Learning to Resist Gait-Slip Falls: Long-Term Retention in Community-Dwelling Older Adults

Bhatt T, Yang F, Pai Y-C. Learning to resist gait-slip falls: long-term retention in community-dwelling older adults. Arch Phys Med Rehabil 2012;93:557-64. Objectives: To determine whether the fall-resisting skills acquired from a single perturbation training session can be retained for 6 months or enhanced by an intermediate ancillary session. Design: A randomized controlled trial. Setting: Biomechanics research laboratory. Participants: Community-dwelling elderly (N=48; age, >65y). Interventions: Initial perturbation training applied to all subjects using low-friction platforms to induce unannounced blocks of repeated right-side slips, interspersed with nonslips. The single-session group retested with only I slip 6 months later. The dual-session group received an additional slip at 3 months after the initial session, followed by a retest of slips at 6 months. Main Outcome Measures: Slip outcome (incidence of falls and balance loss), dynamic stability (based on the center-of-mass position and velocity), and vertical limb support (based on hip height). Results: Subjects in both groups significantly reduced fall and balance loss incidence from first to last training slips, which resulted from improved stability and limb support control. Both groups demonstrated significant retention in all outcome measures at 6 months compared with the first novel slip, although performance decay was evident in comparison with the last training slip. The ancillary slip at 3 months led to significantly better control of stability and, hence, reduced balance loss outcome, in the dual-session group at 6 months than in the single-session group. Conclusions: Motor memory could be retained for 6 months or longer after a single session of fall-resistance training, although a single booster slip could further impede its decay. Through the experience of slipping and falling, it may be possible to inoculate older adults against potentially life-threatening falls.