scholarly journals Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

2021 ◽  
Vol 3 ◽  
Author(s):  
Tanvi Bhatt ◽  
Yiru Wang ◽  
Shuaijie Wang ◽  
Lakshmi Kannan
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Step Length ◽  
Community Dwelling ◽  
Control Group ◽  
Reactive Control ◽  
Ctrl Group ◽  
Healthy Older Adults ◽  
Perturbation Training ◽  
Perturbed Walking

This study examined the effects of perturbation training on the contextual interference and generalization of encountering a novel opposing perturbation. One hundred and sixty-nine community-dwelling healthy older adults (69.6 ± 6.4 years) were randomly assigned to one of the three groups: slip-perturbation training (St, n = 67) group received 24 slips, trip-perturbation training (Tt, n = 67) group received 24 trips, and control (Ctrl: n = 31) group received only non-perturbed walking trials (ClinicalTrials.gov NCT03199729; https://clinicaltrials.gov/ct2/show/NCT03199729). After training, all groups had 30 min of rest and three post-training non-perturbed walking trials, followed by a reslip and a novel trip trial for St, a retrip and a novel slip trial for Tt, and randomized novel slip and trip trials for Ctrl. The margin of stability (MOS), step length, and toe clearance of post-training walking trials were compared among three groups to examine interferences in proactive adjustment. Falls, MOS at the instant of recovery foot touchdown, and hip height of post-training perturbation trials were investigated to detect interferences and generalization in reactive responses. Results indicated that prior adaptation to slip perturbation training, resulting in walking with a greater MOS (more anterior) and a shorter step length (p < 0.01) than that of the Ctrl group, would be associated with a greater likelihood to forward balance loss if encountered with a trip. The trip adaptation training mainly induced a higher toe clearance during walking (p < 0.01) than the Ctrl group, which could lead to reduced effectiveness of the reactive response when encountered with a novel slip. However, there was no difference in the reactive MOS, limb support, and falls between the control group and the slip and trip training groups on their respective opposing novel perturbation post-training (MOS, limb support, and falls for novel slip: Tt = Ctrl; for the novel trip: St = Ctrl, both p > 0.05). Current findings suggested that, although perturbation training results in proactive adjustments that could worsen the reactive response (interference) when exposed to an unexpected opposing perturbation, older adults demonstrated the ability to immediately generalize the training-induced adaptive reactive control to maintain MOS, to preserve limb support control, and to reduce fall risk.

scholarly journals Can Treadmill Slip-Perturbation Training Reduce Longer-Term Fall Risk Upon Overground Slip Exposure?

2020 ◽  
Vol 36 (5) ◽  
pp. 298-306 ◽  
Author(s):  
Anna Lee ◽  
Tanvi Bhatt ◽  
Xuan Liu ◽  
Yiru Wang ◽  
Shuaijie Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Center Of Mass ◽  
Control Group ◽  
Initial Training ◽  
Single Session ◽  
Control Groups ◽  
Perturbation Training ◽  
Positive Effect ◽  
Better Than

The purpose was to examine and compare the longer-term generalization between 2 different practice dosages for a single-session treadmill slip-perturbation training when reexposed to an overground slip 6 months later. A total of 45 older adults were conveniently assigned to either 24 or 40 slip-like treadmill perturbation trials or a third control group. Overground slips were given immediately after initial training, and at 6 months after initial training in order to examine immediate and longer-term effects. The performance (center of mass stability and vertical limb support) and fall percentage from the laboratory-induced overground slips (at initial posttraining and at 6 mo) were measured and compared between groups. Both treadmill slip-perturbation groups showed immediate generalization at the initial posttraining test and longer-term generalization at the 6-month retest. The higher-practice-dosage group performed significantly better than the control group (P < .05), with no difference between the lower-practice-dosage and the control groups at the 6-month retest (P > .05). A single session of treadmill slip-perturbation training showed a positive effect for reducing older adults’ fall risk for laboratory-induced overground slips. A higher-practice dosage of treadmill slip perturbations could be more beneficial for further reducing fall risk.

The Effects of a Divided-Attention Timed Stepping Accuracy Task on Balance, Strength, Endurance, and Functional Performance in Healthy Older Adults: A Pilot Study

2019 ◽  
Vol 27 (4) ◽  
pp. 521-528 ◽  
Author(s):  
Susan J. Leach ◽  
Joyce R. Maring ◽  
Ellen Costello
Keyword(s):  
Older Adults ◽  
Divided Attention ◽  
Functional Performance ◽  
Step Length ◽  
Berg Balance Scale ◽  
Primary Outcome Measure ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
Healthy Older Adults ◽  
Stepping Accuracy

The aim of this study was to investigate whether a 6-week Divided-Attention Stepping Accuracy Task (DATSAT) intervention improved the primary outcome measure, maximal step length; other balance measures (Berg Balance scale and Timed Up and Go test); leg strength; endurance (6-min walk test); and functional tasks in 15 community-dwelling healthy older adults (age: 71.5 years, female: 46.7%) compared with 15 community-dwelling healthy older adults in a Bike and Strength (B&S) program (age: 73.8 years, female: 33.3%). Participants trained 3× per week, 30–60 min per session. Stepping-group differences were significant for all measures. B&S group improved in maximal step length (anterior and lateral), strength, and one functional task. Stepping group outperformed B&S group in Timed Up and Go and maximal step length posterior. B&S group outperformed stepping group in two strength measures. Exertion scores were lower for the stepping group. Overall, Divided-Attention Timed Stepping Accuracy Task training resulted in more within-group improvements and two between-group measures with less perceived effort and shorter intervention times.

Safety, Feasibility, and Reliability of the Maximal Step Length, Gait Speed, and Chair Test Measured by Seniors Themselves: The Senior Step Study

2015 ◽  
Vol 23 (3) ◽  
pp. 438-443 ◽  
Author(s):  
Kim T.J. Bongers ◽  
Yvonne Schoon ◽  
Maartje J. Graauwmans ◽  
Marlies E. Hoogsteen-Ossewaarde ◽  
Marcel G.M. Olde Rikkert
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Fall Risk ◽  
Intraclass Correlation ◽  
Step Length ◽  
Community Dwelling ◽  
Self Management ◽  
Training Effect ◽  
Community Dwelling Older Adults ◽  
At Home

Self-management of mobility and fall risk might be possible if older adults could use a simple and safe self-test to measure their own mobility, balance, and fall risk at home. The aim of this study was to determine the safety, feasibility, and intraindividual reliability of the maximal step length (MSL), gait speed (GS), and chair test (CT) as potential self-tests for assessing mobility and fall risk. Fifty-six community-dwelling older adults performed MSL, GS, and CT at home once a week during a four-week period, wherein the feasibility, test-retest reliability, coefficients of variation, and linear mixed models with random effects of these three self-tests were determined. Forty-nine subjects (mean age 76.1 years [SD: 4.0], 19 females [42%]) completed the study without adverse effects. Compared with the other self-tests, MSL gave the most often (77.6%) valid measurement results and had the best intraclass correlation coefficients (0.95 [95% confidence interval: 0.91−0.97]). MSL and GS gave no significant training effect, whereas CT did show a significant training effect (p < .01). Community-dwelling older adults can perform MSL safely, correctly, and reliably, and GS safely and reliably. Further research is needed to study the responsiveness and beneficial effects of these self-tests on self-management of mobility and fall risk.

scholarly journals Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

2020 ◽  
pp. 073346482091266
Author(s):  
Sarah L. Szanton ◽  
Lindy Clemson ◽  
Minhui Liu ◽  
Laura N. Gitlin ◽  
Melissa D. Hladek ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Pilot Trial ◽  
Balance Training ◽  
Community Dwelling ◽  
Control Group ◽  
Timed Up And Go ◽  
Daily Lives ◽  
Fall Risk Factors

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample ( N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.

Electroacupuncture Modulates Resting-State Functional Connectivity in the Default Mode Network for Healthy Older Adults

2019 ◽  
Vol 33 (2) ◽  
pp. 85-92
Author(s):  
Dong-qiong Fan ◽  
Hai-chao Zhao ◽  
Jing Sheng ◽  
Yun-rui Liu ◽  
Jing Yu
Keyword(s):  
Older Adults ◽  
Functional Connectivity ◽  
Cognitive Performance ◽  
Default Mode Network ◽  
Community Dwelling ◽  
Control Group ◽  
Therapeutic Effects ◽  
Healthy Older Adults ◽  
Default Mode ◽  
Ventral Medial Prefrontal Cortex

