Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial

Abstract

Background There is growing interest in using perturbation-based balance training to improve the reactive response to common perturbations (eg, tripping and slipping). The goal of this study was to compare the efficacy of treadmill-based reactive balance training versus Tai Chi performed at, and among independent residents of, older adult senior housing. Methods Thirty-five residents from five senior housing facilities were allocated to either treadmill-based reactive balance training or Tai Chi training. Both interventions were performed three times per week for 4 weeks, with each session lasting approximately 30 minutes. A battery of balance tests was performed at baseline, and again 1 week, 1 month, 3 months, and 6 months post-training. The battery included six standard clinical tests of balance and mobility, and a test of reactive balance performance. Results At baseline, no significant between-group differences were found for any balance tests. After training, reactive balance training participants had better reactive balance than Tai Chi participants. Maximum trunk angle was 13.5° smaller among reactive balance training participants 1 week after training (p = .01), and a reactive balance rating was 24%–31% higher among reactive balance training participants 1 week to 6 months after training (p < .03). Clinical tests showed minimal differences between groups at any time point after training. Conclusion Trip-like reactive balance training performed at senior housing facilities resulted in better rapid balance responses compared with Tai Chi training.

The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial

“…These results contrast with what has been reported in other patient populations with neurological impairment, where PBT resulted in greater improvements in reactive stepping ability ( 51 – 53 ), clinical measures of balance ( 26 , 27 ), and balance confidence ( 26 ) when compared to a frequency-matched control group. However, the participants in these studies were older adults ( 51 – 53 ), individuals with Parkinson's disease ( 26 ), and individuals who had experienced a stroke ( 27 ); none of whom had damage to their spinal cord. To our knowledge, the FES-I has only been evaluated following PBT in one study of older adults, where it was found to be unaffected by the training ( 54 ).…”

Detection of Real-World Trips in At-Fall Risk Community Dwelling Older Adults Using Wearable Sensors

“…Our long-term goal is to increase the sample size and develop an algorithm for automated detection of real-world LOBs and trips in particular. Better understanding of real world trips would be useful in determining the outcomes of reactive balance training protocols ( 19 , 37 ). These data can also provide insight into the frequency, type and characteristics of real world LOBs and recovery and might then provide a more precise estimate of fall risk and lead to more customized treatment for fall prevention.…”

“…Whereas, the laboratory-based protocols provide controlled trip perturbations which may result in more stereotypical responses, real world trips may have more variable etiology (i.e., context dependent) and the LOB responses may be equally more variable and less stereotypical. More importantly, better understanding of real world trips would be useful in determining the outcomes of increasingly common reactive balance training protocols ( 19 ).…”

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

“…PBT for trip training has also been reported elsewhere [5,14]. Briefly, participants stood on a modified treadmill.…”

“…Trips commonly occur when an obstruction impedes the forward motion of the swing leg during gait, and typically result in a forward loss of balance [11]. Examples of PBT for tripping have involved repeated exposure to trips while walking over ground [12], using a cable system to impede forward foot motion while walking on a treadmill [13], or simulated trips while standing on a specialized treadmill [5,14]. These types of PBT have elicited improved kinematics and fall rates after laboratory-induced trips [5,15], and reduced trip-induced falls outside of the laboratory [16].…”