Does Perturbation-Based Balance Training Prevent Falls?
This article was reviewed by Linnet C, MSPT.
Physiological impairments associated with neurological conditions (eg, stroke, Parkinson disease) and the “normal” aging process can contribute to impaired balance control and increased fall risk.
Falls can have direct negative consequences (ie, injuries) but also can result in fear and anxiety, reduced independent mobility, and increased risk of admission to long-term care facilities. Previous work has generally shown that physical exercise focused on balance training can prevent falls [1–5]; however, there is limited or no evidence for reduced falls following balance training in some cases (eg, for people with stroke [6,7]). It is possible that more speciﬁc exercise, focused on the mechanism of occurrence of falls, might be more effective for falls prevention.
Although many factors contribute to increased risk for falls, a speciﬁc fall event ultimately occurs when an individual fails to recover from a loss of balance or postural perturbation. Postural perturbations can occur in daily life for a variety of reasons, including failure to control weight shifting during voluntary movement or experiencing a slip or trip while walking.9 Balance recovery reactions, such as swaying around the ankles or hips, taking a step, or grasping a handhold, are executed rapidly to prevent a fall following a postural perturbation. Individuals with impaired balance control and increased fall risk often show difﬁculty controlling these balance recovery reactions.[11–13] Because all ambulatory individuals are at risk for experiencing a loss of balance during daily life, training to improve control of balance recovery reactions may be an effective means of preventing falls.[14–16] Perturbation-based balance training (PBT) is a novel balance training intervention that incorporates exposure to repeated postural perturbations to evoke rapid balance reactions, enabling the individual to improve control of these reactions with practice. The alternative—training voluntary movements (eg, volitionally executed stepping or reach to-grasp movements)—will likely not lead to improved reactive balance control due to the additional speed and stability requirements of balance reactions.
Studies have shown that PBT can improve speed and control of voluntary movements  and rapid balance reactions [18–20] and can reduce occurrence of “falls” (into a safety harness) following controlled postural perturbations in the laboratory.[18,20,21] However, the effect of PBT on risk of falls during daily life has not been conclusively demonstrated. Several studies with small sample sizes have shown nonsigniﬁcant reductions in fall rates in the trained group compared with a control group.[22,23]
Therefore, the purpose of this study was to estimate the effect of PBT on risk of falls in daily life among individuals at increased risk for falls (ie, older adults and individuals with neurological conditions) by conducting a comprehensive search for, and metaanalysis of, published and unpublished data from randomized controlled trials of PBT.
Conclusions. Perturbation-based balance training appears to reduce fall risk among older adults and individuals with Parkinson disease.