Aging involves cognitive decline and prominent alterations in brain activity. Electroacupuncture (EA), a traditional Chinese medicine approach, is demonstrated to be effective in improving cognitive function of older adults. However, the specific neural mechanism underlying this modulation effect remains unclear. In this study, we used functional magnetic resonance imaging (fMRI) to investigate whether EA could improve cognitive performance of community-dwelling older adults and whether these potential improvements are associated with the EA-induced brain functional connectivity alterations. Thirty healthy older adults were recruited and randomly assigned to the EA group and the control group. Behaviorally, we observed an EA-induced improvement in cognitive performance of older adults in the Montreal Cognitive Assessment. On a neural perspective, the EA intervention significantly increased the functional connectivity within the default mode network. Moreover, we found a positive association between the improvement in delayed memory performance and the alterations in the ventral medial prefrontal cortex-hippocampal formation connectivity in the EA group. This study extends previous findings by showing that healthy older adults exhibit neural plasticity manifested as increased functional connectivity after EA sessions, which could induce therapeutic effects in the treatment of neurodegenerative diseases.

scholarly journals A Home Hazard Removal Program to Reduce Falls in Community-Dwelling Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 385-385
Author(s):  
Susy Stark
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Fall Risk ◽  
Low Cost ◽  
Management Program ◽  
Community Dwelling ◽  
Control Group ◽  
Age In Place ◽  
Increased Risk ◽  
Community Dwelling Older Adults

Abstract The majority of falls experienced by older adults occur in the home with home hazards associated with an increased risk of falling. Low-income older adults, who have more disability and live in substandard housing, need feasible interventions to help them safely age in place. The Home Hazard Removal Program (HARP) is a new home hazard removal and fall risk self-management program delivered in the home by occupational therapists to prevent falls. To evaluate the program, a randomized control trial was conducted with 310 community-dwelling older adults receiving aging services in the community. HARP had high acceptability with older adults and was feasible to deliver in the community. Adjusted for fall risk, individuals in the HARP group fell 1.4 times versus 2.2 times in the control group over 12 months. This low-cost home hazard removal program demonstrated acceptability, feasibility, and a significant reduction in falls for at-risk community-dwelling older adults.

The Effect of Short-Term Balance Training on Community-Dwelling Older Adults

2001 ◽  
Vol 9 (1) ◽  
pp. 19-31 ◽  
Author(s):  
Ann-Charlotte Grahn Kronhed ◽  
Claes Möller ◽  
Boel Olsson ◽  
Margareta Möller
Keyword(s):  
Older Adults ◽  
Balance Training ◽  
Exercise Group ◽  
Community Dwelling ◽  
Control Group ◽  
Balance Performance ◽  
Healthy Older Adults ◽  
Ordinary Life ◽  
Eyes Closed ◽  
The Right

This study evaluated a balance-training program’s influence in healthy older adults. Fifteen community-dwelling participants aged 70–75 years were randomized to an exercise group, and 15 gender- and age-matched participants, to a control group. The 9-week training program comprised ordinary-life balance, vestibular-habituation, and ball exercises and station training. Clinical balance tests were conducted before and after training. Tests that showed significant improvement in the exercise group after the intervention included standing on the right leg with eyes closed, standing on the right leg and the left leg while turning the head and walking 30 m. Significant between-group differences were found at posttest. A significant decrease was seen in the control group in the walking-forward test, and this change was significantly different between groups. The study indicates that balance performance in healthy older adults might be improved by balance training including exercises that stimulate multiple sensory systems and their central integration.

scholarly journals Dual-Task Does Not Increase Slip and Fall Risk in Healthy Young and Older Adults during Walking

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Rahul Soangra ◽  
Thurmon E. Lockhart
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Fall Risk ◽  
Step Length ◽  
Healthy Individuals ◽  
Healthy Older Adults ◽  
Gait Characteristics ◽  
Heel Contact ◽  
Fall Risks ◽  
The Relationship

Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants’ fall risks are modified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task walking have no destabilizing effect on gait and slip responses in healthy individuals. We also found that, during dual-tasking, healthy individuals adopted cautious gait mode (CGM) strategy that is characterized by reduced walking speed, shorter step length, increased step width, and reduced heel contact velocity and is likely to be an adaptation to minimize attentional demand and decrease slip and fall risk during limited available attentional resources. Exploring interactions between gait variability and cognitive functions while walking may lead to designing appropriate fall interventions among healthy and patient population with fall risk.

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