AGE

, 36:9640 | Cite as

Learning from laboratory-induced falling: long-term motor retention among older adults

Article

Abstract

Falls in older adults are a major health and societal problem. It is thus imperative to develop highly effective training paradigms to reduce the likelihood of falls. Perturbation training is one such emerging paradigm known to induce shorter term fall reduction in healthy young as well as older adults. Its longer term benefits are not fully understood, however. The purpose of this study was to determine whether and to what degree older adults could retain their fall-resisting skills acquired from a single perturbation training session. Seventy-three community-dwelling older adults (≥65 years) received identical single-session perturbation training consisting of 24 slips. This was delivered through unannounced unlocking (and mixed with relocking) of low-friction movable sections of the walkway. A single retest was subsequently scheduled based on a three-stage sequential, pre-post-retest design. Outcome measurements, taken upon the first (novel) and the 24th (final) slips of the initial session and the retest slip, included fall-or-no-fall and stability (quantified by the shortest distance from relative motion state of the center-of-mass and the base-of-support to the limits of stability) at instants prior to (proactive) and after (reactive) the onset of the slip. The training boosted subjects’ resilience against laboratory-induced falls demonstrated by a significant reduction from 42.5 % falls on the first slip to 0 % on the 24th slip. Rate of falls which occurred during the laboratory retest remained low in 6-month (0 %), 9-month (8.7 %), and 12-month retest (11.5 %), with no significant difference between the three time intervals. Such reduction of laboratory-induced falls and its retention were attributable to the significant training-induced improvement in the proactive and reactive control of stability. This unique pre-post-retest design enabled us to provide scientific basis for the feasibility of a single session of perturbation training to “inoculate” older adults and to reduce their annual risk of falls in everyday living.

