REDUCING FALLS USING TASK-SPECIFIC TRAINING

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DESCRIPTION (adapted from applicant's abstract): Fall-related injuries to, and deaths of older adults are a considerable societal problem that is the focus of the presently proposed research that builds upon the previous experience in this laboratory. The research uses a simple within- and between-subject experimental design to determine the effectiveness of task-specific training to decrease the incidence of trip-related falls. Trips account for up to, and greater than 50% of fall-related hip and upper extremity fractures, respectively, in older adults. A key element of avoiding a fall after a trip is controlling the motion of the trunk. The simple and task-specific training involves delivery of a large, forward directed postural disturbance that requires stepping responses to avoid falling. These disturbances have been shown to mimic the disturbances induced by, and the recovery requirements from an actual tripping event using an innovative tripping protocol. The global hypothesis is that fall incidence will be smaller in subjects who have participated in task-specific training compared to controls. To test the hypothesis, 215 older women will be recruited over a three-year period to address two specific aims and three primary hypotheses. In Specific Aim 1 the extent to which motor skill learning occurs will be characterized over a four-week period and the extent to which the motor skill is retained after training is withheld. The hypothesis is that increased skill level will be associated with significantly smaller trunk flexion angle and trunk flexion acceleration after the treadmill disturbance. Also, the hypothesis is that skill level will not degrade significantly after four weeks during which training is withheld. In Specific Aim 2 the extent to which the learned motor skill reduces the incidence of falls after inducing forward-directed trip will be quantified. It is hypothesized that subjects who participated in the skill specific training protocol will have a significantly lower incidence of falls compared to the untrained control group. Support of the hypotheses will provide evidence that task-specific exercise can contribute meaningfully and efficiently to fall prevention programs. Such evidence will provide a springboard for further study of graded task-specific exercise as a component of fall prevention programs targeting older adults with documented fear of falling, physical impairments, and disabilities.