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      Adaptation to large-magnitude treadmill-based perturbations: improvements in reactive balance response

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      Physiological Reports
      BlackWell Publishing Ltd
      Compensatory stepping, fall prevention, learning, slips

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          Abstract

          We aimed to examine the trial-to-trial changes in the reactive balance response to large magnitude slip-like treadmill perturbations in stance and whether the acquired adaptive changes could be appropriately scaled to a higher intensity perturbation. Seventeen young adults experienced 15 slips for training on level I intensity. Pre- and post-training slips were delivered at a higher intensity (20% > level I). Pre- and post-slip onset stability (at liftoff and touchdown of stepping limb) was measured as the shortest distance of the center of mass (COM) position (X COM/BOS) and velocity (Ẋ COM/BOS) relative to base of support (BOS) from a predicted threshold for backward loss of balance. The number of steps to recover balance, compensatory step length and peak trunk angle were recorded. The post-slip onset stability (at liftoff and touchdown) significantly increased across the trials with no change in preslip stability. Improvement in stability at touchdown positively correlated with an anterior shift in X COM/BOS but not with Ẋ COM/BOS. Consequently, the number of steps required to recover balance declined. The adaptive change in X COM/BOS resulted from an increase in compensatory step length and reduced trunk extension. Individuals also improved post-slip onset stability on a higher intensity perturbation post-training compared with the pre-training trial. The results support that the CNS adapts to fixed intensity slip-like perturbations primarily by improving the reactive stability via modulation in compensatory step length and trunk extension. Furthermore, based on prior experience from the training phase, the acquired adaptive response can be successfully calibrated to a higher intensity perturbation.

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          Interventions for preventing falls in older people living in the community

          Cochrane Database of Systematic Reviews
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            Central programming of postural movements: adaptation to altered support-surface configurations.

            We studied the extent to which automatic postural actions in standing human subjects are organized by a limited repertoire of central motor programs. Subjects stood on support surfaces of various lengths, which forced them to adopt different postural movement strategies to compensate for the same external perturbations. We assessed whether a continuum or a limited set of muscle activation patterns was used to produce different movement patterns and the extent to which movement patterns were influenced by prior experience. Exposing subjects standing on a normal support surface to brief forward and backward horizontal surface perturbations elicited relatively stereotyped patterns of leg and trunk muscle activation with 73- to 110-ms latencies. Activity began in the ankle joint muscles and then radiated in sequence to thigh and then trunk muscles on the same dorsal or ventral aspect of the body. This activation pattern exerted compensatory torques about the ankle joints, which restored equilibrium by moving the body center of mass forward or backward. This pattern has been termed the ankle strategy because it restores equilibrium by moving the body primarily around the ankle joints. To successfully maintain balance while standing on a support surface short in relation to foot length, subjects activated leg and trunk muscles at similar latencies but organized the activity differently. The trunk and thigh muscles antagonistic to those used in the ankle strategy were activated in the opposite proximal-to-distal sequence, whereas the ankle muscles were generally unresponsive. This activation pattern produced a compensatory horizontal shear force against the support surface but little, if any, ankle torque. This pattern has been termed the hip strategy, because the resulting motion is focused primarily about the hip joints. Exposing subjects to horizontal surface perturbations while standing on support surfaces intermediate in length between the shortest and longest elicited more complex postural movements and associated muscle activation patterns that resembled ankle and hip strategies combined in different temporal relations. These complex postural movements were executed with combinations of torque and horizontal shear forces and motions of ankle and hip joints. During the first 5-20 practice trials immediately following changes from one support surface length to another, response latencies were unchanged. The activation patterns, however, were complex and resembled the patterns observed during well-practiced stance on surfaces of intermediate lengths.(ABSTRACT TRUNCATED AT 400 WORDS)
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              Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

              Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home. Design Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website. Setting Residents in metropolitan Sydney, Australia. Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran’s Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises. Interventions Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months. Main outcome measures Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily living activities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass. Results After 12 months’ follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls. Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity. Trial registration Australia and New Zealand Clinical Trials Registry 12606000025538.
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                Author and article information

                Journal
                Physiol Rep
                Physiol Rep
                phy2
                Physiological Reports
                BlackWell Publishing Ltd (Oxford, UK )
                2051-817X
                2051-817X
                February 2015
                03 February 2015
                : 3
                : 2
                : e12247
                Affiliations
                Department of Physical Therapy, University of Illinois at Chicago 1919 W, Taylor Street, 4th Floor., Chicago, Illinois, 60612
                Author notes
                Correspondence Tanvi Bhatt, University of Illinois at Chicago, Department of Physical Therapy 514-E, 1919 W. Taylor Street. Chicago IL 60612., Tel: 312 355 4443, Fax: 312 996 4583, E-mail: tbhatt6@ 123456uic.edu

                Funding Information No funding information provided.

                Article
                10.14814/phy2.12247
                4393185
                25649245
                f791082e-a526-40e4-a31d-833088e5ab8b
                © 2015 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 October 2014
                : 28 October 2014
                Categories
                Original Research

                compensatory stepping,fall prevention,learning,slips
                compensatory stepping, fall prevention, learning, slips

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