Clinical trial NCT06076525: Motor Flexibility in Multidirectional Balance Control
Official title: Understanding Motor Flexibility and Reactive Balance Control to Improve Fall Prevention Strategies in Older Adults
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: NA
Conditions: Falling
Lead sponsor: University of Nebraska
Sponsor class: OTHER
First posted: 2023-10-11
Enrollment: 0
Sex: ALL
Minimum age (years): 19
Maximum age (years): 79
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This is a Parallel Assignment interventional study aimed at investigating the role of behavioral flexibility in multidirectional balance control and fall prevention across different age groups and fall histories. The study will recruit 42 participants divided into three groups: 14 Older Adult Fallers, 14 Older Adult Non-Fallers, and 14 Younger Adult Non-Fallers. Participants will undergo treadmill walking sessions where perturbations in different directions and magnitudes will be introduced. Older Adult Non-Fallers and Younger Adult Non-Fallers will partake in two different aims, involving walking sessions and training epochs. Due to concerns over fatigue, Older Adult Fallers will only participate in one of these aims. The study aims to provide insight into the trade-offs between speed and flexibility in reactive balance control, and the potential for improving balance through targeted interventions.
Primary purpose: BASIC_SCIENCE

Brief summary: The goal of this observational study is to learn about how older adults (those 65 and above) manage to maintain balance when experiencing a slip or trip while walking. The study is especially interested in how quickly and flexibly adjustments to movement can be made to avoid falling. The main questions this study aims to answer are:

* How does the ability to adjust movements quickly, also known as "motor flexibility," affect the chances of recovering from a slip or trip?
* Can targeted training improve this ability in older adults, making falls less likely? Participants will walk on a specially designed treadmill that can simulate slips and trips and undergo a training program designed to improve the ability to adjust movements quickly.

Researchers will compare older adults to younger adults to see if age affects the ability to adjust movements quickly and recover balance after a slip or trip. Researcher's will also compare the performance of older adults before and after the training program to see if balance recovery improves.

Detailed description: Falls are the leading cause of injury-related fatalities in people aged 65 and above, often triggered by unexpected disruptions like slips or trips during walking. Such events necessitate rapid and adaptable motor responses to regain balance, a mechanism referred to as "reactive balance control." Within this complex interplay, "motor flexibility," or the ability to modulate one's movements in real-time based on sensory feedback, becomes critical. However, there exists a trade-off: increased flexibility requires more complex sensory processing, potentially delaying the initiation of corrective actions-a delay that can prove perilous in the context of a fall. This study seeks to explore the role of motor flexibility in reactive balance control, particularly in older adults, with a focus on understanding how individuals adapt stepping patterns in response to diverse and unpredictable balance disturbances. State-of-the-art technology will be employed including a Computer-Assisted Rehabilitation Environment (CAREN), to simulate various types of walking surface disruptions. By studying younger and older adults and introducing different types of perturbations, the study aims to understand the trade-offs between the speed of motor response and the flexibility to adapt to different fall scenarios. Additionally, the extent to which training can improve this balance control flexibility is investigated. The central hypothesis is that motor flexibility is a modifiable feature of reactive balance control and is positively correlated with the ability to recover from multi-directional disturbances. The study will quantify this relationship and assess the potential for improvement through targeted interventions. Aim 1 of the research is designed to measure these trade-offs in older adults by introducing controlled perturbations to a walking platform, thereby providing critical data on how speed and flexibility interact in real-world fall scenarios. Computational models will be used to evaluate how these variables contribute to an individual's ability to resist falls from varying directions and magnitudes. Aim 2 will explore the potential for improving balance control flexibility through targeted training, studying both younger and older adults to gauge the effects of age on the adaptability of motor control. Improvements in balance flexibility and determine how these changes interact with other physiological factors like body mass index and rate of force development. The results of this study will provide foundational data that can be used to develop more effective fall-prevention strategies for older adults. This research bridges biomechanics and computational modeling, offering an interdisciplinary lens through which to view a problem of substantial public health significance. By understanding the nuances of how motor flexibility and reaction speed interact in the context of unexpected balance disturbances, we aim to make strides in mitigating the risks and consequences of falls in older adults.

Eligibility criteria: Inclusion Criteria:

* The proposed study will include individuals from two distinct age ranges, between 19 to 35 years old and 65 to 79 years old. This approach ensures a wide demographic representation and allows for comparison across different age groups.

Exclusion Criteria:

* Uncontrolled hypertension
* Peripheral arterial disease
* Knee osteoarthritis
* Vertigo
* Meniere's disease
* Chronic dizziness
* History of back or lower extremity injury that currently limits completing multidirectional perturbation protocol
* Prior surgery that affects the subject's mobility
* Any neurological disease or impairment that limits the ability to walk, including but not limited to stroke, Parkinson's disease, and multiple sclerosis.

Primary outcomes:
measure: Motor Flexibility Index in Reactive Balance Control
timeFrame: Immediately after intervention
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
affiliation: University of Nebraska
name: Nathaniel H Hunt, PhD
role: PRINCIPAL_INVESTIGATOR
References: