Can higher training practice dosage with treadmill slip-perturbation necessarily reduce risk of falls following overground slip?

Abstract

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.

Retention of improvement in gait stability over 14 weeks due to trip-perturbation training is dependent on perturbation dose

“…Perturbation training has emerged as a promising approach to reduce falls in the elderly (Gerards et al, 2017;McCrum et al, 2017) since several studies demonstrate significant improvements in reactive response in older adults after repeated exposure to various laboratory-induced mechanical gait perturbations (Bierbaum et al, 2011;Epro et al, 2018a;Lee et al, 2018;Pai et al, 2010). These improvements in reactive gait stability in the elderly can be retained over several months (Bhatt et al, 2012;Pai et al, 2014a) or even years (Epro et al, 2018b) without any additional training.…”

Can Treadmill Slip-Perturbation Training Reduce Longer-Term Fall Risk Upon Overground Slip Exposure?

“…They were conveniently assigned to 3 groups with equivalent treadmill walking durations: the treadmill training group with 24 slip perturbations (TM_24, n = 15), the treadmill training group with 40 slip perturbations (TM_40, n = 15), and the control group without slip perturbations (Control, n = 15). 23 One group of the experiment (TM_24) was finished before the second group (TM_40). Twenty-four repetitions of treadmill slips was chosen as the standard dosage for the first group because many previous overground slip-training studies used this dosage.…”

“…At the 14-week posttraining retest, they found that subjects who received a higher-practice dosage had a better margin of stability in comparison with those who received a lower-practice dosage. However, Lee et al 23 reported that there was no difference in the immediate overground generalization between a higher dosage (40 trials) of treadmill slip-perturbation training and a lower-practice dosage (24 trials), with both dosage groups having better stability on the overground slip trial compared with the control group. This can be explained by the notion that better consolidation of memory usually occurs 24 hours after training.…”

“…[20][21][22] In addition, it has been reported that treadmill slip-perturbation training can be beneficial for older adults, and the improvements in reactive stability control were maintained when they were immediately exposed to a novel overground slip, leading to a reduced fall incidence compared with older adults who received no training. 17,23 However, all of these previous studies only examined the transfer of immediate effects from treadmill to overground gait-slip perturbations; longer-term effects of such generalization have yet to be determined.…”

Differences in Falls and Recovery from a Slip Based on an Individual’s Lower Extremity Corrective Response

“…To reduce fall risks and improve balance and mobility, several types of training modalities have been previously used (Kosma, Hondzinski, & Buchanan, 2017;Parijat & Lockhart, 2012;Sadeghi et al, 2017)Perturbation training is an emerging paradigm to reduce falls (Lee, Bhatt, Liu, Wang, & Pai, 2018), with recent work demonstrating reduced fall outcomes when exposed to a slip as well as improved stability measures. Further, in addition to improved slip outcomes, slip training has shown improvements in reactive slip reactions in both young, and old adults (Parijat & Lockhart, 2012).…”