A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial

<p>Abstract</p> <p>Background</p> <p>Gait and balance impairments may increase the risk of falls, the leading cause of accidental death in the elderly population. Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering. A rapid step is the most important protective postural strategy, acting to recover equilibrium and prevent a fall from initiating. It can arise from large perturbations, but also frequently as a consequence of volitional movements. We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling. We describe the water-based balance training program and a study protocol to evaluate its efficacy (Trial registration number #NCT00708136).</p> <p>Methods/Design</p> <p>The proposed water-based training program involves use of unpredictable, multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses. Perturbations are made by pushing slightly the subjects and by water turbulence, in 24 training sessions conducted over 12 weeks. Concurrent cognitive tasks during movement tasks are included. Principles of physical training and exercise including awareness, continuity, motivation, overload, periodicity, progression and specificity were used in the development of this novel program. Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning. A prospective, randomized, cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program. A total of 36 community-dwelling adults (age 65–88) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group (no training). Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training.</p> <p>Discussion</p> <p>This study will determine whether a water-based balance training program that includes perturbation exercises, in a group setting, can improve speed of voluntary stepping responses and improve balance control. Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly.</p

An experimental and analytical investigation of the behaviour of reinforced concrete beams subjected to combined bending and torsion

BACKGROUND The current study investigated the repeatability (test-retest reliability) of ground reaction force parameters recorded during a voluntary step execution under single (motor task) and dual task (motor and cognitive task) conditions for healthy adults and elderly individuals as well as the number of trials required to produce repeatable results. METHODS Twenty-four healthy adults (21–63 years old) and 16 elderly adults (66–87 years) performed a voluntary rapid step execution following a tap on their heel while standing on a force platform under single and dual task conditions on three separate occasions. The first two tests were performed 30–60 minutes apart and the third test was performed a week later. Variables analyzed from the ground reaction force data included onset latency of step initiation (initiation phase), preparation and swing phases, foot-off and foot-contact times. RESULTS Intraclass correlation coefficients (ICC(2,1)) were good to excellent across all parameters and test conditions for the pooled population and for elderly (0.74–0.92 and 0.62–0.88, respectively) except for the swing phase duration where lower values were seen (0.54–0.60 and 0.32–0.64 respectively). Values were similar under single and dual task conditions. CONCLUSION A voluntary step execution test, performed under single and dual task conditions especially foot-off and foot-contact times, is a reliable outcome measure that may be a useful tool to asses dynamic balance function for diagnostic purposes as well as clinical intervention trials.Retirement Research Foundation; National Institute on Disability and Rehabilitation Researc

Foot-off times from the 1, 2(an hour later) and 3(a week later) test session for the elderly and younger group of subjects, respectively, across 6 trials and Task conditions: single task condition (top) and dual task condition (bottom)

<p><b>Copyright information:</b></p><p>Taken from "Reliability of voluntary step execution behavior under single and dual task conditions"</p><p>http://www.jneuroengrehab.com/content/4/1/16</p><p>Journal of NeuroEngineering and Rehabilitation 2007;4():16-16.</p><p>Published online 29 May 2007</p><p>PMCID:PMC1894973.</p><p></p> Values represent mean foot-off times of elderly (filled square) and young (open circle) subjects. Vertical bars indicate one standard deviation. Notice decrease in foot-off times during the first test session for the elderly subjects, especially between the first and second trial under dual task conditions. A similar decrease is seen under dual task conditions for the third test session. Such effects were not present in the younger group

A rehabilitation tool for functional balance using altered gravity and virtual reality-0

<p><b>Copyright information:</b></p><p>Taken from "A rehabilitation tool for functional balance using altered gravity and virtual reality"</p><p>http://www.jneuroengrehab.com/content/4/1/25</p><p>Journal of NeuroEngineering and Rehabilitation 2007;4():25-25.</p><p>Published online 10 Jul 2007</p><p>PMCID:PMC1936992.</p><p></p>0 deg/s, left) and fast (35 deg/s, right) isokinetic squat extension, respectively. Similarly, cross-hatched and striped graphs show post test MVC values for S&B and S groups, respectively. Graphs represent mean with bars indicating+ 1 standard deviation of the mean. All pre- to post-training changes were statistically significant

A rehabilitation tool for functional balance using altered gravity and virtual reality

<p>Abstract</p> <p>Background</p> <p>There is a need for effective and early functional rehabilitation of patients with gait and balance problems including those with spinal cord injury, neurological diseases and recovering from hip fractures, a common consequence of falls especially in the elderly population. Gait training in these patients using partial body weight support (BWS) on a treadmill, a technique that involves unloading the subject through a harness, improves walking better than training with full weight bearing. One problem with this technique not commonly acknowledged is that the harness provides external support that essentially eliminates associated postural adjustments (APAs) required for independent gait. We have developed a device to address this issue and conducted a training study for proof of concept of efficacy.</p> <p>Methods</p> <p>We present a tool that can enhance the concept of BWS training by allowing natural APAs to occur mediolaterally. While in a supine position in a 90 deg tilted environment built around a modified hospital bed, subjects wear a backpack frame that is freely moving on air-bearings (cf. puck on an air hockey table) and attached through a cable to a pneumatic cylinder that provides a load that can be set to emulate various G-like loads. Veridical visual input is provided through two 3-D automultiscopic displays that allow glasses free 3-D vision representing a virtual surrounding environment that may be acquired from sites chosen by the patient. Two groups of 12 healthy subjects were exposed to either strength training alone or a combination of strength and balance training in such a tilted environment over a period of four weeks.</p> <p>Results</p> <p>Isokinetic strength measured during upright squat extension improved similarly in both groups. Measures of balance assessed in upright showed statistically significant improvements only when balance was part of the training in the tilted environment. Postural measures indicated less reliance on visual and/or increased use of somatosensory cues after training.</p> <p>Conclusion</p> <p>Upright balance function can be improved following balance specific training performed in a supine position in an environment providing the perception of an upright position with respect to gravity. Future studies will implement this concept in patients.</p