V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. A Randomized Trial to Measure the Impact of a Community-Based Cognitive Training Intervention on Balance and Gait in Cognitively Intact Black Older Adults A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial. Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study Effect of guided relaxation and imagery on falls self-efficacy: a randomized controlled trial. Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Effect of 24 weeks strength training on unstable surfaces on mobility, balance and concern about falling in older adults. Action observation training for functional activities after stroke: a pilot randomized controlled trial. Neural mechanisms underlying balance improvement with short term Tai Chi training Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older.
Background Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits . Indeed , everyday walking in complex environments utilizes executive function , dual tasking , planning and scanning , all while walking forward . Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction . The proposed r and omized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk . Methods / Design Three hundred older adults with a history of falls will be recruited to participate in this study . This will include older adults ( n=100 ) , patients with mild cognitive impairment ( n=100 ) , and patients with Parkinson ’s disease ( n=100 ) . These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits . Subjects will be r and omly assigned to the intervention group ( treadmill training with virtual reality ) or to the active-control group ( treadmill training without virtual reality ) . Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks . Assessment s will take place before , after , and 1 month and 6 months after the completion of the training . A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence ( i.e. , the number of falls , multiple falls and falls rate ) . In addition , we will measure gait under usual and dual task conditions , balance , community mobility , health related quality of life , user satisfaction and cognitive function . Discussion This r and omized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality  reduces fall risk , improves mobility and enhances cognitive function in a diverse group of older adults . In addition , the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit . Trial Registration This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults BACKGROUND AND PURPOSE This prospect i ve clinical investigation examined the effects of a multidimensional exercise program on balance , mobility , and risk for falls in community-dwelling older adults with a history of falling . Factors used to predict adherence and a successful response to exercise were identified . SUBJECTS A total of 105 community-dwelling older adults ( > or = 65 years of age ) with a history of two or more falls in the previous 6 months ( no neurologic diagnosis ) participated . They were classified into ( 1 ) a control group of fallers ( n = 21 ) , ( 2 ) a fully adherent exercise group ( n = 52 ) , and ( 3 ) a partially adherent exercise group ( n = 32 ) . METHODS Following evaluation , each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment . The control group received no intervention . Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups . RESULTS Both exercise groups scored better than the control group on all measures of balance and mobility . Although both exercise groups showed a reduction in fall risk compared with the control group , the greatest reduction was found in the fully adherent exercise group . Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment . CONCLUSION AND DISCUSSION Exercise can improve balance and mobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling . The amount of exercise needed to achieve these results , however , could not be determined from this study Introduction . Fall prevention is important for maintaining mobility and independence into old age . Approaches for reducing falls include exercise , tai chi , and home modifications ; however , causes of falling are multifactorial and include not just physical but cognitive factors . Cognitive decline occurs with age , but older adults with the greatest declines in executive function experience more falls . The purpose of this study was twofold : to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population . Method . This pilot study used a pretest/posttest r and omized trial design with assignment to an intervention or control group . Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks . Classes were held at senior/community centers . Primary outcomes included balance as measured by the Berg Balance Scale ( BBS ) , 10-meter gait speed , and 10-meter gait speed under visuospatial dual-task condition . All measures were assessed at baseline and immediately post-intervention . Results . Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls ( N = 45 ) . Compared to controls , intervention participants experienced statistically significant improvements in BBS and gait speed . Mean performance on distracted gait speed also improved more for intervention participants compared to controls . Conclusion . Findings from this pilot r and omized trial demonstrate the feasibility of a community-based cognitive training intervention . They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com BACKGROUND older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups . OBJECTIVE to determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls . DESIGN a r and omised controlled trial model . SETTING Neurological Disorders , Ageing and Balance Clinic , Department of Physiotherapy , The University of Queensl and . SUBJECTS 73 males and females over 60 years , living independently in the community and who had fallen in the previous year were recruited . METHODS all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study . Treatment sessions were once a week for 10 weeks . Subject assessment before and after intervention and at 3 months follow-up included number of falls , co-morbidities , medications , community services and activity level , functional motor ability , clinical and laboratory balance measures and fear of falling . RESULTS all participants significantly reduced the number of falls ( P < 0.000 ) . The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group ( P = 0.034 ) . Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group ( P < 0.04 ) . The control group only improved in TUG and TUGcog . CONCLUSIONS the results provide evidence that all participants achieved a significant reduction in falls .  Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance Purpose To investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance . Patients and methods Thirty independent adults aged > 65 years took part in the r and omized controlled trial . The study was conducted within an exercise science laboratory . Participants were r and omly divided into three groups following baseline locomotor testing : motor imagery training , physical training , and control groups . The motor imagery training group completed 20 imagined repetitions of a locomotor task , the physical training group completed 20 physical repetitions of a locomotor task , and the control group spent 25 minutes playing mentally stimulating games on an iPad .  Imagined and physical performance times were measured for each training repetition . Gait speed ( preferred and fast ) , timed-up- and -go , gait variability and the time to complete an obstacle course were completed before and after the single training session . Results Motor learning occurred in both the motor imagery training and physical training groups . Motor imagery training led to refinements in motor planning result ing in imagined movements better matching the physically performed movement at the end of training . Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up- and -go . There were no training effects on gait variability . Conclusion A single session of motor imagery training promoted motor learning of locomotion in independent older adults .  Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - OBJECTIVES To examine the effects of guided relaxation and imagery ( GRI ) on improvement in falls self-efficacy in older adults who report having a fear of falling . DESIGN R and omized , controlled trial with allocation to GRI or guided relaxation with music of choice . SETTING General community . PARTICIPANTS Ninety-one men and women aged 60 to 92 . INTERVENTION Participants were r and omized to listen to a GRI audio compact disk ( intervention group ) or a guided relaxation audio compact disk and music of choice ( control group ) twice a week for 6 weeks for 10 minutes per session . MEASUREMENTS Primary outcome measure was the Short Falls Efficacy Scale-International ( FES-I ) . Secondary outcome measures were the Leisure Time Exercise Question naire ( LTEQ ) and the Timed Up and Go ( TUG ) mobility test . RESULTS GRI participants reported greater improvements on the Short FES-I ( P = .002 ) and LTEQ ( P = .001 ) scores and shorter time on the TUG ( P = .002 ) than the guided relaxation and music-of-choice group . CONCLUSION GRI was more effective at increasing falls self-efficacy and self-reported leisure time exercise and reducing times on a simple mobility test than was guided relaxation with music of choice . GRI is an effective , simple , low-cost tool for older adults to improve falls self-efficacy and leisure time exercise behaviors OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved OBJECTIVE To evaluate the effects of 24-weeks of strength training on stable ( ST ) and unstable surfaces ( UST ) on the functional mobility , balance and concern about falling in healthy older adults , younger than 70 . DESIGN A single-center , r and omized clinical trial . PARTICIPANTS Sixty-four older adults ( 58 females and 6 males ; 68 years ) were r and omized into control , ST or UST groups . INTERVENTIONS Both ST and UST intervention groups received a core muscles , upper and lower limbs , moderate-intensity strength exercises using stable and unstable surfaces . The classes were performed three times per week over a 24-week period . The control group did not receive any type of active intervention . MEASUREMENTS The primary outcomes measure were the dynamic balance ( Berg Balance Scale ( BBS ) ) and functional mobility ( timed up and go test ( TUG ) ) . The secondary outcomes included the sitting and rising test ( SRT ) and Falls Efficacy Scale International ( FESI ) scores . RESULTS There was a significant improvement in balance performance ( BBS= + 4 points ) after 24-weeks of both ST ( + 1.22 ; 95 % CI- .19 to 2.63 ) and UST ( + 2.26 ; 95 % CI , .83 to 3.70 ) compared with the control group . Additionally , compared with the control , only UST experienced functional mobility gains ( TUG= -2.44 ; 95 % CI , -4.41 to - .48 ; SRT= + 1.12 ; 95 % CI , .08 to 2.17 ) and decreased concern about falling ( FESI= -4.41 ; 95 % CI , -9.30 to -.27 ) . CONCLUSION Long-term ST with and without unstable devices were effective to improve dynamic balance in older adults . Furthermore , the effects of UST were extended to functional mobility gains , and reduced concern about falling . This article is protected by copyright . All rights reserved OBJECTIVE The objective of this study was to compare the effects of action observation training and motor imagery training on recovery from  chronic stroke .  METHODS Thirty patients who were more than six months post stroke participated in this study and were r and omly allocated to three groups . The action observation training group practice d additional action observation training for five 30-minute sessions over a four-week period . The motor imagery training group practice d additional motor imagery training for five 30-minute sessions over a four-week period . The following clinical measures were used for assessment of dynamic balance and gait abilities : Timed Up and Go Test , Functional Reaching Test , Walking Ability Question naire , and Functional Ambulation Category . Spatiotemporal gait parameters were also collected using a GAITRite system . RESULT Compared with the physical training group , the action observation training group showed significant improvement in the Timed Up and Go test , gait speed , cadence , and single limb support of the affected side . No significant differences in any of the outcome measures were observed between the action observation training group and the motor imagery training group . CONCLUSION Action observation training and motor imagery training results in improvement of dynamic balance and gait ability . These results suggest the feasibility and suitability of action observation training for patients with chronic stroke Background and aims : Though previous research has shown that Tai Chi reduces falls risk in older adults , no studies have examined underlying neural mechanisms responsible for balance improvement . We aim ed to determine the efficacy of Tai Chi training in improving neuromuscular response characteristics underlying balance control in balance-impaired older adults . Methods : Twenty-two balance-impaired older adults were r and omly divided into Tai Chi ( TC ) or control groups .  Nineteen subjects ( age 68–92 , BERG 44 or less ) completed the study .  TC training included repetitive exercises using TC motor and biomechanical strategies , techniques , and postural elements . Control training included axial mobility exercises , balance/awareness education and stress reduction . Groups trained 1.5 hours/day , 5 days/week for 3 weeks . After post-testing the control group received TC training . Subjects walked across a force plate triggered to move forward 15 cm at 40 cm/sec at heel strike . Tibialis anterior ( TA ) and medial gastrocnemius ( GA ) responses during balance recovery were measured with electromyograms ( EMGs ) . Four clinical measures of balance were also recorded . Results : TC subjects , but not controls , significantly reduced both TA response time from 148.92±45.11 ms to 98.67±17.22 ms ( p≤0.004 ) and occurrence of co-contraction of antagonist muscles ( p≤0.003 ) of the perturbed leg . Clinical balance measures also significantly improved after TC . Conclusions : TC enhanced neuromuscular responses controlling the ankle pint of the perturbed leg . Fast , accurate neuromuscular activation is crucial for efficacious response to slips or trips For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients BACKGROUND Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes
Motor imagery training improves balance and mobility in older adults who do not have a neurological condition .
These results suggest that motor imagery training could be an adjunct to st and ard physiotherapy care in older adults , although it is unclear whether or not the effects are clinical ly worthwhile .
QUESTION Does motor imagery training improve measures of balance , mobility and falls in older adults without a neurological condition ?