For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.
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Investigating Relationships between Balance Confidence and Balance Ability in Older Adults
Increasing balance confidence in older individuals is important towards improving their quality of life and reducing activity avoidance. Here, we investigated if balance confidence (perceived ability) and balance performance (ability) in older adults were related to one another and would improve after balance training. The relationship of balance confidence in conjunction with balance performance for varied conditions (such as limiting vision, modifying somatosensory cues, and also base of support) was explored. We sought to determine if balance confidence and ability, as well as their relationship, could change after several weeks of training. Twenty-seven healthy participants were trained for several weeks during standing and walking exercises. In addition, seven participants with a higher risk of imbalance leading to falls (survivors of stroke) were also trained. Prior to and after training, balance ability and confidence were assessed via the Balance Error Scoring System (BESS) and Activities Specific Balance Confidence (ABC) Scale, respectively. Both groups showed improvements in balance abilities (i.e., BESS errors significantly decreased after training). Balance confidence was significantly higher in the healthy group than in the stroke group; however, ABC results reflected that balance confidence did not significantly increase after training for each. The correlations between balance ability and balance confidence were explored. Encouragingly, healthy participants displayed a negative correlation between BESS errors and ABC (i.e., enhancements in balance confidence (increases in ABC Scale results) were related to improvements in balance ability (decreases in BESS errors)). For the stroke participants, despite improvements in balance ability, our results showed that there was no relation to balance confidence (i.e., no correlation between BESS errors and ABC) in this group.
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- NSF-PAR ID:
- 10315734
- Editor(s):
- Mulherkar, Shalaka
- Date Published:
- Journal Name:
- Journal of Aging Research
- Volume:
- 2021
- ISSN:
- 2090-2204
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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null (Ed.)With the massive growth of the aging population worldwide, of utmost importance is reducing falls. Critical to reducing fall risk is one's ability to weight incoming sensory information towards maintaining balance. The purpose of this research was to investigate if simple, targeted sensory training on aging individuals (50 - 80 years old), including twelve healthy and eight individuals with chronic stroke, could improve their balance. Repeated sensory training targeted visual (via eyes-open/closed) and somatosensory inputs (via light touch to the fingertip as well as hard, soft foam, and hard foam support surfaces to the feet) during standing and dynamic base-of-support (BOS) exercises. Study participants underwent six weeks of training. Prior to and post training, standing balance was assessed via a simple, clinical measure: the balance error scoring system (BESS). Following several weeks of training, participants showed significant improvements in BESS errors: healthy participants for small BOS with limited somatosensory information (i.e., tandem and single-leg standing on foam) and participants with stroke in all conditions.Clinical Relevance- This research study demonstrated that simple, accessible exercises, can positively impact balance in the aging population, a pressing need.more » « less
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The purpose of this study was to investigate the effects of utilizing sensory (i.e., vision and touch), as well as static and dynamic base of support training on the balance of senior participants aged 60–80 years old. For each participant, there were several weeks of training, two sessions per week and assessments every two weeks. Training included walking and standing exercises on a hard surface, compliant and stiffer foam walking and standing balance training, and navigating obstacles. Within each session, to modify vision, all training included eyes-open and closed. Further, there were increases in training difficulty as the sessions progressed.
It was observed that training over several weeks resulted in increases in stability, as observed by the decreases in Balance Error Scoring System (BESS) assessment results. However, increases in balance confidence, as observed by the Activities-Specific Balance Confidence (ABC) scale were less certain in this healthy elderly (or senior) population. It is an interesting and positive finding that, in doing relatively simple, but targeted exercises and training, senior individuals can have moderate improvements in their balance and, perhaps ultimately, reduce their fall-risk.
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Quantitative assessment of movement using motion capture provides insights on mobility which are not evident from clinical evaluation. Here, in older individuals that were healthy or had suffered a stroke, we aimed to investigate their balance in terms of changes in body kinematics and muscle activity. Our research question involved determining the effects on post- compared to pre-sensorimotor training exercises on maintaining or improving balance. Our research hypothesis was that training would improve the gait and balance by increasing joint angles and extensor muscle activities in lower extremities and spatiotemporal measures of stroke and elderly people. This manuscript describes a motion capture-based evaluation protocol to assess joint angles and spatiotemporal parameters (cadence, step length and walking speed), as well as major extensor and flexor muscle activities. We also conducted a case study on a healthy older participant (male, age, 65) and an older participant with chronic stroke (female, age, 55). Both participants performed a walking task along a path with a rectangular shape which included tandem walking forward, right side stepping, tandem walking backward, left side stepping to the starting location. For the stroke participant, the training improved the task completion time by 19 s. Her impaired left leg had improved step length (by 0.197 m) and cadence (by 10 steps/min) when walking forward, and cadence (by 12 steps/min) when walking backward. The non-impaired right leg improved cadence when walking forward (by 15 steps/min) and backward (by 27 steps/min). The joint range of motion (ROM) did not change in most cases. However, the ROM of the hip joint increased significantly by 5.8 degrees (p = 0.019) on the left leg side whereas the ROMs of hip joint and knee joint increased significantly by 4.1 degrees (p = 0.046) and 8.1 degrees (p = 0.007) on the right leg side during backward walking. For the healthy participant, the significant changes were only found in his right knee joint ROM having increased by 4.2 degrees (p = 0.031) and in his left ankle joint ROM having increased by 5.5 degrees (p = 0.006) during the left side stepping.more » « less
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Abstract Introduction Split-belt treadmill training has been used to assist with gait rehabilitation following stroke. This method modifies a patient’s step length asymmetry by adjusting left and right tread speeds individually during training. However, current split-belt training approaches pay little attention to the individuality of patients by applying set tread speed ratios (e.g., 2:1 or 3:1). This generalization results in unpredictable step length adjustments between the legs. To customize the training, this study explores the capabilities of a live feedback system that modulates split-belt tread speeds based on real-time step length asymmetry. Materials and methods Fourteen healthy individuals participated in two 1.5-h gait training sessions scheduled 1 week apart. They were asked to walk on the Computer Assisted Rehabilitation Environment (CAREN) split-belt treadmill system with a boot on one foot to impose asymmetrical gait patterns. Each training session consisted of a 3-min baseline, 10-min baseline with boot, 10-min feedback with boot (6% asymmetry exaggeration in the first session and personalized in the second), 5-min post feedback with boot, and 3-min post feedback without boot. A proportional-integral (PI) controller was used to maintain a specified step-length asymmetry by changing the tread speed ratios during the 10-min feedback period. After the first session, a linear model between baseline asymmetry exaggeration and post-intervention asymmetry improvement was utilized to develop a relationship between target exaggeration and target post-intervention asymmetry. In the second session, this model predicted a necessary target asymmetry exaggeration to replace the original 6%. This prediction was intended to result in a highly symmetric post-intervention step length. Results and discussion Eleven out of 14 participants (78.6%) developed a successful relationship between asymmetry exaggeration and decreased asymmetry in the post-intervention period of the first session. Seven out of the 11 participants (63.6%) in this successful correlation group had second session post-intervention asymmetries of < 3.5%. Conclusions The use of a PI controller to modulate split-belt tread speeds demonstrated itself to be a viable method for individualizing split-belt treadmill training.more » « less
- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1155/2021/3214366
