Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Phys Ther. 2010 Apr;90(4):476-91. doi: 10.2522/ptj.20090070. Epub 2010 Feb 18.
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.
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.
This was a double-blind randomized controlled trial.
The study was conducted at research laboratories in a large urban hospital.
Thirty community-dwelling older adults (aged 64-80 years) with a recent history of falls or self-reported instability participated in the study.
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.
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.
/b> 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.
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.
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.
代偿跨步和抓握反应是对突然失去平衡的常见反应，对防止跌倒起着至关重要的作用。老年人执行这些反应的能力受损。
本研究旨在评估一种基于扰动的平衡训练计划，该计划旨在针对与年龄相关的代偿跨步和抓握平衡恢复反应的特定损伤。
这是一项双盲随机对照试验。
该研究在一家大型城市医院的研究实验室进行。
30 名居住在社区的老年人（年龄 64-80 岁），近期有跌倒或自述不稳定史。
参与者随机分配接受基于扰动（运动平台）的平衡训练计划或为期 6 周的涉及灵活性和放松训练的对照组。
基于扰动的计划针对的平衡反应特征包括：（1）多步反应，（2）前后向扰动后额外的侧向步，（3）侧向扰动后的足部碰撞，以及（4）完成抓握反应的时间。反应在测试过程中通过高度不可预测的表面平移和电缆拉扰动引发，这两种扰动都与训练中使用的扰动不同。
与对照组相比，基于扰动的训练导致多步反应和足部碰撞的频率显著降低，这在表面平移方面具有统计学意义，但在电缆拉动方面则没有。与对照组相比，扰动组在电缆拉动时扶手接触时间明显缩短，在表面平移时也有这种趋势。
需要进一步研究以确定是否需要维持计划来保持训练效果，并评估这些效果是否能降低日常生活中的跌倒风险。
基于扰动的训练有望成为改善老年人在失去平衡时防止跌倒能力的有效干预措施。
