Reactive Balance / Perturbation Drills (Supervised)
Controlled slip-, trip- and nudge-recovery drills: one way to carry out what Okubo 2016 reports, that reactive and volitional stepping interventions reduced falls among older adults by approximately 50%; Okubo 2016 states that reactive step training requires a full body harness and individual supervision.
By design these provoke near-falls, do not attempt high intensity unsupervised.
- Two or more falls in the past 12 months, or any fall with injury
- Dizziness, lightheadedness, or fainting during standing or movement
- New or worsening unsteadiness, neurological symptoms, or numbness in the feet
- Fear of falling severe enough to restrict daily activity
How to do it
- Okubo 2016 states that reactive step training requires a full body harness and individual supervision. The drills progress from gentle to more unpredictable perturbations.
What the evidence says
This practice is one way to carry out what the sources on the concept entry (phys.neuromotor.reactive-training-real-world-falls) studied: perturbation-based and stepping training and falls in older adults. Okubo 2016 (meta-analysis, 7 studies, 660 participants) reports that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. Gerards 2017 (systematic review) reports that perturbation-based training appears to be a feasible and effective approach to falls reduction among older adults in clinical settings, especially with treadmill-based systems and therapist-applied perturbations. Allin 2020 (randomised trial) reports that perturbation training improved reactive balance and fall incidence after laboratory-induced slips (18% against 80% at baseline), with no improvement after laboratory-induced trips. The full account, source by source, is on the concept entry this practice links to (phys.neuromotor.reactive-training-real-world-falls).
- 'Never let yourself almost fall' (controlled near-falls are the training stimulus)
- Does not guarantee prevention of any fall or injury
- Not a substitute for medical evaluation of dizziness, syncope, or unexplained falls
- Do not perform intense perturbation drills without a harness, a treadmill system or a trained spotter
- Agreement
- The review summary this entry was written from does not say whether its sources agree at this claim. Direction recorded for 2 of 3 sources; not yet recorded for the rest. A review summary is the written synthesis this entry was first built from; it is not one of the sources counted here.
- The claim's outcome
- Outcome not yet recorded
- Certainty
- No source states a certainty rating.
What each source measured and concluded (3)
- What it measured
- Falls incidence
- How it measured it
- Prospective monitoring or retrospective reporting
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What it measured
- Number of falls during follow-up and the proportion of fallers.
- How it measured it
- Monthly fall diaries supplemented by follow-up telephone calls or face-to-face interviews.
- Direction it states for the claim's outcome
- Improved
- Its conclusion, in its own words
- “The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%.”
- How it was read
- read in full text
- What the review says it includes
- systematic review and meta-analysis
- Studies and participants, as stated
- N = 660 participants across 7 studies
- Heterogeneity, as stated
- Substantial heterogeneity within the training programs which limited subgroup analyses.
- What it measured
- Peak slip speed for slips and trunk angle at touchdown for trips.
- How it measured it
- Laboratory-induced slips and trips with motion capture system, force platform, and load cell.
- How it was read
- read in full text
Each source below is shown with its study design and a link to the original study, or, where it is not a completed research paper, with what kind of record it is; those are not counted. This is the audit trail.
Why do some records show a record type instead of a study design?
A study design is shown for a completed, peer-reviewed paper. A registered protocol, a preprint, a conference abstract, a referee report or a book chapter has not been through peer review as a finished paper, so it is labelled for what it is, and it is counted in no source count. Where a record could not be confirmed as a completed paper at all, it says so rather than guessing. They all stay in the list, and their DOI still resolves, because the count of what was screened is part of the audit trail.
- Protocol / registration A registered plan for a review or trial, not its results.
- Preprint Posted by its authors before peer review.
- Conference abstract A conference summary rather than a peer-reviewed paper.
- Peer-review report A referee's report on a paper, not the paper itself.
- Guideline / position stand A recommendation derived from evidence, which is a step further from the data than the evidence itself.
- Book chapter A chapter in a scholarly book rather than a journal paper.
- Type not recorded Our record does not say what kind of publication this is, so it is counted in no source count. That is a gap in our data, not a judgement about the research.