To determine whether the plantar perceptual learning task, using a hardness discrimination training, efficiently improves walking stability in the elderly.
Design:
A randomized controlled trial.
Setting:
Elder day-care center.
Participants:
Eighty-six elderly people (73.84 SD 5.98 years) who went to an elder day-care center were randomly assigned evenly to either an intervention or a control group.
Intervention:
The intervention group performed a task to discriminate hardness differences while standing on sponge mats of different levels of hardness. The control group underwent the same task except that they were not instructed to discriminate hardness levels of the mats. The tasks were carried out over a four-week period for 10 days for both groups.
Outcome measures:
Outcome was assessed by determining root mean squares of trunk acceleration during walking.
Results:
Plantar perception was significantly improved in the intervention group after training (F = 26.24, p < 0.01). In addition, changes in root mean square values of acceleration were significantly greater after training in the intervention group (medial–lateral, 0.36 SD 0.26; vertical, 0.32 SD 0.24; anterio–posterior, 0.26 SD 0.24) than in the control group (medial–lateral, 0.14 SD 0.28, vertical, 0.16 SD 0.35, anterio–posterior, 0.12 SD 0.29) (p < 0.05). Changes in walking speed were not significantly different (p = 0.13) between the intervention (0.06 SD 0.13) and control groups (0.02 SD 0.14).
Conclusion:
The plantar perceptual learning task might efficiently stabilize postural control during walking in the elderly.
BlakeAJMorganKBendallMJ. Falls by elderly people at home: prevalence and associated factors. Age Ageing1988; 17: 365–372.
2.
TinettiMESpeechleyMGinterSF. Risk factors for falls among elderly persons living in the community. N Engl J Med1988; 319: 1701–1707.
3.
GillespieLDGillespieWJRobertsonMC. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev2003; (4): CD000340.
4.
RobertsonMCCampbellAJGardnerMM. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc2002; 50: 905–911.
5.
ShimadaHKimHYoshidaH. Relationship between age-associated changes of gait and falls and life-space in elderly people. J Phys Ther Sci2010; 22: 419–424.
6.
CaliCMKielDP. An epidemiologic study of fall-related fractures among institutionalized older people. J Am Geriatr Soc1995; 43: 1336–1340.
7.
IwamotoJSuzukiHTanakaK. Preventative effect of exercise against falls in the elderly: a randomized controlled trial. Osteoporos Int2009; 20: 1233–1240.
8.
OrrRde VosNJSinghNA. Power training improves balance in healthy older adults. J Gerontol A Biol Sci Med Sci2006; 61: 78–85.
9.
JacobsonBHThompsonBWallaceT. Independent static balance training contributes to increased stability and functional capacity in community-dwelling elderly people: a randomized controlled trial. Clin Rehabil2011; 25: 549–556.
10.
SteadmanJDonaldsonNKalraL. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. J Am Geriatr Soc2003; 51: 847–852.
11.
AvelarNCBastoneACAlcântaraMA. Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people. Rev Bras Fisioter2010; 14: 229–236.
12.
KatsuraYYoshikawaTUedaSY. Effects of aquatic exercise training using water-resistance equipment in elderly. Eur J Appl Physiol2010; 108: 957–964.
13.
MoriokaSYagiF. Influence of perceptual learning on standing posture balance: repeated training for hardness discrimination of foot sole. Gait Posture2004; 20: 36–40.
14.
MoriokaSYagiF. Effects of perceptual learning exercises on standing balance using a hardness discrimination task in hemiplegic patients following stroke: a randomized controlled pilot trial. Clin Rehabil2003; 17: 600–607.
15.
MoriokaSHiyamizuMFukumotoT. Effects of plantar hardness discrimination training on standing postural balance in the elderly: a randomized controlled trial. Clin Rehabil2009; 23: 483–491.
16.
MoriokaSFujitaHHiyamizuM. Effects of plantar perception training on standing posture balance in the old old and the very old living in nursing facilities: a randomized controlled trial. Clin Rehabil2011; 25: 1011–1020.
17.
