Effects of Balance Training on Fall Risk and Mobility in the Elderly
Condition: Fall
Study type: Interventional

Summary: 
      Pakistan is a country devoid of health-care facilities and training programs on fall
      prevention. There is lack of research, awareness and implication of geriatric rehabilitation
      on elderly population addressing balance and fall risk assessment however very few
      cross-sectional studies of poor quality evidence are available on this issue. To best of
      investigators' knowledge, no interventional studies have been conducted in our country so far
      on this topic. . We aim to use a integrated method of balance training that uses patients
      judgment, visual feedback, proprioception and balance training with the help of new
      technology/devices to improve balance. And compare it to conventional treatment. We also aim
      to assess risk factors of fall in geriatric population, decreasing risks of falls and
      increasing awareness regarding geriatric rehabilitation and balance training.
    

Detailed description: 
      Balance is use of multiple systems of the body including auditory, motor, visual, vestibular
      and nervous to keep body staying inside limits of stability. It includes maintaining posture
      under different conditions in standing or sitting, ability to facilitate movement and to
      recover and stay in limits of stability after external (Trip, push, slip) and internal (body
      movements) protuberance. Impaired balancing system of body results in increased risk of fall
      which is major cause of mortality and morbidity in geriatric population.

      A report of 2014 stated that Pakistan has 12.13 million population of Age 60 years and above
      which is expected to rise to 17.53 Million by year 2025. According to a study 30-50 % of
      population of age 65 years and above have some problems with balance. Another study states
      that 75 % of people aging 70 years and above have balance impairments which leads to fall.
      Additionally number of conditions including poly pharmacy, female gender, visual problems,
      environmental problems and cognitive issue contribute to in fall risk and balance problems.
      One of the major goal of Balance re-education is to decrease fall risk. Literature has
      suggested that one of the most effective methods of reducing falls in geriatric population is
      to prophylactically intervene on multiple risks factors of fall. This includes outpatient
      balance training and fall risk assessment.

      Force plate systems and mirrors which are the part of visual biofeedback are often used for
      treatment of balance disorders but are found to have no difference in educating compared to
      conventional management. In current era technology has advances to a great extend and new
      systems that quantifies balance and provide a reliable and valid data regarding balance which
      then can be used in formation of balance training plan. These systems can also be used for
      treatment purposes and also have various visual feedback systems for more educational
      benefits. One of these systems is Biodex balance system which is used for balance and
      postural reduction, increase proprioception, somatosensory and neuromuscular control. It
      incorporates patient data saving and printing system for record management and uses an
      integrated system which involves patient in activities of re-education with relation to
      visual feedback to accommodate body accordingly.

      As mentioned earlier Falls result in high morbidity and mortality among geriatric population
      which leads to increased costs and need for rehabilitation services. Falls are brought about
      by detrimental effects of aging on postural control as a result of deterioration in
      neuromuscular and sensory mechanisms, physical inactivity, pre-existing pathology and use of
      medications. However, balance training and exercise interventions tend to decrease risk of
      falling and eventually fall itself. Moreover, conventional balance training programs have
      decreased adherence; hence, sensor-based training programs have been advocated. These
      programs have quiet good advantages including visual feedback with interactive environment
      and targeted interventions. This exercise system incorporates human-computer interface
      providing a three-dimensional and real-time feedback.
    

Intervention name(s): Warm Up; Conventional Balance Training; Biodex Balance Training
Intervention type(s): Other; Other; Other
Intervention description(s): 10 low jumps 5 Illiopoase Stretches 5 L/L Abductor Stretches 10 Trunk rotations 10 Should Circumduction Clock wise/Counter clockwise 10 Cervical Rotations Clockwise/Counter Clockwise; Internal Protuberances:
Looking up/Looking down/looking over the shoulder (Rt. /Lt.) 10 Reps Each
Looking behind over the shoulder (Rt. /Lt.)10 Reps
Looking Up with overhead Upper Limb Flexion. 5 Reps
Reaching out of Base of support (Rt. /Lt. / midline Cross) 10 Reps Each
Side to Side weight Shifting 10 Reps
Standing on toes/Heels 10 Reps each
External Protuberance:
Tuck forward/ Backward/ Sideways(Rt. /Lt.) 10 reps Each
Bosu Ball Training; Biodex Balance Training Using Biodex Balance System SD
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Impaired Balance; Geriatrics; Balance Training; Dynamic Stability Training; Fall Risk; Berg Balance Scale; Physical Therapy; Forward Reach Test