First published on February 18, 2010

Physical Therapy 2010;90:476.

Physical Therapy
DOI: 10.2522/ptj.20090070
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Research Reports

Effect of a Perturbation-Based Balance Training Program on Compensatory Stepping and Grasping Reactions in Older Adults: A Randomized Controlled Trial

Avril Mansfield, Amy L. Peters, Barbara A. Liu and Brian E. Maki

A. Mansfield, PhD, is Postdoctoral Fellow, Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, and Toronto Rehabilitation Institute, Toronto, Ontario, Canada. She was affiliated with the Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada, and the Centre for Studies in Aging, Sunnybrook Health Sciences Centre, at the time the study was conducted.
A.L. Peters, MHK, is Research Assistant, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom. She was affiliated with the Centre for Studies in Aging, Sunnybrook Health Sciences Centre, at the time the study was conducted.
B.A. Liu, MD, is Associate Scientist, Clinical Integrative Biology–Brain Sciences Program, Sunnybrook Health Science Centre, and Assistant Professor, Department of Medicine, University of Toronto.
B.E. Maki, PhD, is Senior Scientist and Director, Centre for Studies in Aging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5 Canada. He also is Professor, Department of Surgery, University of Toronto, and is affiliated with the Toronto Rehabilitation Institute.

brian.maki{at}sri.utoronto.ca

Background: Compensatory stepping and grasping reactions are prevalent responses to sudden loss of balance and play a critical role in preventing falls. The ability to execute these reactions effectively is impaired in older adults.

Objective: The purpose of this study was to evaluate a perturbation-based balance training program designed to target specific age-related impairments in compensatory stepping and grasping balance recovery reactions.

Design: This was a double-blind randomized controlled trial.

Setting: The study was conducted at research laboratories in a large urban hospital.

Participants: Thirty community-dwelling older adults (aged 64–80 years) with a recent history of falls or self-reported instability participated in the study.

Intervention: Participants were randomly assigned to receive either a 6-week perturbation-based (motion platform) balance training program or a 6-week control program involving flexibility and relaxation training.

Measurements: Features of balance reactions targeted by the perturbation-based program were: (1) multi-step reactions, (2) extra lateral steps following anteroposterior perturbations, (3) foot collisions following lateral perturbations, and (4) time to complete grasping reactions. The reactions were evoked during testing by highly unpredictable surface translation and cable pull perturbations, both of which differed from the perturbations used during training.

Results: Compared with the control program, the perturbation-based training led to greater reductions in frequency of multi-step reactions and foot collisions that were statistically significant for surface translations but not cable pulls. The perturbation group also showed significantly greater reduction in handrail contact time compared with the control group for cable pulls and a possible trend in this direction for surface translations.

Limitations: Further work is needed to determine whether a maintenance program is needed to retain the training benefits and to assess whether these benefits reduce fall risk in daily life.

Conclusion: Perturbation-based training shows promise as an effective intervention to improve the ability of older adults to prevent themselves from falling when they lose their balance.


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F. B. Horak and L. A. King
Invited Commentary
Physical Therapy, April 1, 2010; 90(4): 491 - 492.
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A. Mansfield, A. L. Peters, B. A. Liu, and B. E. Maki
Author Response
Physical Therapy, April 1, 2010; 90(4): 492 - 492.
[Full Text] [PDF]