Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: “Principles and Mechanisms” and “Implementation in Practice.” In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: “Principles and Mechanisms” and “Implementation in Practice.” In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice

Robotic Strategies to Characterize and Promote Postural Responses in Standing, Squatting and Sit-to-Stand

In people with neuromotor deficits of trunk and lower extremities, maintaining and regaining balance is a difficult task. Many undergo rehabilitation to improve their movement capabilities, health, and overall interactions with their environment. Rehabilitation consists of a set of interventions designed to improve the individual’s mobility and independence. These strategies can be passive, active or task-specific and are dependent on the type of injury, how the individual progresses, and the intensity of the activity. Some of the common rehabilitation interventions to strengthen muscles and improve coordination are accomplished either by the manual assistance of a physical therapist, bodyweight suspension systems or through robotic-assisted training. There are several types of rehabilitation robotic systems and robotic control strategies.However, there are few robotic studies that compare their robotic device’s control strategy to common rehabilitation interventions. This dissertation introduces robotic strategies centered around rehabilitation ones and characterizes human motion in response to the robotic forces. Two cable-driven robotic systems are utilized to implement the robotic controllers for different tasks. Further details of the two cable-driven systems are discussed in Chapter 1. The validation and evaluation of these robotic strategies for standing rehabilitation is discussed in Chapter 2. A case study of a robotic training paradigm for individuals with spinal cord injury is presented in Chapter 3. Chapter 4 introduces a method to redistribute individuals’ weight using pelvic lateral forces. Chapter 5 and 6 characterizes how young and older groups respond to external perturbations during their sit-to-stand motion. This dissertation presents robotic strategies that can be implemented as rehabilitation interventions. It also presents how individuals’ biomechanics and muscle responses may change depending on the force control paradigm.These robotic strategies can be utilized by training individuals to improve their reactive and active balance control and thus reduce their risk of falling