Reducing Fall Risk with the use of Neuromuscular Electrical Stimulation to Maximize the Hip Abductor Muscles in Older Veterans

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Falls are a leading cause of injurious death and non-fatal injuries in older adults. While fall prevention is a major VA initiative, the current best fall preventions program only reduces falls by ~30% suggesting further research and interventions are needed to reduce fall risk. Decreased lower extremity muscle mass and strength contribute to balance and mobility limitations. Our recent studies show the hip abductors have a unique role in balance and mobility function. Older adults with impaired hip abductor muscles demonstrate decreased hip abductor strength, lower balance scores, and poor stepping mechanics when recovering from a balance perturbation. Our preliminary results also show increased fatty infiltration of the hip abductor muscles may contribute to poor muscle recruitment and make changing the hip abductor muscles with a traditional strength intervention difficult. Neuromuscular electrical stimulation is one method to improve muscles in older adults, though it is not traditionally used on the hip abductors. Our preliminary results demonstrate that older adults who use neuromuscular electrical stimulation on their hip abductors, in conjunction with a balance training intervention; demonstrate larger improvements in hip abductor strength, balance, and mobility function. Our central hypothesis is that the addition of neuromuscular electrical stimulation applied to the hip abductors during a balance intervention will result in: improved balance, larger improvements in muscle and mobility function, and fewer falls than a balance intervention alone. In this randomized control trial, we will determine the effects of a balance and strengthening program with and without neuromuscular electrical stimulation on fall risk and mobility (aim 1), changes in hip abductor composition, function, activation and gait variability (aim 2), and the retention of these changes at a six and twelve-month follow up (aim 3). We anticipate that this patient-oriented translational research will provide the first evidence from a large randomized control trial for the use of neuromuscular electrical stimulation applied to the primary hip abductors as an efficacious adjunct to traditional rehabilitation programs to improve balance, mobility, and muscle in older Veterans at risk for falls.