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A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults

BACKGROUND: Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention...

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Autores principales: McCrum, Christopher, Gerards, Marissa H. G., Karamanidis, Kiros, Zijlstra, Wiebren, Meijer, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335723/
https://www.ncbi.nlm.nih.gov/pubmed/28270866
http://dx.doi.org/10.1186/s11556-017-0173-7
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author McCrum, Christopher
Gerards, Marissa H. G.
Karamanidis, Kiros
Zijlstra, Wiebren
Meijer, Kenneth
author_facet McCrum, Christopher
Gerards, Marissa H. G.
Karamanidis, Kiros
Zijlstra, Wiebren
Meijer, Kenneth
author_sort McCrum, Christopher
collection PubMed
description BACKGROUND: Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults. METHODS: A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined. RESULTS: In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies. CONCLUSIONS: To date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s11556-017-0173-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-53357232017-03-07 A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults McCrum, Christopher Gerards, Marissa H. G. Karamanidis, Kiros Zijlstra, Wiebren Meijer, Kenneth Eur Rev Aging Phys Act Review Article BACKGROUND: Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults. METHODS: A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined. RESULTS: In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies. CONCLUSIONS: To date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s11556-017-0173-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-03-02 /pmc/articles/PMC5335723/ /pubmed/28270866 http://dx.doi.org/10.1186/s11556-017-0173-7 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review Article
McCrum, Christopher
Gerards, Marissa H. G.
Karamanidis, Kiros
Zijlstra, Wiebren
Meijer, Kenneth
A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title_full A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title_fullStr A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title_full_unstemmed A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title_short A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
title_sort systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5335723/
https://www.ncbi.nlm.nih.gov/pubmed/28270866
http://dx.doi.org/10.1186/s11556-017-0173-7
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