Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Abstract

Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation-based balance training (PBT) is an emerging task-specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill-based systems and therapist-applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long-term follow-up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294-2303..

Keywords: aged; falls; gait; locomotion; postural balance.

Figure 1

Examples of different types of perturbations used in clinical and research settings. (a) A therapist‐applied lean‐and‐release perturbation in the mediolateral direction. (b) A cable trip perturbation on a standard treadmill causing a forward loss of balance. (c) A treadmill belt acceleration perturbation using the Computer Assisted Rehabilitation Environment (Motekforce Link, Amsterdam, the Netherlands), causing a forward loss of balance.

Figure 2

Flowchart of systematic search and article inclusion and exclusion process. PBT, perturbation‐based balance training.