Abstract
Introduction: Older adults can reduce the risk of falls after participation in a perturbation-based balance training (PBBT). We aimed to compare two perturbation motor learning paradigms: random versus block practice. Methods: Twenty community-dwelling older adults were recruited and randomly allocated to a random PBBT group (n = 8), participants were exposed to unannounced perturbations in multiple directions during each training session, or a block PBBT group (n = 12) participants experienced perturbations from a single during every training session during treadmill walking. Both groups received eight training sessions over a 4-week period that included a concurrent cognitive task during training. Primary outcome measures were parameters of reactive stepping, i.e., step thresholds in walking and kinematics of reactive stepping during walking, and secondary outcome measures were proactive balance, i.e., voluntary step test and cognitive performance. All outcomes were measured before and after PBBT. Results: Both PBBT groups improved their ability to cope with higher perturbations post-training and a reduction in center of mass path displacement during the recovery after the perturbation in walking. No improvement was found in voluntary stepping post-training; both groups, however, showed improvement in cognitive performance post-training. Discussion: Results show some improvements in reactive stepping performance but not in proactive voluntary stepping in both random and block PBBT methods, with no superiority of one training method over the other. Some improvements in cognitive performance in both groups suggest a transfer effect post-training, regardless of training method. Given the small sample size, results are preliminary and should be interpreted with caution.
Plain Language Summary
A fall in elderly people is a life-changing event that often limits their participation in the community, decreases their quality of life, and increases their fear of fall. Balance training specifically aimed at preventing falls has been found to be effective in reducing falls. There are many types of balance training described and investigated in the literature; one of them is perturbation-based training approach that exposes the participants to unexpected balance losses. This approach is found to be more effective in reducing falls. We aimed to explore repeated practices of balance perturbations with fixed direction, and intensity (i.e., block training) is better than training where the perturbations are delivered randomly (i.e., random training). Each group trained for a month, twice a week for half an hour. We found that both groups improved their ability to recover balance to prevent a fall after balance loss and were able to tolerate higher intensity balance disturbances at the end of the training. Interestingly, a cognitive improvement was found alongside the improvement of motor.
