A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing

Abstract

Background: A growing number of studies are using modified treadmills to train reactive balance after trip-like perturbations that require multiple steps to recover balance. The goal of this study was thus to develop and validate a low-tech reactive balance rating method in the context of trip-like treadmill perturbations to facilitate the implementation of this training outside the research setting.

Methods: Thirty-five residents of five senior congregate housing facilities participated in the study. Participants completed a series of reactive balance tests on a modified treadmill from which the reactive balance rating was determined, along with a battery of standard clinical balance and mobility tests that predict fall risk. We investigated the strength of correlation between the reactive balance rating and reactive balance kinematics. We compared the strength of correlation between the reactive balance rating and clinical tests predictive of fall risk with the strength of correlation between reactive balance kinematics and the same clinical tests. We also compared the reactive balance rating between participants predicted to be at a high or low risk of falling.

Results: The reactive balance rating was correlated with reactive balance kinematics (Spearman's rho squared = .04-.30), exhibited stronger correlations with clinical tests than most kinematic measures (Spearman's rho squared = .00-.23), and was 42%-60% lower among participants predicted to be at a high risk for falling.

Conclusion: The reactive balance rating method may provide a low-tech, valid measure of reactive balance kinematics, and an indicator of fall risk, after trip-like postural perturbations.

Figure 1.

Photograph of a participant performing a reactive balance test. Visible is the harness and overhead gantry that prevented falls in the event of an unsuccessful test, and spotters on either side of the resident.

Figure 2.

Reactive balance rating was determined for each individual treadmill perturbation by (a) rating the extent of support the participant experienced, (b) rating the quality of the stepping response, and (c) combining these two subratings into the reactive balance rating.

Figure 3.

Box and whisker plots of reactive balance rating for fall risk groups identified using each of the six clinical tests. Boxes show median, 75th percentile, and 25th percentile for each group. Whiskers show the range for each group.