2016
DOI: 10.1186/s12877-016-0223-4
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Unexpected perturbations training improves balance control and voluntary stepping times in older adults - a double blind randomized control trial

Abstract: BackgroundFalls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls.MethodsIn a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions o… Show more

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Cited by 59 publications
(58 citation statements)
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References 48 publications
(80 reference statements)
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“…Both virtual reality training with perturbations and unaltered viewing showed significantly improved performance compared with virtual reality without perturbations. Increased improvement during perturbations training agrees with similar research using unexpected mechanical perturbations during walking to improve balance control (Kurz et al 2016). Comparing the two virtual reality groups, we found no evidence that the perturbation affects the quantity of training errors, subjects' experience of virtual reality, or physical exertion.…”
Section: Discussionsupporting
confidence: 87%
“…Both virtual reality training with perturbations and unaltered viewing showed significantly improved performance compared with virtual reality without perturbations. Increased improvement during perturbations training agrees with similar research using unexpected mechanical perturbations during walking to improve balance control (Kurz et al 2016). Comparing the two virtual reality groups, we found no evidence that the perturbation affects the quantity of training errors, subjects' experience of virtual reality, or physical exertion.…”
Section: Discussionsupporting
confidence: 87%
“…Previously, it was assumed that small and/or predicted internal perturbations can be counteracted with a feed-forward control (APAs) whereas a feedback-based postural muscle activation (CPAs) is the main mechanism of balance restauration to cope with large and/or unexpected perturbations ( 78 , 79 ). However, several studies reported an increase of efficiency in the reactive recovery response after unexpected perturbation training which challenged mechanisms for dynamic stability ( 70 , 80 ).…”
Section: Discussionmentioning
confidence: 99%
“…Thus, we believe that during a fall from standing height, it takes about 300 ms for postural responses to start correcting the body trajectory, while the impact is expected (to occur) around 700 ms. It has been argued that this time is sufficient to change the way one falls and that this makes it possible to apply safer ways of falling ( 7 , 69 , 70 ), for example by using martial arts fall techniques ( 68 , 71 73 ). Despite these constraints, our study also supports the idea that learning is possible even though it may take a large number of trials.…”
Section: Discussionmentioning
confidence: 99%
“…Overall, the findings indicated that although reduced stability at first foot contact could be a determinant of taking additional steps, stepping responses could also be attributable to the COM motion state as early as first step lift-off, preceding foot contact. Since perturbation training has been reported to improve the reactive control of balance stability (Barrett et al, 2012; Dijkstra et al, 2015; Kurz et al, 2016; Mansfield et al, 2015; Pai et al, 2014; Rosenblatt et al, 2013), which increased balance stability at the instant of step lift-off (Lee et al, 2016; Liu et al, 2016), perturbation-based training interventions aimed at improving the reactive control of stability would reduce initial balance instability at first step lift-off and possibly the consequent need for multiple steps in response to balance perturbations.…”
Section: Discussionmentioning
confidence: 99%