Mechanisms of failed recovery following postural perturbations on a motorized treadmill mimic those associated with an actual forward trip

Owings, Tammy M.; Pavol, Michael J.; Grabiner, Mark D.

doi:10.1016/s0268-0033(01)00077-8

Cited by 146 publications

(138 citation statements)

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“…The ability to control balance is a critical condition for minimizing the risk of falls [38]. The skills necessary to recover from the treadmill-induced postural disturbances such as resisting trunk rotation and quickly executing long steps [6,32,43] are the same skills required to recover from trips [35] and slips [48]. The focus of the rehabilitation program was to increase the ability of the subjects to respond to large postural perturbations and perform the recovery steps necessary to avoid a fall.…”

Section: Discussionmentioning

confidence: 99%

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Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Kaufman

Wyatt

Sessoms

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Key factors limiting patients with lower extremity amputations to achieve maximal functional capabilities are falls and fear of falling. A task-specific fall prevention training program has successfully reduced prospectively recorded trip-related falls that occur in the community by the elderly. However, this program has not been tested in amputees. Questions/purposes In a cohort of unilateral transtibial amputees, we aimed to assess effectiveness of a falls prevention training program by (1) quantifying improvements in trunk control; (2) measuring responses to a standardized perturbation; and (3) demonstrating retention at 3 and 6 months after training. Second, we collected patientreported outcomes for balance confidence and falls control. Methods Fourteen male military service members (26 ± 3 years) with unilateral transtibial amputations and who had been walking without an assistive device for a median of 10 months (range, 2-106 months) were recruited to participate in this prospective cohort study. The training program used a microprocessor-controlled treadmill designed to deliver task-specific postural perturbations that simulated a trip. The training consisted of six 30-minute sessions delivered over a 2-week period, during which task difficulty, including perturbation magnitude, increased as the patient's ability progressed. Training effectiveness was assessed using a perturbation test in an This study was funded by the Department of Defense Grant Number W81X-WH-11-2-0058 (Log No. DM090896) and the Navy Bureau of Medicine and Surgery, Wounded, Ill, and Injured Program. Approved for public release; distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of human subjects (protocol NMCSD.2001.003 and Protocol NHRC.2001.0031). The institution of one or more of the authors (MDG) has a patent on technology (ActiveStep TM ; Symbex, Lebanon, NH, USA) noted in this manuscript. One of the authors (MDG) is an inventor of the ActiveStep TM system but has no conflicts of interest to declare with regard to the present study. The views expressed are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® immersive virtual environment. The key outcome variables were peak trunk flexion and velocity, because trunk kinematics at the recovery step have been shown to be a determinant of fall likelihood. The patient-reported outcomes were also collected using questionnaires. The effectiveness of the rehabilitation program was also assessed by collecting data before perturbation training and comparing the key outcome parameters with those measured immediately after perturbation training (0 months) as well as both 3 and 6 months posttraining. Results Mean trunk flexion angle and velocity significantly improved after participating in the ...

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Section: Discussionmentioning

confidence: 99%

“…The key outcome variables were peak trunk flexion and velocity. These variables have been shown to be determinants of the likelihood of a fall [5,32]. Trunk flexion angle was defined as the angle of the trunk segment with respect to vertical.…”

Section: Methodsmentioning

confidence: 99%

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Kaufman

Wyatt

Sessoms

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Previous research has demonstrated that older adults can learn within one training session to avoid falling after a forward-directed trip [1,2] and slip [3]. This suggests that fall-prevention programs could benefit from emphasizing task-specific training.…”

Section: Introductionmentioning

confidence: 99%

“…Based on the published literature on slip-related falls we hypothesized that avoiding a fall after a slip would be dependent upon arresting the motion of the slipping foot [4,5] and rapidly lowering the non-slipping limb to the ground posterior to the trunk center of mass [6,7]. Based on our previously published research on recovery from induced trips [1,8] we hypothesized that avoiding a fall after a slip would be dependent upon arresting the slip-related trunk extension motion.…”

Section: Introductionmentioning

confidence: 99%

Modifiable performance domain risk-factors associated with slip-related falls

et al. 2008

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“…노인들에게 사망률의 직접적인 원인이 되는 낙상은 53%가 발을 헛디뎌 발생하는 것으로 조사되 었으며(Pavol, Owings, Foley & Grabiner, 1999), 나이가 들수록 몸 의 균형을 유지할 수 있는 근신경계의 손상이 낙상의 주된 원인 이라고 하였다 (Rogers, Hedman, Johnson, Martines & Mille, 2003;Woollacott, 2000). 이러한 낙상을 예방하는 데에 있어 고려해야할 변인으로는 체형, 걷는 자세, 반응시간, 몸통의 유연성, 하지의 안 정성 등이 있다고 하였다 (Owings, Pavol & Grabiner, 2001). (Figure 1).…”

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Comparison of Gait Pattern during the Support Phase after Perturbation According to Age

Chun¹,

Shin

2011

Korean Journal of Sport Biomechanics

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The purpose of this study was to analyze the difference in reaction patterns during the support phase after perturbation in gait according to different age. A total of 12 subjects participated; 5 elderly and 7 adults(control), to investigate the differences between normal and perturbed gait. The step length didn't change during normal and perturbed gait but was longer in the control group. There was no difference in the step width. When the right foot was perturbed, the control group's left foot speed was faster than the elderly group's which was to maintain stability. The elderly flexed both right and left knees more than the control group. After the perturbation, the elderly group had a larger trunk anterior flexion. With the larger flexion of both legs of the elderly group it shows that the lack of knee flexion strength is a factor, that could cause falling and so a prevention program should focus on strengthening the quadriceps. With the excessive trunk flexion after the perturbation by the elderly group observed, it is suggested that while walking everyday a good routine of walking with an upright posture should be developed.

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Mechanisms of failed recovery following postural perturbations on a motorized treadmill mimic those associated with an actual forward trip

Cited by 146 publications

References 15 publications

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Task-specific Fall Prevention Training Is Effective for Warfighters With Transtibial Amputations

Modifiable performance domain risk-factors associated with slip-related falls

Comparison of Gait Pattern during the Support Phase after Perturbation According to Age

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