Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance. Effects of balance training in elderly evaluated by clinical tests and dynamic posturography. Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial Short-term effectiveness of vestibular rehabilitation in elderly patients with postural instability: a randomized clinical trial Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. Motor imagery training improves precision of an upper limb movement in patients with hemiparesis. A randomised controlled trial investigating motor skill training as a function of attentional focus in old age Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults – A Randomized Controlled Trial Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Motor imagery training improves upper extremity performance in stroke patients Effect of virtual reality-based balance training in multiple sclerosis Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Impact of the combination of cognitive and balance training on gait, fear and risk of falling and quality of life in seniors with mild cognitive impairment. A multimodal training modulates short-afferent inhibition and improves complex walking in a cohort of faller older adults with an increased prevalence of Parkinson's disease.
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 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 The effects of st and ing balance training on the ability to maintain stability in both static two-leg and one-leg stance were tested in healthy older adults . METHODS Subjects ( age range 65 - 90 years ) were r and omly assigned to a  training ( n = 12 ) or  control group ( n = 12 ) . Training subjects received a 10-hour balance training program which selectively manipulated sensory inputs from the visual , vestibular , and somatosensory systems . RESULTS Training subjects showed significantly improved stability ( root-mean-square values of anteroposterior platform torque ) after training in five of the eight training conditions ( when somatosensory inputs were changed or when two or more sensory systems were simultaneously manipulated ) ( p < .006 ) . When tested 4 weeks after completion of training , subjects ( a ) fell less frequently when the ankle/foot somatosensory inputs were minimized and ( b ) stood longer on one leg than the control group ( p < .001 ) . CONCLUSIONS Balance training design ed to improve intersensory interaction could effectively improve balance performance in healthy older adults All persons aged 70 through 75 years ( N = 457 ) in a Swedish community were invited to participate in a 9 week balance training study . Out of 55 interested subjects , 15 were chosen at r and om for a study group ; 15 matched controls were also selected . Before and after the investigation period the balance function was assessed by clinical balance tests and dynamic posturography . In the clinical balance tests , the training group significantly improved their balance st and ing on one leg with eyes closed as well as st and ing on one leg while shaking the head ; they also walked 15 m back and forth faster . In the dynamic  posturography  the training group significantly improved their equilibrium scores in the 3 most difficult test conditions . The results of the control group were unchanged except for one test condition in the dynamic posturography . The differences in one-leg st and ing with head shaking , walking 2 x 15 m , and the equilibrium score using sway-referenced platform in dynamic posturography were proved to be attributable to the training . The first investigation in all 29 subjects formed normative dynamic posturography data for the age group 70 through 75 years . The normative posturographic data of this age group differed from previously obtained data in the age groups 20 through 59 and 60 through 69 years . It is concluded that elderly may improve their balance by regular balance training exercises for as short a period as 9 weeks . This might prove to be of great value in improving balance and thereby preventing accidental falls and subsequent fractures in elderly 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 Balance becomes more precarious with age , and even without pathological disorders , the physiological decline in balance that occurs with age is a factor that also favors falls . So the aim of the present study is to assess the short-term effectiveness of three different methods of vestibular rehabilitation , compared to a control group , in improving balance in elderly patients with postural instability . 139 elderly patients with high risk of falls were included and r and omized to one of the following study arms : computer dynamic posturography ( CDP ) training , optokinetic stimulus , exercises at home , or control group . Patients were assessed with objective and subjective outcome measures . The individuals that trained using CDP improved significantly more than the control group on the average balance score ( p < 0.001 ) and reducing the number of falls in the sensorial organization test ( p < 0.001 ) . In addition , the analysis showed a statistically significant effect in the limits of stability only with the CDP training in comparison with the control group ( p < 0.001 ) . In our present study , supervised and customized exercises with CDP were more effective than the control group in the posturographic short-term