi Bhatt, PhD PT

Principal Investigator

University of Illinois at Chicago

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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 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]

References

1. England pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial. [2023]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. [2023]

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

Exercise-based fall prevention: can you be a bit more specific? [2014]

4. Switzerland pubmed.ncbi.nlm.nih.gov

A proposed methodology for trip recovery training without a specialized treadmill. [2023]

5. England pubmed.ncbi.nlm.nih.gov

A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. [2023]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention. [2021]

7. England 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. [2023]