Balance Training for Fall Prevention

Overseen By Michael L Madigan, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Virginia Polytechnic Institute and State University

Disqualifiers: Weight over 250 pounds, others

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

Compensation: Varies

Number of Visits: 5

80 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to evaluate the feasibility of applying slip recovery training, a novel balance training exercise intervention, to workers who are at increased risk of slip-induced falls. This will be done via field studies with industrial partners. Note that the slip recovery training is not a device or drug. It is a detailed exercise regimen that aims to improve the the ability to recover balance after slipping. The main specific aims are are: * To investigate the feasibility of on-site slip recovery training * To validate field assessments for evaluating slip recovery training efficacy in subsequent research Participants will complete 3-6 once-weekly sessions of slip recovery training, answer daily text messages indicating any falls they experience while working over the 12 weeks after completing slip recovery training, and a subset of workers will be asked to participate in focus group discussions after the 12 weeks to provide information on the long-term feasibility of slip recovery training. A group of workers at Virginia Tech will also be asked to complete a laboratory session of testing during which they will be exposed to a laboratory-induced slip so that gold-standard measures of slip-induced fall recovery can be used to validate field assessments. Workers who complete slip recovery training will be compared to another group of workers who complete an alternative balance training that should improve balance but not improve slip recovery that is targeted by slip recovery training.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. Since the trial involves balance training exercises and not medication, it's likely you can continue your current medications, but you should confirm with the trial organizers.

What data supports the effectiveness of the treatment Alternative Balance Training, Slip Recovery Training for fall prevention?

Research shows that slip recovery training methods, like repeated unexpected slip training and volitional slip-recovery training, help improve balance recovery after a slip. These methods are practical and cost-effective, making them promising for preventing falls. ^{1 2 3 4 5}

Is balance training for fall prevention safe for humans?

Research on balance training methods like slip recovery training shows they are generally safe for humans. Participants in studies used safety equipment like harnesses to prevent injury during training, and no significant safety concerns were reported. ^{1 4 5 6 7}

How is the Alternative Balance Training, Slip Recovery Training treatment different from other treatments for fall prevention?

This treatment is unique because it uses low-cost, low-tech methods to improve balance recovery after slips, unlike other methods that require expensive equipment. It involves practicing unexpected slips and volitional slip-recovery, which enhances proactive control and reactive stepping responses, making it more accessible and practical for fall prevention. ^{1 2 8 9 10}

Research Team

Michael L Madigan, PhD

Principal Investigator

Virginia Polytechnic Institute and State University

Eligibility Criteria

This trial is for Virginia Tech workers in Dining Services, Facilities and Housekeeping, construction, and Veolia field workers in water distribution and main construction aged between 18-65. They must be willing to complete training sessions, lab testing, and daily falls tracking for 12 weeks. Those over 250 pounds or not cleared by the Physical Activity Readiness Questionnaire cannot join.

Inclusion Criteria

Virginia Tech workers in Dining Services, Facilities and Housekeeping, and construction

Veolia field workers in water distribution and water main construction

I am willing to attend training, lab tests, and track falls for 12 weeks.

Exclusion Criteria

Weigh over 250 pounds

Answer 'no' to all questions of the Physical Activity Readiness Questionnaire

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2 years

Training

Participants undergo slip recovery training or alternative balance training once weekly for 3 to 6 weeks

3-6 weeks

3-6 visits (in-person)

Laboratory Testing

Participants complete a laboratory session of testing with a lab-induced slip to validate field assessments

1 week

1 visit (in-person)

Follow-up

Participants are monitored for slips and falls through daily text messages and participate in focus group discussions

12 weeks

Daily virtual check-ins, 1 focus group discussion

Treatment Details

Interventions

• Alternative Balance Training
• Slip Recovery Training

Trial Overview The study tests slip recovery training against an alternative balance training among workers at risk of slipping on the job. Participants will undergo weekly sessions for up to six weeks and report any falls for three months post-training. Some will also attend focus groups to discuss long-term feasibility.

Participant Groups

Group I: Slip recovery training Experimental Treatment 1 Intervention

Once weekly sessions of slip recovery training for 3 or 6 weeks. Each session will be 20 minutes of training. Training will involve volitional and reactive stepping movements that mimic the movements necessary to recover balance after slipping while walking.

Group II: Alternative balance training Active Control 1 Intervention

Once weekly sessions of balance training for 3 or 6 weeks. Each session will be 20 minutes of training. Training will involve standing balance under varied sensory conditions, and tandem walking forward and backward under varied sensory conditions.

Who Is Running the Clinical Trial?

Virginia Polytechnic Institute and State University

Lead Sponsor

Trials

162

Recruited

26,900+

Findings from Research

A pilot study with 36 young adults demonstrated that two low-cost methods for slip recovery training, repeated unexpected slip training (UST) and volitional slip-recovery training (VST), significantly improved balance recovery ability compared to a control group.

UST enhanced proactive control and reactive stepping responses after slips, while VST improved the ability to stop the slipping foot, suggesting both methods could be effective and practical for fall prevention training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two Novel Slip Training Methods Improve the Likelihood of Recovering Balance After a Laboratory-Induced Slip. Allin, LJ., Nussbaum, MA., Madigan, ML.[2022]

Balance training on a foam rubber pad significantly improves balance abilities in older adults more effectively than training on a stable surface, with benefits observed as early as 2 months into the program.

The foam rubber exercise group showed notable improvements in key balance tests compared to both the control group and the stable surface group, indicating that this method of training can enhance physical functioning with fewer exercise sessions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a balance training program using a foam rubber pad in community-based older adults: a randomized controlled trial. Hirase, T., Inokuchi, S., Matsusaka, N., et al.[2022]

The treadmill-based stance-slip perturbation training program significantly reduced the fall rate among young adults, with only 28.6% of the training group falling compared to 55.0% in the control group during an unexpected slip.

Participants in the training group demonstrated better control and dynamic stability when responding to slips, suggesting that this training method may enhance the body's ability to recover from falls, although more extensive training may be needed to fully modify regular gait patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a single-session stance-slip perturbation training program on reducing risk of slip-related falls. Yang, F., Saucedo, F., Qiao, M.[2019]

Training with short-distance slips (12-cm and 18-cm) significantly improved stability control in young subjects, with the 18-cm group showing better reactive stability than the 12-cm group.

The 18-cm training group experienced a lower incidence of balance loss during a novel 'free' slip (58.3%) compared to the 12-cm group (83.3%) and the control group (100%), suggesting that even low-intensity training can enhance stability and may be beneficial for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reduced intensity in gait-slip training can still improve stability. Yang, F., Wang, TY., Pai, YC.[2021]

A 6-week strength training program improved balance recovery in older adults, with participants showing about 15%-30% improvements in their ability to recover from forward and lateral falls.

Power training did not result in greater improvements in balance recovery compared to strength training, suggesting that both types of training can be beneficial for enhancing balance in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of strength and power training on single-step balance recovery in older adults: a preliminary study. Pamukoff, DN., Haakonssen, EC., Zaccaria, JA., et al.[2021]

A new framework suggests that improving weight support, rather than just stability, is crucial in reducing fall risk from slips in older adults, highlighting the importance of hip height in maintaining balance.

Single sessions of repeated-slip training can significantly enhance the ability to recover from slips, improving dynamic stability and weight support, with benefits that can last for several months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Repeated-slip training: an emerging paradigm for prevention of slip-related falls among older adults. Pai, YC., Bhatt, TS.[2019]

A study involving 10 healthy young adults confirmed that trunk kinematics, specifically trunk flexion angle and angular velocity, remain consistent regardless of whether the safety harness is fixed or free during postural perturbation training on a treadmill.

This finding is significant for developing fall prevention training programs, as it ensures that the harness configuration does not affect the measurement of trunk movements, allowing for reliable assessments of recovery strategies in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of overhead harness configurations for measuring trunk kinematics during treadmill disturbances. Miller, EJ., Kaufman, KR.[2019]

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]

Training with unpredictable slip and trip hazards significantly improved balance recovery in older adults, as indicated by a substantial increase in their margin of stability after just one day of training.

While the training reduced falls from slips in both young (from 44.4% to 0%) and older adults (from 28.6% to 14.3%), increased anxiety levels and a notable dropout rate highlight the need for more tailored, longer-term training approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot study of reactive balance training using trips and slips with increasing unpredictability in young and older adults: Biomechanical mechanisms, falls and clinical feasibility. Okubo, Y., Brodie, MA., Sturnieks, DL., et al.[2020]

The study identified three distinct balance recovery patterns in 60 young participants after induced slips, which were linked to varying likelihoods of falling, highlighting the importance of understanding these patterns for fall prevention.

By analyzing 150 slip trials, including both successful and failed recovery attempts, the research provides insights into the mechanisms of balance recovery, which can inform the development of effective fall prevention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identification of balance recovery patterns after slips using hierarchical cluster analysis. Hu, X., Li, Y., Chen, G., et al.[2022]

References

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

Two Novel Slip Training Methods Improve the Likelihood of Recovering Balance After a Laboratory-Induced Slip. [2022]

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

Effects of a balance training program using a foam rubber pad in community-based older adults: a randomized controlled trial. [2022]

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

Effects of a single-session stance-slip perturbation training program on reducing risk of slip-related falls. [2019]

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

Reduced intensity in gait-slip training can still improve stability. [2021]

5. New Zealand pubmed.ncbi.nlm.nih.gov

The effects of strength and power training on single-step balance recovery in older adults: a preliminary study. [2021]

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

Repeated-slip training: an emerging paradigm for prevention of slip-related falls among older adults. [2019]

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

Comparison of overhead harness configurations for measuring trunk kinematics during treadmill disturbances. [2019]

8. Switzerland pubmed.ncbi.nlm.nih.gov

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

9. England pubmed.ncbi.nlm.nih.gov

A pilot study of reactive balance training using trips and slips with increasing unpredictability in young and older adults: Biomechanical mechanisms, falls and clinical feasibility. [2020]

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

Identification of balance recovery patterns after slips using hierarchical cluster analysis. [2022]