Theme 1: Measuring Balance Proficiency & Fall Risk

Project 1: A novel beam-walking test to improve fall risk assessment in individuals who use lower limb prostheses

Most clinical tools are insensitive to mild or moderate balance impairments, and most lab-based metrics characterize how we maintain balance not if our balance is better than someone else’s. These gaps may be attributable to the scarcity of easily implemented clinically feasible methods that are of sufficient difficulty to evoke failures in balance performance across the spectrum of motor skill.  To address this gap I developed a novel beam-walking test in which the continuous value of distance walked over a set of balance beams differentiated professional ballet dancers, healthy adults, and lower limb amputees (Sawers and Ting, 2015). Therefore, beam walking can detect differences between groups across the spectrum of motor skill. However, it is unknown if beam walking can discriminate between fallers and non-fallers, or detect changes in balance proficiency within a clinical population more accurately than current clinical tests. Thus, with the objective of developing a simple, quick, inexpensive test of walking balance proficiency and fall risk that could be translated to clinical practice we are currently pursuing the following questions:

1. Can beam walking detect differences in balance proficiency within a group of patients (i.e. fallers and non-falers)?                      
2. Can beam walking detect these differences with greater sensitivity than current clinical tools?
3. Is beam walking sensitive to changes in walking balance proficiency?

If successful this research will yield a simple, quick, and inexpensive test for diagnosing balance impairment and fall risk. Beam walking may also be useful in the titration of medications for neurological patients with balance deficits (e.g. levodopa in PD, botox for cerebral palsy) as well as testing concussion status in athletes and soldiers.

Future Directions                      
1. Can beam-walking be used as a clinical test to determine why someone is at risk for a fall, not just who is at risk for a fall? This would provide clinicians with much needed insight into the cause or etiology of fall risk and facilitate the development of patient-specific treatment plans.

2. Evaluate the efficacy of beam walking in diagnosis fall risk among individuals with incomplete spinal cord injury, and older adults.

Collaborators: Brian Hafner
Funding: NIH, National Institute Of Child Health & Human Development, Award Number K12HD073945 (IREK12), Orthotics and Prosthetics Education and Research Foundation, Inc. (OPERF) grant number OPERF-SGA-2016-1

Theme 2: Neuromechanical Mechanisms of “Better” Balance

Project 1: Mechanisms of Balance Proficiency Revealed thru Failures

Just as engineers investigate failures of bridges and buildings to prevent similar incidents from recurring, it is imperative that we study balance failures. Despite being regarded as a neuromuscular problem, how the robust control of walking and balance fails during a fall remains unknown. To address this gap we have begun to characterize and compare the selection and execution of failed and recovered neuromuscular balance responses during slipsbeam walking, and standing perturbations. Specifically, we examine the inter-limb muscle coordination patterns that characterize successful versus failed balance recoveries.

If successful this research will identify neuromotor mechanisms of balance proficiency that may be used to guide the development, validation, and optimization of rehabilitation interventions to remediate balance impairments.

Future Directions                      
1. This research has led to new hypotheses we are testing about the contributions of the startle response and inter-limb coordination to balance. 

CollaboratorsLena TingClive Pai
Funding: NIH, National Institute Of Child Health & Human Development, Award Number K12HD073945 (IREK12)