PNFand Perturbations Based Exercises on Balance Training in Elder Population

Study Overview
=================
Brief Summary
-----------------
To compare the effects of proprioceptive neuromuscular facilitation techniques and perturbation-based balance training on risk of falls and quality of life in elderly population.65 to 85 years old age both male and female participants experienced fall greater than1 time in last 1 year is included in this study.Two groups in this study group A will receive proprioceptive neuromuscular facilitation techniques and group B will receive pertubations based balance training.berg balance scale,time up and go test quality of life scale and Modified John Hopkins Fall Risk Assessment Tool will be used for pre and post assessment.

Detailed Description
-----------------
Balance is very crucial component for living an independent life among older adults and performing their daily life activities independently. Balance control provides foundation to move and perform daily life functions.balance control deteriorates with age, and balance impairment is a major risk of fall among older adults. Fall may result in severe injuries, fracture, causing severe longstanding pain, low quality of life, disability or death. In older adults, falls most commonly result in many co-morbidities and mortality. The proprioceptive Neuromuscular Facilitation is greatly used technique as an intervention for neuromuscular dysfunction. By applying PNF technique, therapist can improve movement re-education.this technique help in improving muscle strengthening and stabilization. PNF technique uses reflexes of nervous system that help to relax a muscle.proprioceptive neuromuscular facilitation (PNF) promotes strengthening, motor learning and restoration of motor control in elderly individuals despite of neuromuscular and deficits.The Perturbation-based balance training comprises of some unpredictable, multi-directional dynamic-platform perturbations to elicit stepping and grasping reactions. The extent of perturbations is gradually improved over the period of program. The perturbation-based balance training program can help to improve or reverse impairments associated with older age in balance-recovery reactions. This program will greatly help in preventing falls, which may lead to improved health, enhanced mobility, more independence and high quality of life. Increased frequency of collisions are shown by older adults in swing phase and stance leg. Moreover, step length is also reduced and the frequency of multiple-step responses is increased. Older individuals rely more upon arm reactions to recover balance but the speed tends to decrease while initiation and execution of grasping reaction. And all reactions mentioned above are associated with increased risk of falling. The perturbation-based training program promote effective change in support program reactions that may help to reduce risk of falls and this training program should be part of fall prevention program and thus helping in improved quality of life

Official Title
-----------------
Comparison of Effects of PNF Techniques and Perturbation Based Balance Training on Risk of Fall and Quality of Life in Elderly Population

Conditions
-----------------
Balance; Distorted

Intervention / Treatment
-----------------
* Other: proprioceptive neuromuscular facilitation
* Other: pertubation based balance training


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 65 years - 85 years of age Gender: Both Male and Female Participants experienced fall >1 time in last 1 year. Patients should stand independently without upper limb support for >30s. Participants should tolerate at least 10 postural perturbations. Exclusion Criteria: Participants with body weight > 100kgs. Participants with lower extremity amputation. Severe osteoporosis Having recent illness, surgery, cognitive impairment or another neurological deficit.

Ages Eligible for Study
-----------------
Minimum Age: 65 Years
Maximum Age: 85 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: proprioceptive neuromuscular facilitation<br>Each session including three PNF techniques: Balance training exercises,participants will be treated for 20 minutes with PNF techniques that included;Rhythmic initiation, slow reversal techniques practiced with D1 and D2 pattern in lower limb,repeated contraction and Resisted PNF.The Technique will be performed for 3 days per week in same order on all subjects. | Other: proprioceptive neuromuscular facilitation<br>* Each session including three proprioceptive neuromuscular facilitation techniques: Balance training exercises,participants will be treated for 20 minutes with PNF techniques that included;Rhythmic initiation, slow reversal techniques practiced with D1 and D2 pattern in lower limb,repeated contraction and Resisted PNF.The Technique will be performed for 3 days per week in same order on all subjects.<br>|
| Experimental: pertubation based balance training<br>Each session will include a 5-10min warm-up,voluntary tasks intended to induce internal perturbations,voluntary tasks combined with external perturbations and a 5-10mins cool down.The technique will be performed for 2 sets of 10 repetitions on all subjects. | Other: pertubation based balance training<br>* Each session will include a 5-10min warm-up,voluntary tasks intended to induce internal perturbations,voluntary tasks combined with external perturbations and a 5-10mins cool down.The technique will be performed for 2 sets of 10 repetitions on all subjects<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| berg balance scale | Berg Balance Scale is the gold standard scale for assessment of Static and Dynamic Balance of a person. It is widely used in clinical settings. It consists of 14 balance related tasks. If a person performs the task independently it means a score of 4 and if a person is unable to do a task then a score of 0 is given. The sum of all the scores at the end will give us a final measure. It is a valid and reliable tool. | week 6 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time up and Go Test | it is a test used to assess the mobility of an individual. It requires the assessment of both static and dynamic balance. It is a reliable and valid tool. | week 6 | 
| Quality of life Scale | It is a 16-item scale used to assess the quality of life. It is internally consistent (a=0.82 to 0.92 with a test-retest reliability of r=0.78 to 0.84) | week 6 | 
| Modified John Hopkins Fall Risk Assessment Tool | This is a simple tool used for assessment of risk of fall in older adults. It is a multifactor tool with promising sensitivity and specificity. It consists of 7 components. Its Inter-rater reliability is 85.7% | week 6 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
proprioceptive neuromuscular facilitations, pertubation based balance training, elder population