Effects of Dynamic Perturbation-Based Training on Balance Control of Community-Dwelling Older Adults

Abstract

Walking is one of the daily activities that may cause falling in older adults. We developed a novel dynamic balance training program using a perturbation-based training on a custom-made treadmill, which can generate forward, backward, and lateral sway perturbations during walking. The purpose of this study was to investigate the changes in the balance performance of community-dwelling older adults after 8-weeks of perturbation-based balance training. A three-dimensional motion analysis system was used to collect kinematic and kinetic data. Seventeen community-dwelling older adults performed quiet standing with and without the balance perturbation. Biomechanical parameters such as center of pressure (COP) and center of mass (COM) were calculated. A paired t-test was used to compare the difference in balance performance before and after the training. After training, the results showed that the COM control of the older adults was significantly improved during quiet standing with perturbation, while the COP control during quiet standing without perturbation was not changed. The perturbation-based balance training exerted a positive effect on dynamic balance control in older adults. This translational research offers a new paradigm of balance training and can be applied to patient populations who have a high risk of falling.

Transfer and retention effects of gait training with anterior-posterior perturbations to postural responses after medio-lateral gait perturbations in older adults

“…The 16 AP perturbations (8 belt accelerations and 8 belt decelerations) in the trainer group did not enhance this effect. Longer training interventions (Chien and Hsu, 2018), may contribute to consolidate improvements, however one study showed that even with a reduced amount of training in a single session intervention, improvements are still significant (Yang et al, 2018). before effects reach a plateau.…”

“…However, in daily life, perturbations can occur in any direction like a misplaced step during a turning maneuver, obstacle negotiation or side bumps on a busy street. In an 8-week perturbation training study with anterior-posterior and lateral perturbations during walking, participants showed improvements of center of mass displacement while being perturbed during quiet stance (Chien and Hsu, 2018). The study had some limitations as measurements of postural stability during perturbed walking and a control group were lacking.…”

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy

“…Two 1-h training sessions were conducted weekly and eight sessions in total per participant. Each session includes 20 forward, 20 backward, and 40 lateral perturbations (20 rightto-left and 20 left-to-right) (Chien and Hsu, 2018). Unexpected perturbations were triggered during standing and walking.…”

“…The decreased mean velocity of COP after training indicated the reduced postural fluctuation during standing (Masani et al, 2014), which implied the enhanced static balance performance and the efficient neuromotor control strategy. Several tasks have been employed in previous studies to assess the effects of PBT on static postural control, including sitting, quiet standing, and Romberg stance (Chien and Hsu, 2018;Handelzalts et al, 2019). In the current study, we employed the stance task without visual inputs because the proprioceptive system plays a major role in maintaining stability during such task (Horak, 2006) and the enhanced performance in such a task can infer improvement in proprioceptive sensation after training.…”

“…When exposed to repeated perturbations, the neuromotor system would be stimulated to develop necessary neurophysiological changes and sensorimotor skills to prevent falling (Grabiner et al, 2014). PBT has been reported to be potentially effective for populations with balance disorders, including enhanced postural stability (Chien and Hsu, 2018;Handelzalts et al, 2019;Klamroth et al, 2019), decreased fall incidence Mansfield et al, 2017), and improved functional performance (Steib et al, 2017) in individuals with neurological conditions after training.…”