In the past years, several studies have demonstrated the potential of task-specific perturbation-based balance training (PBT) for preventing falls at age. However, different paradigms of PBT have been investigated so far, while a comparison of these paradigms is lacking. Therefore, in this study, we plan to compare two promising PBT approaches in terms of feasibility and effects on fall risk-associated motor performance: 1. Training of dynamic stability mechanisms in the presence of perturbations induced by unstable surfaces; 2. Technology-supported training on a perturbation treadmill. In addition, both approaches will be compared with a passive control group. One-hundred and eleven participants aged 65 years or older will be randomly assigned to the three arms of the study. As the primary outcome, we will assess fall risk by use of the Brief-BESTest. Secondary outcomes include balance performance, functional performance, force capacity, and more. We hypothesize that both interventions will lead to a significant reduction of fall risk compared to the control group. Additionally, we will explore whether one of the two PBT paradigms is superior regarding feasibility and effectiveness.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
71
Perturbations into different directions are induced during static and dynamic tasks on a treadmill. Perturbations include announced and unannounced perturbations. Intensity and number of perturbations increases over the course of the intervention based on judgement of participant. Intervention duration: 6 weeks, 3 sessions a week, each session approx. 30 minutes.
The mechanisms of dynamic stability recovery are trained under unstable conditions. Different unstable undergrounds are used to stand on, perform lunges or jumps. Additionally, balance is challenged by different restrictions (e.g. decreased base of support, closed eyes) or therapist-applied perturbations. Intervention duration: 6 weeks, 3 sessions a week, each session approx. 45 minutes.
Heidelberg University, Network Aging Research
Heidelberg, Germany
Balance performance
Brief Balance Evaluation Systems Test (Brief-BESTest)
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Neuromuscular control during perturbations
Muscle synergies derived by non-negative matrix factorization from surface electromyography on 13 leg muscles
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Reactive balance performance
Step, stepping, fall-threshold test on Balance Tutor
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Static balance performance
Center of pressure on force plate
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Limits of stability
Limits of stability on force plate
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Spatio-temporal gait parameters
GAITRite System
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Functional leg strength (a)
30 s Chair rise test
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Functional leg strength (b)
Timed Up-and-Go test
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Force capacity of knee extensors
Isometric force test on force plate
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Fear of falling
Short Falls Efficacy Scale-International (Short FES-I); range: 7-28 points, high value indicates high fear of falling
Time frame: Change from baseline to post intervention test (an average of 7 weeks)
Feasibility of training paradigms
Acceptance of training questionnaire; range: 1-6 points, high value indicates high acceptance
Time frame: Post intervention test (on average 7 weeks after baseline)
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