V-TIME: a treadmill training program augmented by virtual reality to decrease fall risk in older adults: study design of a randomized controlled trial Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. A Randomized Trial to Measure the Impact of a Community-Based Cognitive Training Intervention on Balance and Gait in Cognitively Intact Black Older Adults A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial The efficacy of a specific balance-strategy training programme for preventing falls among older people: a pilot randomised controlled trial. Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study Effect of guided relaxation and imagery on falls self-efficacy: a randomized controlled trial. Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Effect of 24 weeks strength training on unstable surfaces on mobility, balance and concern about falling in older adults. Action observation training for functional activities after stroke: a pilot randomized controlled trial. Neural mechanisms underlying balance improvement with short term Tai Chi training Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial Effects of a Sensory‐Motor Exercise Program for Older Adults With Osteoarthritis or Prosthesis of the Hip Using Measurements Made by the Posturomed Oscillatory Platform Effects of proprioception training with exercise imagery on balance ability of stroke patients Effects of a multimodal exercise program on balance, functional mobility and fall risk in older adults with cognitive impairment: a randomized controlled single-blind study. Motor imagery training improves upper extremity performance in stroke patients A randomised controlled trial investigating motor skill training as a function of attentional focus in old age
Background Recent work has demonstrated that fall risk can be attributed to cognitive as well as motor deficits . Indeed , everyday walking in complex environments utilizes executive function , dual tasking , planning and scanning , all while walking forward . Pilot studies suggest that a multi-modal intervention that combines treadmill training to target motor function and a virtual reality obstacle course to address the cognitive components of fall risk may be used to successfully address the motor-cognitive interactions that are fundamental for fall risk reduction . The proposed r and omized controlled trial will evaluate the effects of treadmill training augmented with virtual reality on fall risk . Methods / Design Three hundred older adults with a history of falls will be recruited to participate in this study . This will include older adults ( n=100 ) , patients with mild cognitive impairment ( n=100 ) , and patients with Parkinson ’s disease ( n=100 ) . These three sub-groups will be recruited in order to evaluate the effects of the intervention in people with a range of motor and cognitive deficits . Subjects will be r and omly assigned to the intervention group ( treadmill training with virtual reality ) or to the active-control group ( treadmill training without virtual reality ) . Each person will participate in a training program set in an outpatient setting 3 times per week for 6 weeks . Assessment s will take place before , after , and 1 month and 6 months after the completion of the training . A falls calendar will be kept by each participant for 6 months after completing the training to assess fall incidence ( i.e. , the number of falls , multiple falls and falls rate ) . In addition , we will measure gait under usual and dual task conditions , balance , community mobility , health related quality of life , user satisfaction and cognitive function . Discussion This r and omized controlled trial will demonstrate the extent to which an intervention that combines treadmill training augmented by virtual reality  reduces fall risk , improves mobility and enhances cognitive function in a diverse group of older adults . In addition , the comparison to an active control group that undergoes treadmill training without virtual reality will provide evidence as to the added value of addressing motor cognitive interactions as an integrated unit . Trial Registration This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults BACKGROUND AND PURPOSE This prospect i ve clinical investigation examined the effects of a multidimensional exercise program on balance , mobility , and risk for falls in community-dwelling older adults with a history of falling . Factors used to predict adherence and a successful response to exercise were identified . SUBJECTS A total of 105 community-dwelling older adults ( > or = 65 years of age ) with a history of two or more falls in the previous 6 months ( no neurologic diagnosis ) participated . They were classified into ( 1 ) a control group of fallers ( n = 21 ) , ( 2 ) a fully adherent exercise group ( n = 52 ) , and ( 3 ) a partially adherent exercise group ( n = 32 ) . METHODS Following evaluation , each patient received an individualized exercise program addressing the impairments and functional disabilities identified during the assessment . The control group received no intervention . Changes in performance on five