Human Response to Longitudinal Perturbations of Standing Passengers on Public Transport During Regular Operation

This study investigates the response of standing passengers on public transport who experience balance perturbations during non-collision incidents. The objective of the study was to analyse the effects of the perturbation characteristics on the initial responses of the passengers and their ability to maintain their balance. Sled tests were conducted on healthy volunteers aged 33.8 ± 9.2 years (13 males, 11 females) standing on a moving platform, facilitating measurements of the initial muscle activity and stepping response of the volunteers. The volunteers were exposed to five different perturbation profiles representing typical braking and accelerating manoeuvres of a public transport bus in the forward and backward direction. The sequence of muscle activations in lower-extremity muscles was consistent for the perturbation pulses applied. For the three acceleration pulses combining two magnitudes for acceleration (1.5 and 3.0 m/s2) and jerk (5.6 and 11.3 m/s3), the shortest muscle onset and stepping times for the passengers to recover their balance were observed with the higher jerk value, while the profile with the higher acceleration magnitude and longer duration induced more recovery steps and a higher rate of safety-harness deployment. The tendency for a shorter response time was observed for the female volunteers. For the two braking pulses (1.0 and 2.5 m/s2), only the lower magnitude pulse allowed balance recovery without compensatory stepping. The results obtained provide a reference dataset for human body modelling, the development of virtual test protocols, and operational limits for improving the safety of public transportation vehicles and users.

Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability

Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1–6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. Results: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants’ treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). Conclusions: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS.

Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease

Background The correct identification of patients with Parkinson disease (PD) at risk for falling is important to initiate appropriate treatment early. Objective This study compared the Fullerton Advanced Balance (FAB) scale with the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Berg Balance Scale (BBS) to identify individuals with PD at risk for falls and to analyze which of the items of the scales best predict future falls. Design This was a prospective study to assess predictive criterion-related validity. Setting The study was conducted at a university hospital in an urban community. Patients Eighty-five patients with idiopathic PD (Hoehn and Yahr stages: 1–4) participated in the study. Measurements Measures were number of falls (assessed prospectively over 6 months), FAB scale, Mini-BESTest, BBS, and Unified Parkinson's Disease Rating Scale. Results The FAB scale, Mini-BESTest, and BBS showed similar accuracy to predict future falls, with values for area under the curve (AUC) of the receiver operating characteristic (ROC) curve of 0.68, 0.65, and 0.69, respectively. A model combining the items “tandem stance,” “rise to toes,” “one-leg stance,” “compensatory stepping backward,” “turning,” and “placing alternate foot on stool” had an AUC of 0.84 of the ROC curve. Limitations There was a dropout rate of 19/85 participants. Conclusions The FAB scale, Mini-BESTest, and BBS provide moderate capacity to predict “fallers” (people with one or more falls) from “nonfallers.” Only some items of the 3 scales contribute to the detection of future falls. Clinicians should particularly focus on the item “tandem stance” along with the items “one-leg stance,” “rise to toes,” “compensatory stepping backward,” “turning 360°,” and “placing foot on stool” when analyzing postural control deficits related to fall risk. Future research should analyze whether balance training including the aforementioned items is effective in reducing fall risk.