scholarly journals Surface Perturbation Training to Prevent Falls in Older Adults: A Highly Pragmatic, Randomized Controlled Trial

2020 ◽  
Vol 100 (7) ◽  
pp. 1153-1162 ◽  
Author(s):  
Jon D Lurie ◽  
Alexandra B Zagaria ◽  
Lisa Ellis ◽  
Dawna Pidgeon ◽  
Kathleen M Gill-Body ◽  
...  
Keyword(s):  
Older Adults ◽  
Relative Risk ◽  
Physical Therapy ◽  
Treatment Time ◽  
Balance Training ◽  
Surface Perturbation ◽  
Perturbation Training ◽  
Usual Treatment ◽  
Injurious Falls ◽  
Postural Responses

Abstract Background Falls are the leading cause of injuries among older adults, and trips and slips are major contributors to falls. Objective The authors sought to compare the effectiveness of adding a component of surface perturbation training to usual gait/balance training for reducing falls and fall-related injury in high-risk older adults referred to physical therapy. Design This was a multi-center, pragmatic, randomized, comparative effectiveness trial. Setting Treatment took place within 8 outpatient physical therapy clinics. Patients This study included 506 patients 65+ years of age at high fall risk referred for gait/balance training. Intervention This trial evaluated surface perturbation treadmill training integrated into usual multimodal exercise-based balance training at the therapist’s discretion versus usual multimodal exercise-based balance training alone. Measurements Falls and injurious falls were assessed with a prospective daily fall diary, which was reviewed via telephone interview every 3 months for 1 year. A total of 211/253 (83%) patients randomized to perturbation training and 210/253 (83%) randomized to usual treatment provided data at 3-month follow-up. At 3 months, the perturbation training group had a significantly reduced chance of fall-related injury (5.7% versus 13.3%; relative risk 0.43) but no significant reduction in the risk of any fall (28% versus 37%, relative risk 0.78) compared with usual treatment. Time to first injurious fall showed reduced hazard in the first 3 months but no significant reduction when viewed over the entire first year. Limitations The limitations of this trial included lack of blinding and variable application of interventions across patients based on pragmatic study design. Conclusion The addition of some surface perturbation training to usual physical therapy significantly reduced injurious falls up to 3 months posttreatment. Further study is warranted to determine the optimal frequency, dose, progression, and duration of surface perturbation aimed at training postural responses for this population.

scholarly journals Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Acute Hospitalization: Randomized Clinical Trial Protocol

2019 ◽  
Vol 99 (9) ◽  
pp. 1141-1149
Author(s):  
Jason R Falvey ◽  
Kathleen K Mangione ◽  
Amy Nordon-Craft ◽  
Ethan Cumbler ◽  
Kristine L Burrows ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Balance Training ◽  
Standard Of Care ◽  
Home Health ◽  
Care Utilization ◽  
Controlled Clinical Trial ◽  
Exercise Interventions ◽  
Acute Hospitalization

Abstract Background Hospitalization is a profound contributor to functional loss for older adults. Many modifiable risk factors (ie, weakness) may persist after hospitalization, representing portents of poor health, re-hospitalization, or death. Older adults frequently receive home health (HH) care after hospitalization to manage functional deficits that have worsened during hospital stays. However, how best to manage these deficits in HH settings has yet to be determined. Objective The objective is to determine if a higher intensity, progressive, multi-component (PMC) intervention, initiated upon admission to HH after an acute hospitalization, improves objectively measured and self-reported physical function more than usual care (UC) physical therapy. Design This will be a 2-arm randomized controlled clinical trial. Setting The setting will be participant homes. Participants A total of 200 older adults with deconditioning following acute hospitalization and referred for HH physical therapy will participate. Intervention Participants will be randomized to either a PMC treatment group or a UC group and receive 12 therapy visits over a 60-day period. PMC participants will perform lower extremity resistance training at 80% of a 1-repetition maximum, task-specific activities of daily living training, along with advanced gait and balance training. PMC groups will also receive nutritional supplementation and nursing support during transition from hospital to home. The UC group will receive standard of care HH interventions. Measurements Physical performance, self-reported function, fatigue, and health care utilization outcomes will be measured at baseline, 30 days, 60 days, 90 days, and 180 days. All measures will be assessed by blinded study personnel. Limitations The limitation is an inability to blind treating therapists to study allocation. Conclusions The authors hope to determine whether higher intensity, multi-component exercise interventions improve outcomes more than UC physical therapy for older adults recovering from acute hospitalization in HH settings.

