Inoculation Against Falls: Rapid Adaptation by Young and Older Adults to Slips During Daily Activities

Pai Y-C, Bhatt T, Wang E, Espy D, Pavol MJ. Inoculation against falls: rapid adaptation by young and older adults to slips during daily activities. Arch Phys Med Rehabil 2010;91:452-9. Objective: To determine whether aging diminishes one's ability to rapidly learn to resist falls on repeated-slip exposure across different activities of daily living. Design: Quasi-experimental controlled trial. Setting: Two university-based research laboratories. Participants: Young (n=35) and older (n=38) adults underwent slips during walking. Young (n=60) and older (n=41) adults underwent slips during a sit-to-stand task. All (N=174) were healthy and community dwelling. Intervention: Low-friction platforms induced unannounced blocks of 2 to 8 repeated slips interspersed with blocks of 3 to 5 nonslip trials during the designated task. Main Outcome Measures: The incidence of falls and balance loss. Dynamic stability (based on center of mass position and velocity) and limb support (based on hip height) 300ms after slip onset. Results: Under strictly controlled, identical low-friction conditions, all participants experienced balance loss, but older adults were over twice as likely as young to fall on the first, unannounced, novel slip in both tasks. Independent of age or task, participants adapted to avoid falls and balance loss, with most adaptation occurring in early trials. By the fifth slip, the incidence of falls and balance loss was less than 5% and 15%, respectively, regardless of age or task. Reductions in falls and balance loss for each task were accomplished through improved control of stability and limb support in both age groups. A rapidly reversible age- and task-dependent waning of motor learning occurred after a block of nonslip trials. Adaptation to walk slips reached a steady state in the second slip block regardless of age. Conclusions: The ability to rapidly acquire fall-resisting skills on repeated-slip exposure remains largely intact at older ages and across functional activities. Thus, repeated-slip exposure might be broadly effective in inoculating older adults against falls.