title: Unexpected perturbations training improves balance control and voluntary stepping times in older adults - a double blind randomized control trial.
abstract: BACKGROUND
  Falls are common among elderly, most of them occur while slipping or tripping during walking. We aimed to explore whether a training program that incorporates unexpected loss of balance during walking able to improve risk factors for falls.
  
  
  METHODS
  In a double-blind randomized controlled trial 53 community dwelling older adults (age 80.1±5.6 years), were recruited and randomly allocated to an intervention group (n = 27) or a control group (n = 26). The intervention group received 24 training sessions over 3 months that included unexpected perturbation of balance exercises during treadmill walking. The control group performed treadmill walking with no perturbations. The primary outcome measures were the voluntary step execution times, traditional postural sway parameters and Stabilogram-Diffusion Analysis. The secondary outcome measures were the fall efficacy Scale (FES), self-reported late life function (LLFDI), and Performance-Oriented Mobility Assessment (POMA).
  
  
  RESULTS
  Compared to control, participation in intervention program that includes unexpected loss of balance during walking led to faster Voluntary Step Execution Times under single (p = 0.002; effect size [ES] =0.75) and dual task (p = 0.003; [ES] = 0.89) conditions; intervention group subjects showed improvement in Short-term Effective diffusion coefficients in the mediolateral direction of the Stabilogram-Diffusion Analysis under eyes closed conditions (p = 0.012, [ES] = 0.92). Compared to control there were no significant changes in FES, LLFDI, and POMA.
  
  
  CONCLUSIONS
  An intervention program that includes unexpected loss of balance during walking can improve voluntary stepping times and balance control, both previously reported as risk factors for falls. This however, did not transferred to a change self-reported function and FES.
  
  
  BACKGROUND
  ClinicalTrials.gov
  
  
  BACKGROUND
  NCT01439451 .
authors.affiliation: Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 84105, Israel. kurzi@post.bgu.ac.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Kurz
authors.affiliation: Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 84105, Israel. yoavgimmon@gmail.com.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Gimmon
authors.affiliation: Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel. ashapiro@bgu.ac.il.
authors.forename: Amir
authors.initials: A
authors.lastname: Shapiro
authors.affiliation: Orthopedic department, Barzilai Medical Center, Ashkelon, Israel. debbi.ronen@gmail.com.
authors.forename: Ronen
authors.initials: R
authors.lastname: Debi
authors.affiliation: "Beit Yona" senior citizens home, Beer-Sheva, Israel. sara@beityona.co.il.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Snir
authors.affiliation: Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 84105, Israel. itzikm@bgu.ac.il.
authors.forename: Itshak
authors.initials: I
authors.lastname: Melzer
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D015444:Exercise / Q000523:psychology*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D012307:Risk Factors; D016138:Walking / Q000502:physiology*