assessment . An increased age did not affect the potential for improvement after training . So we conclude that elderly patients with high risk of falling should begin vestibular rehabilitation as soon as possible in order to avoid the potential harm of falls , mainly injuries and psychological consequences due to fear of falling again BACKGROUND Physical training to increase muscle strength and balance is considered useful for prevention of falls in older people . AIM This study compares conventional balance training with visual computer feedback training . DESIGN This was a r and omized controlled 12-week intervention trial with pre- and post-training evaluations . SETTING Out- patients referred to a geriatric falls and balance clinic . POPULATION Thirty-five patients were r and omized into two training groups . METHODS Both groups received progressive resistance muscle strength training and physical fitness training . Additionally , one group received traditional balance training and the other group received computer feedback balance training .  Strength , physical endurance , balance and falls efficacy scale scoring were assessed before and after end of training . RESULTS Twenty-seven patients ( 77 % ) were available for the evaluation ; mean compliance was 71 % . In the combined group , significant mean improvement was observed in knee extension ( 19 % ) , ankle dorsiflexion ( 16 % ) , sitting to st and ing ( 16 % ) , and in the six-minute walk test ( 8 % ) . In the traditional balance training group , the static balance in the Modified Clinical Test of Sensory Interaction and Balance st and ing on a foam mat with closed eyes showed a significant increase ( 80 % ) . No increase occurred in the computer balance training group . However , the computer feed-back training group showed a marked improvement that was up to 400 % in the training specific performance . CONCLUSION Elderly frail patients were able to increase muscle strength and physical endurance . A limited improvement was seen in the static balance tests . The computer feedback group showed a remarkable increase in training specific performance . Clinical Rehabilitation Impact BACKGROUND In healthy participants , beneficial effects of motor imagery training on movement execution have been shown for precision , strength , and speed . In the clinical context , it is still debated whether motor imagery provides an effective rehabilitation technique in patients with motor deficits . OBJECTIVE To compare the effectiveness of two different types of movement training : motor imagery vs. motor execution . METHODS Twenty-five patients with hemiparesis were assigned to one of two training groups : the imagery or the execution-training group . Both groups completed a baseline test before they received six training sessions , each of which was followed by a test session . Using a novel and precisely quantifiable test , we assessed how accurately patients performed an upper limb movement . RESULTS Both training groups improved performance over the six test sessions but the improvement was significantly larger in the imagery group . That is , the imagery group was able to perform more precise movements than the execution group after the sixth training session while there was no difference at the beginning of the training . CONCLUSIONS The results provide evidence for the benefit of motor imagery training in patients with hemiparesis and thus suggest the integration of cognitive training in conventional physiotherapy practice Background Motor learning research has had little impact on clinical applications and rarely extended to research about how older adults learn motor skills . There is consistent evidence that motor skill performance and learning can be enhanced by giving learners instructions that direct their attention . The aim of this study was to test whether elderly individuals that receive an external focus instruction during training of dynamic balance skills would learn in a different manner compared to individuals that received an internal focus instruction . Methods This r and omised trial included 26 older persons ( 81 ± 6 years ) that were training functional balance twice a week for the duration of 5 weeks .  Learning outcomes were recorded after every training session . Weight shifting score and dynamic balance parameters ( Biodex Balance System ) , components of the Extended Timed-Get-Up- and -Go test , five chair rises , and falls efficacy ( FES-I )  was assessed at baseline and post-intervention . Results Participation for training sessions was 94 % . No differences between groups were found following 5 weeks of training for weight shifting score , dynamic balance index and dynamic balance time ( p < 0.95 , p = 0.16 , p < 0.50 ) , implying no learning differences between training groups . Extended Timed-Get-Up- and -Go components Sit-to-st and , p = .036 ; Gait initiation , p = .039 ; Slow down , stop , turnaround , and sit down , p = 0.011 and the Fes-I ( p = 0.014 ) showed improvements for the total group , indicating that function improved compared to baseline . Conclusion A 5-week balance training improved weight shifting scores and dynamic balance parameters as well as functional abilities . The observed improvements were independent from the type of attentional focus instructions . The findings provide support for the proposition of different