scholarly journals Promoting Generalized Learning in Balance Recovery Interventions

2021 ◽  
Vol 11 (3) ◽  
pp. 402
Author(s):  
Sara A. Harper ◽  
Anne Z. Beethe ◽  
Christopher J. Dakin ◽  
David A. E. Bolton
Keyword(s):  
Older Adults ◽  
Motor Learning ◽  
Daily Life ◽  
Balance Training ◽  
Community Dwelling ◽  
Specific Training ◽  
Balance Recovery ◽  
Parallel Streams ◽  
Postural Perturbations ◽  
Community Dwelling Older Adults

Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates that compensatory responses trained using PBT can be retained for many months and can lead to a reduction in falls in community-dwelling older adults. A notable shortcoming with PBT is that it does not transfer well to similar but contextually different scenarios (e.g., falling sideways versus a forward trip). Given that it is not feasible to train all conditions in which someone could fall, this limited transfer presents a conundrum; namely, how do we best use PBT to appropriately equip people to deal with the enormous variety of fall-inducing scenarios encountered in daily life? In this perspective article, we draw from fields of research that explore how general learning can be promoted. From this, we propose a series of methods, gleaned from parallel streams of research, to inform and hopefully optimize this emerging field where people receive training to specifically improve their balance reactions.

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

P-287: Unsupervised interactive video-based balance training to improve balance in older adults: a pilot study

2015 ◽  
Vol 6 ◽  
pp. S108
Author(s):  
C. Lamoth ◽  
M. van Diest ◽  
J. Stegenga ◽  
B. Verkerke ◽  
K. Postema
Keyword(s):  
Older Adults ◽  
Pilot Study ◽  
Interactive Video ◽  
Balance Training

Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial

2021 ◽  
Author(s):  
Jan A Overgaard ◽  
Thomas Kallemose ◽  
Kathleen K Mangione ◽  
Morten T Kristensen
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Hip Fracture ◽  
Physical Therapy ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Walking Distance ◽  
Randomized Controlled ◽  
Multicenter Randomized Controlled Trial ◽  
Cognitively Intact

Abstract Background Recovery of function and regaining muscle strength are challenging after hip fracture. We compared the effectiveness of a 12- versus 6-week outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance. Methods This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics that enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6 weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-week follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment. Results Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days after hip fracture surgery and randomized into a 12-week group (n = 50) or a 6-week group (n = 50). Mean (SD) change scores in the 6MWT were 143.8 (81.1) and 161.5 (84.1) m in the 12- and 6-week groups, respectively (both exceeding the minimal clinically important difference of 55 m). The mean between-group difference was −17.7 m (95% CI −50.1, 14.8). Pain during training did not exceed moderate levels nor increase as training intensity increased. Conclusion Twelve weeks of physical therapy with PRT was not superior to 6 weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated. Clinical Trials Registration Number: NCT01174589

Organization of postural responses following a rotational support surface perturbation, after TKA: Sagittal plane rotations

2007 ◽  
Vol 25 (1) ◽  
pp. 112-120 ◽  
Author(s):  
William H. Gage ◽  
James S. Frank ◽  
Stephen D. Prentice ◽  
Peter Stevenson
Keyword(s):  
Sagittal Plane ◽  
Support Surface ◽  
Surface Perturbation ◽  
Postural Responses
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