Client Perspectives on Perturbation-Based Balance Assessment and Training. A Survey-Based Study

Falls are a major concern among community-dwelling older adults and people with neurological disorders (e.g., stroke, Parkinson’s disease, and multiple sclerosis). Presence of motor, sensory, and cognitive declines in the aging population as well as disease-induced impairments in the neurological population impose a higher risk of falls. These falls create a huge economic burden on the health care system as they are associated with significant non-fatal injuries and fatal accidents. Various clinical assessment and conventional interventions are widely used to assess and improve impaired balance; however, they suffer from ceiling effect and limited predictive capacity of falls. In addition, interventions lack task specificity, which may be the reason for lacking greater reductions in falls. Perturbation-based balance assessment and training (PBBAT) has recently emerged as a paradigm involving unexpected perturbations in a safe (laboratory) environment. These perturbations are induced via motorized devices or manual devices. The devices vary in perturbation simulation and intensities as well as diverse perturbation characteristics (type, direction, and magnitude) and program (frequency and volume). Due to the promising findings of PBBAT in research, few recent studies evaluate the efficacy and feasibility of translating the training for the clinical setting, thus current evidence remains limited. One potential reason for such poor clinical transition is the limited availability of commercial perturbation devices and therapists’ safety concerns. In addition, client acceptability to PBBAT may also relate to the delayed transition to clinical setting. Focusing on the clients’ needs and perspective by using the client-cantered approach might play an important role in their recovery experience and enhance their transition to the community. For this reason, our purpose is to explore the clients’ perspective from different populations -healthy older adults, populations with a neurological condition, and people who perceive themselves at risk of fall - by conducting a survey questionnaire. The questionnaire aims to explore 1) clients’ knowledge and awareness of PBBAT, 2) clients’ willingness to try devices and the most preferred device, 3) clients’ perception of devices and perception of safety. We conducted statistical analyses on the data collected from 101 responses of the questionnaire to explore the client’s knowledge and awareness, willingness, perception of safety, and tolerability of PBBAT. The exploratory findings indicate that the majority of clients acknowledged PBBAT by its definition rather than its name alone. Furthermore, the Overground Walkway device had the higher portion of willingness to try; however, the Surefooted Trainer device and the Spring Scale devices were the most preferred devices to be picked for training or assessment, respectively. For perception of devices, “Curiosity” was the dominant feeling across all devices. Moreover, clients felt safe to undergo the assessment or training with one therapist by their side in addition to the overhead harness. The device design (e.g., harness) had been the majority of how they perceive safety. Also, the most expected outcome of PBBAT is physical improvement in walking and balance. Finally, the most accepted dosage for PBBAT is thirty minutes session twice a week for six weeks duration. The data is presented in Chapter III.