motor learning principles in older adults compared to younger adults . Trial Registration IS RCT Purpose Interactive cognitive-motor training ( ICMT ) requires individuals to perform both gross motor movements and complex information processing . This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults . Methods A single-blinded r and omized controlled trial was conducted in community-dwelling older adults ( N = 90 , mean age 81.5±7 ) without major cognitive impairment . Participants in the intervention group ( IG ) played four stepping games that required them to divide attention , inhibit irrelevant stimuli , switch between tasks , rotate objects and make rapid decisions . The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home . Participants in the control group ( CG ) received an evidence -based brochure on fall prevention .  Measures of processing speed , attention/executive function ( EF ) , visuo-spatial ability , concerns about falling and depression were assessed before and after the intervention . Results Eighty-one participants ( 90 % ) attended re- assessment . There were no improvements with respect to the Stroop Stepping Test ( primary outcome ) in the intervention group . Compared to the CG , the IG improved significantly in measures of processing speed , visuo-spatial ability and concern about falling . Significant interactions were observed for measures of EF and divided attention , indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance . The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline . Additionally , low and high-adherer groups differed in their baseline performance and responded differently to the intervention . Compared to high adherers , low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF . Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people . Low adherers improved in less complex functions while high-adherers improved in EF . Trial Registration Australian New Zeal and Clinical Trials Registry BACKGROUND AND PURPOSE Visual biofeedback/forceplate systems are often used for treatment of balance disorders . In this study , the research ers investigated whether the addition of visual biofeedback/forceplate training could enhance the effects of other physical therapy interventions on balance and mobility following stroke . SUBJECTS The study included a sample of convenience of 13 out patients with hemiplegia who ranged in age from 30 to 77 years ( mean=60.4 , SD=15.4 ) and were 15 to 538 days poststroke . METHODS Subjects were assigned r and omly to either an experimental group or a control group when the study began , and their cognitive and visual-perceptual skills were tested by a psychologist . Subjects were also assessed using the Berg Balance Scale and the Timed " Up & Go " Test before and after 4 weeks of physical therapy . Both groups received physical therapy interventions design ed to improve balance and mobility 2 to 3 times per week . The experimental group trained on the NeuroCom Balance Master for 15 minutes of each 50-minute treatment session . The control group received other physical therapy for 50 minutes . RESULTS Following intervention , both groups scored higher on the Berg Balance Scale and required less time to perform the Timed " Up & Go " Test . These improvements corresponded to increased independence of balance and mobility in the study population . However , a comparison of mean changes revealed no differences between groups . DISCUSSION AND CONCLUSION Although both groups demonstrated improvement following 4 weeks of physical therapy interventions , no additional effects were found in the group that received visual biofeedback/forceplate training combined with other physical therapy [ Purpose ] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients . [ Subjects and Methods ] Twenty-four patients were r and omly assigned to one of the following two groups : motor imagery ( n = 12 ) or control ( n = 12 ) . Over the course of 4 weeks , the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks ( 9 hours total ) related to their daily living activities . After the 4-week intervention period , the Fugl-Meyer Assessment -Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared . [ Results ] The post-test score of the motor imagery group on the Fugl-Meyer Assessment -Upper Extremity outcomes was significantly higher than that of the control group . In particular , the shoulder and wrist sub-items demonstrated improvement in the motor imagery group . [ Conclusion ] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation . These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients Abstract Objectives : Balance and mobility impairments are common life-altering complications in patients with multiple sclerosis ( MS ) . In this study , we aim ed to investigate the efficacy of a short-term virtual reality (VR)-based balance training program on the balance ability of patients with MS . Methods : In this r and omized controlled trial , 30 patients with relapsing – remitting or secondary -progressive MS were r and omly assigned to an intervention or a control group . The intervention group performed a balance training program [ postural stability training program ( PST ) ] using the Biodex Balance System SD . Subjects in both groups were assessed using the manual muscle test ( MMT ) , timed ‘ up and go ’ ( TUG ) test , the modified Ashworth