Short-term changes in protective stepping for lateral balance recovery in older adults

Background: Fall prevention for older adults is dependent on the ability to maintain protective balance. This study measured the short-term changes of protective stepping following waist-pull perturbations in the medio-lateral direction, to identify what, if any, properties of protective stepping are improved with repeated perturbation exposures. Methods: Sixty waist-pulls (2 directions × 5 intensities × 6 repetitions) from a single session were analyzed separately as early, middle, and late testing periods, for a comparison over time of typical responses. Outcome measures included the number of evoked steps, type of step, incidence of interlimb collisions, and kinematic and kinetic properties of the first step in frequently used crossover-type responses. Findings: Improvements were evident as significantly reduced number of steps and collisions. However, these improvements could not be completely accounted for by significant changes in first step kinematic or kinetic properties. Interpretation: We infer that older individuals experiencing repeated lateral waist-pull perturbations optimize the predictive or feed-forward motor control for balance recovery through stepping.