Keywords

Stability control Motor memory Resilience Inoculation Perturbation training 

References

  1. Adkin AL, Frank JS, Carpenter MG, Peysar GW (2000) Postural control is scaled to level of postural threat. Gait Posture 12:87–93PubMedCrossRefGoogle Scholar
  2. Bhatt T, Pai Y-C (2009a) Generalization of gait adaptation for fall prevention: from moveable platform to slippery floor. J Neurophysiol 101(2):948–957PubMedCentralPubMedCrossRefGoogle Scholar
  3. Bhatt T, Pai Y-C (2009b) Prevention of slip-related backward balance loss: the effect of session intensity and frequency on long-term retention. Arch Phys Med Rehabil 90(1):34–42PubMedCentralPubMedCrossRefGoogle Scholar
  4. Bhatt T, Wang E, Pai Y-C (2006a) Retention of adaptive control over varying intervals: prevention of slip- induced backward balance loss during gait. J Neurophysiol 95(5):2913–2922PubMedCrossRefGoogle Scholar
  5. Bhatt T, Wening JD, Pai Y-C (2006b) Adaptive control of gait stability in reducing slip-related backward loss of balance. Exp Brain Res 170(1):61–73PubMedCrossRefGoogle Scholar
  6. Blakemore SJ, Goodbody SJ, Wolpert DM (1998) Predicting the consequences of our own actions: the role of sensorimotor context estimation. J Neurosci 18(18):7511–7518PubMedGoogle Scholar
  7. de Leva P (1996) Adjustments to Zatsiorsky-Seluyanov's segment inertia parameters. J Biomech 29:1223–1230PubMedCrossRefGoogle Scholar
  8. Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41(5):733–746PubMedGoogle Scholar
  9. Fitzharris MP, Day L, Lord SR, Gordon I, Fildes B (2010) The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates. Age Ageing 39(6):728–733PubMedCrossRefGoogle Scholar
  10. Folstein MF, Folstein SE, McHugh PR (1975) A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 12:189–198CrossRefGoogle Scholar
  11. Hof AL, Gazendam MG, Sinke WE (2005) The condition for dynamic stability. J Biomech 38(1):1–8PubMedCrossRefGoogle Scholar
  12. Joh AS, Adolph KE (2006) Learning from falling. Child Dev 77:89–102PubMedCrossRefGoogle Scholar
  13. Kandel ER, Schzwartz JH, Jessell TM (2000) Principles of neural science, 4th edn. Health Professions Division, McGraw HillGoogle Scholar
  14. Karniel A, Mussa-Ivaldi FA (2002) Does the motor control system use multiple models and context switching to cope with a variable environment? Exp Brain Res 143(4):520–524PubMedCrossRefGoogle Scholar
  15. Luukinen H, Herala M, Koski K, Honkanen R, Laippala P, Kivela SL (2000) Fracture risk associated with a fall according to type of fall among the elderly. Osteoporos Int 11(7):631–634PubMedCrossRefGoogle Scholar
  16. Pai Y-C, Bhatt T (2007) Repeated slip training: an emerging paradigm for prevention of slip-related falls in older adults. Phys Ther 87(11):1478–1491PubMedCentralPubMedCrossRefGoogle Scholar
  17. Pai Y-C, Patton JL (1997) Center of mass velocity-position predictions for balance control. J Biomech 30(4):347–354PubMedCrossRefGoogle Scholar
  18. Pai Y-C, Wening JD, Runtz EF, Iqbal K, Pavol MJ (2003) Role of feedforward control of movement stability in reducing slip-related balance loss and falls among older adults. J Neurophysiol 90:755–762PubMedCrossRefGoogle Scholar
  19. Pai Y-C, Bhatt T, Wang E, Espy D, Pavol MJ (2010) Inoculation against falls: rapid adaptation by young and older adults to slips during daily activities. Arch Phys Med Rehabil 91(3):452–459PubMedCentralPubMedCrossRefGoogle Scholar
  20. Parijat P, Lockhart TE (2012) Effects of moveable platform training in preventing slip-induced falls in older adults. Ann Biomed Eng 40(5):1111–1121PubMedCentralPubMedCrossRefGoogle Scholar
  21. Patton JL, Pai Y-C, Lee WA (1999) Evaluation of a model that determines the stability limits of dynamic balance. Gait Posture 9(1):38–49PubMedCrossRefGoogle Scholar
  22. Podsiadlo D, Richardson S (1991) The timed "up & go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  23. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41PubMedGoogle Scholar
  24. Rubenstein LZ, Josephson KR (2006) Falls and their prevention in elderly people: what does the evidence show? Med Clin N Am 90(5):807–824PubMedCrossRefGoogle Scholar
  25. Sacchetti B, Scelfo B, Tempia F, Strata P (2004) Long-term synaptic changes induced in the cerebellar cortex by fear conditioning. Neuron 42:973–982PubMedCrossRefGoogle Scholar
  26. Scheidt RA, Dingwell JB, Mussa-Ivaldi FA (2001) Learning to move amid uncertainty. J Neurophysiol 86(2):971–985PubMedGoogle Scholar
  27. Schmidt RA, Lee TD (1999) Conditions of practice. In: Schmidt RA, Lee TD (eds) Motor control and learning: a behavioral emphasis. Human Kinetics Publishers, Inc., Champaign, pp 285–318Google Scholar
  28. Shadmehr R, Mussa-Ivaldi FA (1994) Adaptive representation of dynamics during learning of a motor task. J Neurosci 14:3208–3224PubMedGoogle Scholar
  29. Shimada H, Obuchi S, Furuna T, Suzuki T (2004) New intervention program for preventing falls among frail elderly people: the effects of perturbed walking exercise using a bilateral separated treadmill. Am J Phys Med Rehabil 83:493–499PubMedCrossRefGoogle Scholar
  30. Shumway-Cook A, Silver IF, LeMier M, York SC, Cummings P, Koepsell TD (2007) Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. J Gerontol A: Biol Med Sci 62(12):1420–1427CrossRefGoogle Scholar
  31. Thompson PW, Taylor J, Oliver R, Fisher A (1998) Quantitative ultrasound (QUS) of the heel predicts wrist ad osteoporosis-related fractures in women aged 45-75 years. J Clin Densitom 1:219–225PubMedCrossRefGoogle Scholar
  32. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707PubMedCrossRefGoogle Scholar
  33. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331(13):821–827PubMedCrossRefGoogle Scholar
  34. Tjernstrom F, Fransson P-A, Hafstrom A, Magnusson M (2002) Adaptation of postural control to perturbations—a process that initiates long-term motor memory. Gait Posture 15(1):75–82PubMedCrossRefGoogle Scholar
  35. Tseng YW, Diedrichsen J, Krakauer JW, Shadmehr R, Bastian AJ (2007) Sensory prediction errors drive cerebellum-dependent adaptation of reaching. J Neurophysiol 98(1):54–62PubMedCrossRefGoogle Scholar
  36. Wolf SL, Sattin RW, Kutner M, O'Grady M, Greenspan AI, Gregor RJ (2003) Intense Tai Chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial. J Am Geriatr Soc 51:1693–1701PubMedCrossRefGoogle Scholar
  37. Wrisley DM, Stephens MJ, Mosley S, Wojnowski A, Duffy J, Burkard R (2007) Learning effects of repetitive administrations of the sensory organization test in healthy young adults. Arch Phys Med Rehabil 88(8):1049–1054PubMedCrossRefGoogle Scholar
  38. Yang F, Pai Y-C (2010) Role of individual lower limb joints in reactive stability control following a novel slip in gait. J Biomech 43:397–404PubMedCentralPubMedCrossRefGoogle Scholar
  39. Yang F, Pai Y-C (2011) Automatic recognition of falls in gait-slip training: harness load cell based criteria. J Biomech 44:2243–2249PubMedCentralPubMedCrossRefGoogle Scholar
  40. Yang F, Anderson FC, Pai Y-C (2008a) Predicted threshold against backward balance loss following a slip in gait. J Biomech 41:1823–1831PubMedCentralPubMedCrossRefGoogle Scholar
  41. Yang F, Passariello F, Pai Y-C (2008b) Determination of instantaneous stability against backward balance loss: two computational approaches. J Biomech 41(8):1818–1822PubMedCentralPubMedCrossRefGoogle Scholar
  42. Yang F, Bhatt T, Pai Y-C (2009) Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities. J Biomech 42:1903–1908PubMedCentralPubMedCrossRefGoogle Scholar
  43. Yang F, Bhatt T, Pai Y-C (2013) Generalization of treadmill-slip training to prevent a fall following a sudden (novel) slip in over-ground walking. J Biomech 46(1):63–69PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© American Aging Association 2014

Authors and Affiliations

  • Yi-Chung Pai
    • 1
  • Feng Yang
    • 1
  • Tanvi Bhatt
    • 1
  • Edward Wang
    • 2
  1. 1.Department of Physical Therapy (MC 898)University of Illinois at ChicagoChicagoUSA
  2. 2.Department of Biomedical and Health Information SciencesUniversity of Illinois at ChicagoChicagoUSA

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