Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Christopher McCrum; Tanvi S Bhatt; Marissa H G Gerards; Kiros Karamanidis; Mark W Rogers; Stephen R Lord; Yoshiro Okubo

doi:10.3389/fspor.2022.1015394

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice

Front Sports Act Living. 2022 Oct 6:4:1015394. doi: 10.3389/fspor.2022.1015394. eCollection 2022.

Authors

Christopher McCrum^{1

2}, Tanvi S Bhatt³, Marissa H G Gerards^{4

5}, Kiros Karamanidis⁶, Mark W Rogers⁷, Stephen R Lord^{8

9}, Yoshiro Okubo^{8

9}

Affiliations

¹ Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.
² Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
³ Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States.
⁴ Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
⁵ Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.
⁶ Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom.
⁷ Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States.
⁸ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.
⁹ Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.

Abstract

Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.

Keywords: accidental falls; aged; balance disorders; gait adaptation; rehabilitation; slips; trips.

Publication types

Review