Perturbation Training

Balance training is aimed at reducing falls risk. Elderly subjects and patients with movement disorders exhibit a high risk for falling compared to their young and healthy peers. Our group has developed novel paradigms where we apply different types of perturbations while subjects are standing or walking on a treadmill. These paradigms have been used to characterize and augment stability in different population groups, including elderly, Parkinson's, Cerebellar ataxia, and others.

    We envision that this system can be used to implement a task-oriented training aimed at improving balance control and reduce the incidence of falls in subjects with different impairments of the nervous and/or musculoskeletal systems.

    Background & Target Population

    Falls and fall-related injuries are one of the most common and serious problems in the elderly and subjects with neurological disorders. The development of innovative solutions to reduce falls is a priority for national health-care systems, not only to reduce costs but also to benefit the society as a whole. One among the various interventions is to promote exercise by involving individuals in ad-hoc training programs that target volitional movements in order to improve strength, coordination, balance and flexibility. However, a specific fall event ultimately occurs when an individual fails to recover from a loss of balance or postural perturbation. The development of new training programs aimed at improve the control of the reactive reactions during these type of recovery responses could increase the outcomes of the intervention.

      To date, the platform has been tested with:

      • Healthy young subjects
      • Elderly people 
      • Patients with Parkinson's disease
      • Patients with cerebellar ataxia

      Perturbation Modalities

      Multidirectional waist-pull perturbations are applied by the A-TPAD, an innovative cable-driven robot conceived for gait rehabilitation that can apply controlled forces and moments at the human pelvis.

      Surface perturbations are delivered by a split-belt treadmill. The two belts can be moved independently, either forward or in reverse, along the antero-posterior direction.

      An immersive Virtual Reality environment is used to deliver visual perturbations in conjunction, or in absence, of the mechanical perturbations.

      Preliminary Results

      After a single training session participants are able to improve their balance reactions to the perturbations and stability during unperturbed gait post-training.

      A single session of perturbation training can produce acute effects in terms of increased cognitive performance in community dwelling healthy older adults.