"First-trial effect" characterizes the rapid adaptive behavior that changes the performance outcome (from fall to non-fall) after merely a single exposure to postural disturbance. The purpose of this study was to investigate how long the first-trial effect could last. Seventy-five (≥ 65 years) community-dwelling older adults, who were protected by an overhead full body harness system, were retested for a single slip 6-12 months after their initial exposure to a single gait-slip. Subjects' body kinematics that was used to compute their proactive (feedforward) and reactive (feedback) control of stability was recorded by an eight-camera motion analysis system. We found the laboratory falls of subjects on their retest slip were significantly lower than that on the novel initial slip, and the reactive stability of these subjects was also significantly improved. However, the proactive stability of subjects remains unchanged between their initial slip and retest slip. The fall rates and stability control had no difference among the 6-, 9-, and 12-month retest groups, which indicated a maximum retention on 12 months after a single slip in the laboratory. These results highlighted the importance of the "first-trial effect" and suggested that perturbation training is effective for fall prevention, with lower trial doses for a long period (up to 1 year). Therefore, single slip training might benefit those older adults who could not tolerate larger doses in reality.

Very little is known how training intensity interacts with the generalization from treadmill-slip to overground slip. The purposes of this study were to determine whether treadmill-slip training improved center-of-mass stability, more so in the reactive than in the proactive control of stability, with high intensity (HI with a trial-to-trial-consistent acceleration of 12 m/s2) better than low intensity training (LO with a consistent acceleration of 6 m/s2), and progressively-increasing intensity (INCR with a block-to-block acceleration varied from 6 to 12 m/s2) better than progressively-decreasing intensity training (DECR with an acceleration varied from 12 to 6 m/s2) in such generalization. Thirty-six young subjects evenly assigned to one of four (HI, LO, INCR, DECR) groups underwent 24 treadmill-slips before their generalization test trial with a novel slip during overground walking. The controls (CTRL, n=9) from existing data only experienced the same novel overground slip without treadmill training but under otherwise identical condition. The results showed that treadmill-slip training did improved balance control on overground slip with a greater impact on subjects’ reactive (44.3%) than proactive control of stability (27.1%) in comparison to the CTRL. HI yielded stronger generalization than LO, while INCR was only marginally better than DECR. Finally, the group means of these four displayed a clear ascending order from CTRL, LO, DECR, INCR, to HI. The results suggested that higher training intensity on treadmill led to a better generalization, while a progressively-increase in intensity had advantage over the progressively-decrease or the low training strategy. (243 words)

Contrary to our hypothesis, increased practice dosage (40-slips) in treadmill slip-perturbation training from the commonly used threshold (24-slips) did not necessarily benefit immediate generalization from treadmill to overground walking among community-dwelling older adults.

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The purpose of this study was to determine any potential falls-resistance benefits that might arise from treadmill-slip-perturbation training. One hundred sixty-six healthy community-dwelling older adults were randomly assigned to either the treadmill-slip-training group (Tt) or the treadmill-control group (Tc). Tt received 40 (± 0.4) slip-like perturbations during treadmill walking. Tc received unperturbed treadmill walking for 30 minutes. Following their treadmill session, both groups were exposed to a novel slip during over-ground walking. Their responses to this novel slip were also compared to previously collected data from participants who received either over-ground-slip training (Ot) with 24 (± 0.3) slips or over-ground walking (Oc) with no training before experiencing their novel over-ground slip. Fall rates and both proactive (pre-slip) and reactive (post-slip) stability were assessed and compared for the novel over-ground slip in groups Tt, Tc, and Oc, as well as for the 24 th slip in Ot. Results showed Tt had fewer falls than Tc (9.6% versus 43.8%, p < 0.001) but more falls than Ot (9.6% versus 0%, p < 0.001). Tt also had greater proactive and reactive stability than Tc (Tt > Tc, p < 0.01), however, Tt's stabilities were lower than those of Ot (p < 0.01). There was no difference in fall-rate or reactive stability between Tc and Oc. While the treadmill-slip-training protocol could immediately reduce the numbers of falls from a novel laboratory-reproduced slip, such improvements were far less than that from the motor adaptation to the over-ground-slip-training protocol.

No abstract

Background After a single slip, older adults rapidly make adaptive changes to avoid or eliminate further backward loss of balance or a fall. This rapid adaptation has been termed the “single trial effect”. The purpose of this study was to explore the relationship between the motor errors subjects experienced upon a novel slip and the selection and execution of corrective response by which they modified their ongoing gait pattern and turned it into a protective step. Methods A forward slip was induced in the laboratory among 145 community-living older (≥65 year old) adults who were protected by an overhead full body harness system. An eight-camera motion analysis system recorded subjects’ kinematics, which was used to compute their instability (motor error), recovery step placement (response selection), and stability gain (motor correction). Findings A linear relationship was found between the stability errors at recovery foot liftoff and the distance between the recovery foot and slipping foot at the time of its touchdown, reflecting an appropriate selection of response that was proportionate to the motor error. A linear relationship was also found between this step modification and resulting stability gain, indicating that greater step modification resulted in greater stability gain. This learning behavior was surprisingly consistent regardless whether the outcome was a recovery or a fall. Interpretations These results suggest that fallers and non-fallers all have an intact motor learning foundation that has enabled them to rapidly improve their stability in subsequent exposures.

Following a slip occurred in the overground walking, a fall can be classified into two exclusive categories: feet-forward fall or split fall. The purposes of this study were to investigate whether the placement of the recovery foot would determine the slip types, the likelihood of fall, and the severity of fall. The fall severity was estimated based on the impact velocity of body segments or trunk orientation upon fall arrest. One hundred ninety-five participants experienced a novel, unannounced slip while walking on a 7-meter walkway. Kinematics of a full-body marker set was collected by a motion capture system which was synchronized with the force plates and loadcell. The results showed that the recovery foot landing position relative to the projected center of mass position at the recovery foot touchdown determined the slip type by 90.8%. Feet-forward slips led to significantly lower rate of falls than did split slips (47.6% vs. 67.8%, p < 0.01). Yet, feet-forward falls were much more dangerous because they were associated with significantly greater estimated maximum hip impact velocity (p < 0.001) and trunk backward leaning angle (p < 0.001) in comparison to split falls.