clinical tests of balance and mobility and fall risk were compared among groups . RESULTS Both exercise groups scored better than the control group on all measures of balance and mobility . Although both exercise groups showed a reduction in fall risk compared with the control group , the greatest reduction was found in the fully adherent exercise group . Factors associated with successful response to exercise included degree of adherence to exercise program and pretest score on the Tinetti Mobility Assessment . CONCLUSION AND DISCUSSION Exercise can improve balance and mobility function and reduce the likelihood for falls among community-dwelling older adults with a history of falling . The amount of exercise needed to achieve these results , however , could not be determined from this study Introduction . Fall prevention is important for maintaining mobility and independence into old age . Approaches for reducing falls include exercise , tai chi , and home modifications ; however , causes of falling are multifactorial and include not just physical but cognitive factors . Cognitive decline occurs with age , but older adults with the greatest declines in executive function experience more falls . The purpose of this study was twofold : to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population . Method . This pilot study used a pretest/posttest r and omized trial design with assignment to an intervention or control group . Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks . Classes were held at senior/community centers . Primary outcomes included balance as measured by the Berg Balance Scale ( BBS ) , 10-meter gait speed , and 10-meter gait speed under visuospatial dual-task condition . All measures were assessed at baseline and immediately post-intervention . Results . Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls ( N = 45 ) . Compared to controls , intervention participants experienced statistically significant improvements in BBS and gait speed . Mean performance on distracted gait speed also improved more for intervention participants compared to controls . Conclusion . Findings from this pilot r and omized trial demonstrate the feasibility of a community-based cognitive training intervention . They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com BACKGROUND older people participate in exercise programmes to reduce the risk of falls but no study has investigated a specific balance strategy training intervention presented in a workstation format for small groups . OBJECTIVE to determine whether a specific balance strategy training programmeme delivered in a workstation format was superior to a community based exercise class programme for reducing falls . DESIGN a r and omised controlled trial model . SETTING Neurological Disorders , Ageing and Balance Clinic , Department of Physiotherapy , The University of Queensl and . SUBJECTS 73 males and females over 60 years , living independently in the community and who had fallen in the previous year were recruited . METHODS all subjects received a falls risk education booklet and completed an incident calendar for the duration of the study . Treatment sessions were once a week for 10 weeks . Subject assessment before and after intervention and at 3 months follow-up included number of falls , co-morbidities , medications , community services and activity level , functional motor ability , clinical and laboratory balance measures and fear of falling . RESULTS all participants significantly reduced the number of falls ( P < 0.000 ) . The specific balance strategy intervention group showed significantly more improvement in functional measures than the control group ( P = 0.034 ) . Separate group analyses indicated significantly improved performance in functional motor ability and most clinical balance measures for the balance group ( P < 0.04 ) . The control group only improved in TUG and TUGcog . CONCLUSIONS the results provide evidence that all participants achieved a significant reduction in falls .  Specific balance strategy training using workstations is superior to traditional exercise classes for improving function and balance 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 Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - OBJECTIVES To examine the effects of guided relaxation and imagery ( GRI ) on improvement in falls self-efficacy in older adults who report having a fear of falling . DESIGN R and omized , controlled trial with allocation to GRI or guided relaxation with music of choice . SETTING General community . PARTICIPANTS Ninety-one men and women aged 60 to 92 . INTERVENTION Participants were r and omized to listen to a GRI audio compact disk ( intervention group ) or a guided relaxation audio compact disk and music of choice ( control group ) twice a week for 6 weeks for 10 minutes per session . MEASUREMENTS Primary outcome measure was the Short Falls Efficacy Scale-International ( FES-I ) . Secondary outcome measures were the Leisure Time Exercise Question naire ( LTEQ ) and the Timed Up and Go ( TUG ) mobility test . RESULTS GRI participants reported greater improvements on the Short FES-I ( P = .002 ) and LTEQ ( P = .001 ) scores and shorter time on the TUG ( P = .002 ) than the guided relaxation and music-of-choice group . CONCLUSION GRI was more effective at increasing falls self-efficacy and self-reported leisure time exercise and reducing times on a simple mobility test than was guided relaxation with music of choice . GRI is an effective , simple , low-cost tool for older adults to improve falls self-efficacy and leisure time exercise behaviors 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 OBJECTIVE To evaluate the effects of 24-weeks of strength training on stable ( ST ) and unstable surfaces ( UST ) on the functional mobility , balance and concern about falling in healthy older adults , younger than 70 . DESIGN A single-center , r and omized clinical trial . PARTICIPANTS Sixty-four older adults ( 58 females and 6 males ; 68 years ) were r and omized into control , ST or UST groups . INTERVENTIONS Both ST and UST intervention groups received a core muscles , upper and lower limbs , moderate-intensity strength exercises using stable and unstable surfaces . The classes were performed three times per week over a 24-week period . The control group did not receive any type of active intervention . MEASUREMENTS The primary outcomes measure were the dynamic balance ( Berg Balance Scale ( BBS ) ) and functional mobility ( timed up and go test ( TUG ) ) . The secondary outcomes included the sitting and rising test ( SRT ) and Falls Efficacy Scale International ( FESI ) scores . RESULTS There was a significant improvement in balance performance ( BBS= + 4 points ) after 24-weeks of both ST ( + 1.22 ; 95 % CI- .19 to 2.63 ) and UST ( + 2.26 ; 95 % CI , .83 to 3.70 ) compared with the control group . Additionally , compared with the control , only UST experienced functional mobility gains ( TUG= -2.44 ; 95 % CI , -4.41 to - .48 ; SRT= + 1.12 ; 95 % CI , .08 to 2.17 ) and decreased concern about falling ( FESI= -4.41 ; 95 % CI , -9.30 to -.27 ) . CONCLUSION Long-term ST with and without unstable devices were effective to improve dynamic balance in older adults . Furthermore , the effects of UST were extended to functional mobility gains , and reduced concern about falling . This article is protected by copyright . All rights reserved OBJECTIVE The objective of this study was to compare the effects of action observation training and motor imagery training on recovery from  chronic stroke .  METHODS Thirty patients who were more than six months post stroke participated in this study and were r and omly allocated to three groups . The action observation training group practice d additional action observation training for five 30-minute sessions over a four-week period . The motor imagery training group practice d additional motor imagery training for five 30-minute sessions over a four-week period . The following clinical measures were used for assessment of dynamic balance and gait abilities : Timed Up and Go Test , Functional Reaching Test , Walking Ability Question naire , and Functional Ambulation Category . Spatiotemporal gait parameters were also collected using a GAITRite system . RESULT Compared with the physical training group , the action observation training group showed significant improvement in the Timed Up and Go test , gait speed , cadence , and single limb support of the affected side . No significant differences in any of the outcome measures were observed between the action observation training group and the motor imagery training group . CONCLUSION Action observation training and motor imagery training results in improvement of dynamic balance and gait ability . These results suggest the feasibility and suitability of action observation training for patients with chronic stroke Background and aims : Though previous research has shown that Tai Chi reduces falls risk in older adults , no studies have examined underlying neural mechanisms responsible for balance improvement . We aim ed to determine the efficacy of Tai Chi training in improving neuromuscular response characteristics underlying balance control in balance-impaired older adults . Methods : Twenty-two balance-impaired older adults were r and omly divided into Tai Chi ( TC ) or control groups .  Nineteen subjects ( age 68–92 , BERG 44 or less ) completed the study .  TC training included repetitive exercises using TC motor and biomechanical strategies , techniques , and postural elements . Control training included axial mobility exercises , balance/awareness education and stress reduction . Groups trained 1.5 hours/day , 5 days/week for 3 weeks . After post-testing the control group received TC training . Subjects walked across a force plate triggered to move forward 15 cm at 40 cm/sec at heel strike . Tibialis anterior ( TA ) and medial gastrocnemius ( GA ) responses during balance recovery were measured with electromyograms ( EMGs ) . Four clinical measures of balance were also recorded . Results : TC subjects , but not controls , significantly reduced both TA response time from 148.92±45.11 ms to 98.67±17.22 ms ( p≤0.004 ) and occurrence of co-contraction of antagonist muscles ( p≤0.003 ) of the perturbed leg . Clinical balance measures also significantly improved after TC . Conclusions : TC enhanced neuromuscular responses controlling the ankle pint of the perturbed leg . Fast , accurate neuromuscular activation is crucial for efficacious response to slips or trips 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 Falls and fall-related injuries are a major public health concern , a financial challenge for health care providers , and critical issues for older adults . Poor balance and limited mobility are major risk factors for falls . OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance , mobility , and balance confidence in older adults . METHODS Participants ( N = 47 , mean age 75.6 ) were r and omly assigned to a Feldenkrais group ( FG , n = 25 ) or to a control group ( CG , n = 22 ) . The FG group attended a 5-week Feldenkrais program , 60 minutes three times per week , while the CG group was a waitlist control . The outcome measures were balance ( t and em stance ) , mobility ( Timed Up and Go ) , gait characteristics ( GAITRite Walkway System ) , balance confidence ( Balance Confidence Scale ; ABC ) , and fear of falling ( Falls Efficacy Scale ) . Pre- and post-tests were conducted . RESULTS After completion of the program , balance ( p = 0.030 ) and mobility ( p = 0.042 ) increased while fear of falling ( p = 0.042 ) decreased significantly for the FG group . No other significant changes were observed . However , participants of the FG group showed improvements in balance confidence ( p = 0.054 ) and mobility while performing concurrently a cognitive task ( p = 0.067 ) . CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility , and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults . A long-term follow-up study of balance and mobility is warranted . Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults OBJECTIVES To primarily ascertain the effect of the Otago Exercise Program ( OEP ) on physiological falls risk , functional mobility , and executive functioning after 6 months in older adults with a recent history of falls and to ascertain the effect of the OEP on falls during a 1-year follow-up period . DESIGN R and omized controlled trial . SETTING Dedicated falls clinics . PARTICIPANTS Seventy-four adults aged 70 and older who presented to a healthcare professional after a fall . INTERVENTION The OEP , a home-based program that consists of resistance training and balance training exercises . MEASUREMENTS Physiological falls risk was assessed using the Physiological Profile Assessment . Functional mobility was assessed using the Timed Up and Go Test . Three central executive functions were assessed : set shifting , using the Trail Making Test Part B ; updating , using the verbal digits backward test ; and response inhibition , using the Stroop Color-Word Test . Falls were prospect ively monitored using daily calendars . RESULTS At 6 months , there was no significant between-group difference in physiological falls risk or functional mobility ( P > or= .33 ) . There was a significant between-group difference in response inhibition ( P=.05 ) . A falls histogram revealed two outliers . With these cases removed , using negative binomial regression , the unadjusted incidence rate ratio of falls in the OEP group compared with the control group was 0.56 . The adjusted incidence rate ratio was 0.47 . CONCLUSION The OEP may reduce falls by improving cognitive performance Objective : To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy , fear of falling , gait and balance performance , and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects . Design : R and omized controlled trial , including three groups : two intervention groups ( Training , or Training+Physical activity ) and one Control group , with a 12-week follow-up . Setting : Stockholm County , Sweden . Participants : Ninety-six older adults , aged 66 - 87 , with verified osteoporosis . Interventions : A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks , and physical activity for 30 minutes , three times/week . Main measures : Fall-related self-efficacy ( Falls Efficacy Scale-International ) , fear of falling ( single-item question – ‘ In general , are you afraid of falling ? ’ ) , gait speed with and without a cognitive dual-task at preferred pace and fast walking ( GAITRite ® ) , balance performance tests ( one-leg stance , and modified figure of eight ) , and physical function ( Late-Life Function and Disability Instrument ) . Results : Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034 , 4 points ) and improved their balance performance . Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003 ) , at fast walking speed ( p=0.008 ) , and for advanced lower extremity physical function ( p=0.034 ) . Conclusions : This balance training program , including dual- and multi-task , improves fall-related self-efficacy , gait speed , balance performance , and physical function in older adults with osteoporosis Objectives To assess changes in balance capacities after a 12-week sensory-motor training program for older adults with osteoarthritis or prosthesis of the hip . Background Sensory-motor training is recommended to help aging adults with osteoarthritis maintain activity , avoid injurious falls , and improve functioning . Up to now , however , there has been no st and ard training protocol for sensory-motor training . Methods and Measures Thirty-five participants in a hip exercise group who had a mean age of 58 years ( SD 12 ) were quasi-r and omized into a training group ( TG ) and a control group ( CG ) by the month they applied for the Hip School program . The TG performed balance exercises using balance pads and received Hip School training once a week . The CG did not receive any training intervention .  Balance was measured by recording center-of-pressure excursion while participants were in 1-legged stance on the oscillatory Posturomed platform . Outcome measures were the total path of center of pressure on the platform during balance recovery and the percentage of failed attempts . Results The TG had a lower percentage of failed attempts ( TG 5 % , CG 18 % , P = .001 ) and required fewer balance recovery movements to maintain balance ( TG : mean [ SD ] measurement is 59 [ 36 ] mm ; CG : 96 [ 68 ] mm , P = .036 ] after completing the 12-week training program . After the training period , participants in the TG compensated better for perturbations in the nondisplaced medial-lateral ( ML ) direction ( pretest [ SD ] measurement was 48 [ 18 ] mm ; posttest , 36 [ 14 ] mm ; P = .001 ] . Conclusions Participants could successfully cope with more disturbances and improved their reactions to sudden displacements after training intervention . This exercise setting improves balance abilities and should be included in Hip School programs for patients with osteoarthritis [ Purpose ] The purpose of the present study was to examine and compare the effects of proprioceptive training accompanied by motor imagery training and general proprioceptive training on the balance of stroke patients . [ Subjects and Methods ] Thirty-six stroke patients were r and omly assigned to either an experimental group of 18 patients or a control group of 18 patients . The experimental group was given motor imagery training for 5 minutes and proprioceptive training for 25 minutes , while the control group was given proprioceptive training for 30 minutes . Each session and training program was implemented 5 times a week for 8 weeks . The Korean version of the Berg Balance Scale ( K-BBS ) , Timed Up and Go test ( TUG ) , weight bearing ratio ( AFA-50 , Alfoots , Republic of Korea ) , and joint position sense error ( Dualer IQ Inclinometer , JTECH Medical , USA ) were measured . [ Results ] Both groups showed improvements in K-BBS , TUG , weight bearing ratio , and joint position sense error . The measures of the experimental group showed greater improvement than the control group . [ Conclusion ] Motor imagery training , which is not subject to time restrictions , is not very risky and can be used as an effective treatment method for improving the balance ability of stroke patients BACKGROUND Exercise programs have important role in prevention of falls , but to date , there are conflicting findings about the effects of exercise programs on balance , functional performance and fall risk among cognitively impaired older adults . AIM . To investigate the effects of a multimodal exercise program on static and dynamic balance , and risk of falls in older adults with mild or moderate cognitive impairment . DESIGN A r and omized controlled study . SETTING A long-term care institute . POPULATION Cognitively impaired individuals aged over 60 years . METHODS Eighty-six participants were r and omized to an exercise group providing multimodal exercise program for 12 months or a control group which did not participate in any exercise program . The Performance Oriented Mobility Assessment scale , Timed Up and Go test , and incidence of falls were measured at baseline , at 6 months and at 12 months . RESULTS There was a significant improvement in balance-related items of Performance Oriented Mobility Assessment scale in the exercise group both at 6 month and 12 month ( P<0.0001 , P=0.002 ; respectively ) . There was no statistically significant increase in gait-related items of Performance Oriented Mobility Assessment scale after the first 6-month treatment period ( P=0.210 ) , but in the second 6-month treatment period the POMA-G score improved significantly ( P=0.001 ) . There was no significant difference between groups regarding falls . CONCLUSION Our results confirmed that a 12-month multimodal exercise program can improve the balance in cognitively impaired older adults . CLINICAL REHABILITATION IMPACT Based on our results , the multimodal exercise program may be a promising fall prevention exercise program for older adults with mild or moderate cognitive impairment improving static balance but it is supposed that more emphasis should be put on walking component of exercise program and environmental fall risk assessment [ 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 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
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 ?