NakanoHMikiKFujitaH. Influence of plantar hardness discrimination training on center-of-gravity sway while standing on one leg: a randomized controlled trial. J Phys Ther Sci2011; 23: 741–744.
18.
SendenRSavelbergHHGrimmB. Accelerometry-based gait analysis, an additional objective approach to screen subjects at risk for falling. Gait Posture. 2012; 36: 296–300.
19.
WeissAHermanTPlotnikM. An instrumented timed up and go: the added value of an accelerometer for identifying fall risk in idiopathic fallers. Physiol Meas2011; 32: 2003–2018.
20.
BautmansIJansenBVan KeymolenB. Reliability and clinical correlates of 3D-accelerometry based gait analysis outcomes according to age and fall-risk. Gait Posture2011; 33: 366–372.
21.
GietzeltMNemitzGWolfKH. A clinical study to assess fall risk using a single waist accelerometer. Inform Health Soc Care2009; 34: 181–188.
22.
MenzHBLordSRFitzpatrickRC. Acceleration patterns of the head and pelvis when walking are associated with risk of falling in community-dwelling older people. J Gerontol A Biol Sci Med Sci2003; 58: M446–452.
23.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189–198.
24.
Moe-NilssenRHelbostadJL. Trunk accelerometry as a measure of balance control during quiet standing. Gait Posture2002; 16: 60–68.
25.
AuvinetBBerrutGTouzardC. Reference data for normal subjects obtained with an accelerometric device. Gait Posture2002; 16: 124–134.
26.
MenzHBLordSRFitzpatrickRC. Acceleration patterns of the head and pelvis when walking on level and irregular surfaces. Gait Posture. 2003; 18: 35–46.
27.
MizuikeCOhgiSMoritaS. Analysis of stroke patient walking dynamics using a tri-axial accelerometer. Gait Posture2009; 30: 60–64.
28.
IosaMFuscoAMoroneG. Assessment of upper-body dynamic stability during walking in patients with subacute stroke. J Rehabil Res Dev2012; 49: 439–450.
29.
IosaMMazzàCPecoraroF. control of the upper body movements during level walking in patients with facioscapulohumeral dystrophy. Gait Posture2010; 31: 68–72.
30.
KavanaghJJBarrettRSMorrisonS. Upper body accelerations during walking in healthy young and elderly men. Gait Posture2004; 20: 291–298.
31.
LamothCJvan DeudekomFJvan CampenJP. Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people. J Neuroeng Rehabil2011; 8: 2.
32.
MarigoldDSPatlaAE. Age-related changes in gait for multi-surface terrain. Gait Posture2008; 27: 689–696.
33.
MazzàCIosaMPecoraroF. control of the upper body accelerations in young and elderly women during level walking. J Neuroeng Rehabil2008; 5: 30.
34.
Shumway-CookAWoollacottM. Motor control, international edition: translating research into clinical practice. 4th revised international ed. Philadelphia: Lippincott Williams and Wilkins, 2011.
35.
PerrySD. Evaluation of age-related plantar-surface insensitivity and onset age of advanced insensitivity in older adults using vibratory and touch sensation tests. Neurosci Lett2006; 392: 62–67.
36.
KenshaloDRSr. Somesthetic sensitivity in young and elderly humans. J Gerontol1986; 41: 732–742.
37.
MoriokaSFukumotoTHiyamizuM. Changes in the equilibrium of standing on one leg at various life stages. Curr Gerontol Geriatr Res2012; 2012: 516283.
38.
MenzHBMorrisMELordSR. Foot and ankle risk factors for falls in older people: a prospective study. J Gerontol A Biol Sci Med Sci2006; 61: 866–870.
39.
NakanoHMikiKOsumiM. Influence of a plantar perceptual learning task on brain activity: fNIRS study. J Phys Ther Sci2012; 24: 711–713.
40.
NaitoE. Sensing limb movements in the motor cortex: how humans sense limb movement. Neuroscientist2004; 10: 73–82.
41.
WoollacottMHTangPF. Balance control during walking in the older adult: research and its implications. Phys Ther1997; 77: 646–660.
