June 10, 2020
A protocol for perturbation-based gait training in older adults at risk of falling.
Daily-life fall risk in the elderly is becoming increasingly relevant, particularly given the ageing population in Europe and in the wider world and the increasing health care costs associated with falls. Therefore, research focus is rising over the last years on how these falls might be prevented, with many research groups focussing on how to tackle this problem. One promising new method of reducing falls is perturbation-based gait training. Perturbations applied in a safe environment, for example using the Motek GRAIL, CAREN or C-Mill allow people at risk for falling to train their reactive balance control.
A recent article by Rieger et al. presents the protocol for a 4-week perturbation-based treadmill training programme.1 The protocol is for a randomised control trial (RCT) to evaluate the effects of a 4-week treadmill training program with a combination of gait perturbations under dual task conditions. The specific aim is to evaluate the added value of the perturbation-based treadmill training combined with cognitive dual-tasking compared to treadmill training under cognitive dual-task conditions without perturbations on the C-Mill on daily life gait quality, clinically assessed balance and gait performance, self-efficacy and falls. The authors designed the study to be a single blinded (assessor blinded), mono centre RCT, with participants equally assigned to either the experimental intervention or the control intervention. The protocol specifies that the participants must be generally healthy, 65 years of age or older and identified at risk for falling. . For the full exclusion criteria, please refer to the article. For the experimental intervention group (REACT), training consists of a combination of perturbation training, specifically quick accelerations and decelerations of the treadmill belt, and cognitive dual-task exercises on the C-Mill. This is specifically designed to be a very task specific training. Training in the control intervention group consists of treadmill training under cognitive dual-task conditions using the same programme, but without the perturbations. All participants in the study are assessed before and after the intervention using a combination of clinical balance and gait assessments and self-efficacy questionnaires. Additional training measurements are assessed at each of the 8 training sessions. In addition, this study proposes a novel use of 3D accelerometery using a single sensor worn on the lower back, to measure gait quality and physical activity in daily life before and after the intervention. The purpose of these extra measurements is to evaluate the transfer of balance and gait improvements observed in the lab to daily life gait quality.
This is the first study applying perturbation-based gait training in a clinical setting by using Motek’s C-Mill VR+ and investigates transfer of training effects to daily-life gait quality.
To read more about the protocol, please check out the full article here.
- Rieger, M.M., Papegaaij, S., Steenbrink, F. et al. Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling: protocol for the REACT randomized controlled trial. BMC Geriatr 20, 167 (2020). https://doi.org/10.1186/s12877-020-01566-z