Effect of Single Session Perturbation Training on Individuals with Progressive Neurological Disease

The purpose was to investigate the efficacy of PBBT in improving fall risk in people with MS (PwMS) and PD in a clinical setting.

A sample of convenience was used. Twenty-eight participants with either an MS or PD diagnosis. MS participants (N=7; X̄ age=57.5, six relapsing-remitting, one secondary progressive, EDSS score 6).  PD participants (N=21; X̄ age=71, Modified UPDRS scores 5-17). Outcome measures included the Timed Up and Go (TUG), Dual Task TUG (TUGDT), 3-Meter Backward Walking (BW), and the reactive portion of the Mini Balance Evaluation Systems Test (MiniBEST) before and after a single session of PBBT, as well as at a 4 or 5 month follow up. The intervention consisted of a single session of PBBT in a dynamic overhead harness consisting of four two-minute trials with at least twenty-four randomized slips or trips administered via slip trainer. Number of falls and single vs. multistep reactions were also recorded. 

Calculated paired t-test and repeated measures of within-subject ANOVA revealed statistical and clinical improvements. Statistical significance was noted in BW from pre-test to post-test (p=0.035), with clinical significance observed in TUGDT, indicating a sustained improvement at the five-month follow-up (d=0.695) in PwMS. Significant improvements in the 3MBW test (p 0.001) and an increase in the use of single-step recovery strategies from 27.45% to 43.4% over trials in those diagnosed with PD.

Results indicated that a single session of PBBT can lead to meaningful improvements in balance and reduce fall risk in both populations. The findings in PwMS suggest that PBBT may help maintain predictive fall risk scores despite the progressive nature of the disease. In individuals with PD, enhancements in automatic stepping and balance recovery techniques point to the intervention's efficacy in promoting greater stability. Future research should evaluate the ideal frequency for administering PBBT to individuals with progressive neurological diseases to effectively reduce fall risk.

PBBT aligns with current practice guidelines for managing fall risk in both MS and PD. Its ease of administration in clinical settings makes it a valuable addition to treatment protocols aimed at improving postural stability and reducing fall incidence. Implementing PBBT can serve as a secondary prevention strategy, addressing functional decline and the risks associated with falls, thereby potentially reducing hospital admissions and improving overall quality of life for individuals with these neurological conditions.