scale , the Romberg test , the Berg balance scale ( BBS ) , and the fall risk and postural stability tests , at baseline and after 12 weeks . Results : The TUG , fall risk index ( FRi ) , and overall stability index ( OSI ) were significantly improved in the intervention group after 24 sessions of balance training . The changes in TUG , Fri , and OSi indices in the intervention group were significantly higher than the control group . Discussion : According to the fall risk and postural stability tests results , the VR-based balance training program could improve the balance ability of the patients with MS Objectives : To investigate the effects of motor imagery training on the balance and gait abilities of post-stroke patients . Design : R and omized controlled trial . Setting : Outpatient rehabilitation centre . Subjects : Twenty-eight individuals with chronic stroke . Interventions : The experimental group ( n = 15 ) performed motor imagery training involving imagining normal gait movement for 15 minutes embedded in gait training for 30 minutes ( 45 minutes/day , 3 times/week ) ; the control group ( n = 13 ) performed gait training only ( 30 minutes/day , 3 times/week ) . Main measures : Balance and gait abilities were measured by the Functional Reach Test , Timed Up- and -Go Test , 10-m Walk Test and Fugl-Meyer assessment before and after interventions . Results : All measurements improved significantly compared with baseline values in the experimental group . In the control group , there were significant improvements in all parameters except the Fugl-Meyer assessment . All parameters of the experimental group increased significantly compared to those of the control group as follows : Functional Reach Test ( control vs. experimental : 28.1 ± 3.1 vs. 37.51 ± 3.0 ) , Timed Up- and -Go Test ( 20.7 ± 4.0 vs. 13.2 ± 2.2 ) , 10-m Walk Test ( 17.4 ± 4.6 vs. 16.0 ± 2.7 ) and Fugl-Meyer assessment ( 12.0 ± 2.9 vs. 17.6 ± 1.3 ) . Conclusions : Gait training with motor imagery training improves the balance and gait abilities of chronic stroke patients significantly better than gait training alone Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls AIM To investigate the effect of specific cognitive training with CogniPlus and balance training , affecting cognitive functioning , gait speed , risk and fear of falling , and quality of life in an elderly cohort with mild cognitive impairment . METHODS The research sample was composed of 80 older adults with a mild cognitive deficit ( mean age 67.07 years ) divided into the experimental group ( n = 40 ) and control group ( n = 40 ) . This was a r and omized , controlled trial . The experimental group carried out selected exercises from the CogniPlus program combined with balance training . Patients participated in 20 sessions twice per week in an outpatient clinic . Both groups completed 30 min of balance training daily for 10 weeks . Cognitive functions were evaluated by the Mini-Mental State Examination . The fear of falling was assessed by Falls Efficacy Scale-I. The static and dynamic aspects of balance were assessed by the Tinetti test and functional stretching . Gait speed was assessed by four forms of the Timed Up & Go test . Quality of life was investigated according to Spitzer . RESULTS The two groups showed significant differences recorded after training in the Mini-Mental State Examination , Up and Go test with dual tasking , balance by Tinetti test and the quality of life in favor of the experimental group ( P < 0.03 - 0.0001 ) . There were no significant differences found between the groups in the assessment of fear of falling and other monitored parameters . CONCLUSIONS The combination of selected exercises from the CogniPlus program with balance training contributed to achieving better results than balance training alone for elderly people with mild cognitive impairment . Geriatr Gerontol Int 2016 ; 16 : 1043 - 1050 BACKGROUND Falls are frequent in Parkinson 's disease and ageing . Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk , especially when obstacles challenge gait . Interventions combining motor-cognitive approaches have been shown to improve motor performance , cognitive skills and falls number . Here , we hypothesized that an intervention simulating an attention-dem and ing walking condition could impact not only complex gait performance and fall risk but also short-latency afferent inhibition ( SAI ) , as a marker of cholinergic activity . METHODS Thirty-nine participants at falls risk ( 24 Parkinson 's disease subjects and 15 older adults ) were recruited in a r and omized controlled trial . Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained 3 times a week for 6 weeks . SAI , a transcranial magnetic stimulation paradigm , was used to assess cholinergic activity . Gait kinematics was measured during usual walking and while negotiating physical obstacles . Transcranial magnetic stimulation and gait assessment s were performed pre , post , and 6 months post intervention . RESULTS Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability , improved obstacle negotiation performance and induced a reduction of the number of falls compared to treadmill training . Furthermore , the more SAI increased after training , the more the obstacle negotiation performance improved and fall rate decreased
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 ?