Provoking artificial slips and trips towards perturbation-based balance training: a narrative review

Humans’ balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients’ fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients’ reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT’s effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community. This work was supported by the FCT—Fundação para a Ciência e Tecnologia—national funds, under the scholarship references UMINHO-VC/BII/2021/02, POCI-01-0247-FEDER-039868_ BI_02_2022_CMEMS and PD/BD/141515/2018, and the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, and under Stimulus of Scientific Employment with the grant 2020.03393.CEECIND.