State-of-the-Art: Balance training is a crucial component of fall prevention and training of standing balance on unstable surfaces, such as wobble boards, is effective in reducing fall risk and is promising as it could be applied even in the home environment without requiring expensive instrumentation. It is, however, unknown how psychological, neurophysiological and biomechanical factors determine this outcome. Interestingly, several weeks of balance training on unstable surfaces resulted in decreased fear of falling in elderly. This may underlie the positive outcomes, as fear of falling has been suggested to coincide with less effective balance strategies. However, fear of falling may actually enhance balance control mechanisms and results from our lab indicate that short-term (<1 hour) training on an unstable surface affects neurophysiological and biomechanical strategies used to maintain balance in young adults without fear of falling. Hence the mechanisms underlying improvement in standing balance and fall risk remain unknown, which precludes optimisation of this training approach.

Approach: In this project, we will use a long-term (6 weeks) training paradigm in older adults, to determine the psychological (fear of falling), neurophysiological (cortical involvement and sensory weighting) and biomechanical (motor strategies) correlates of improved standing balance performance. In addition, we will study generalisation of training effects to daily-life motor tasks, such as unperturbed and perturbed gait, and the effect on more general parameters that will eventually allow the integration of the acquired measures into the ICF model. Outcome measures will be standardised between WP 2.1 and 2.2 to allow comparisons of these different training approaches. The results of this project will allow optimisation of standing balance training in particular, and balance training in general, to achieve more effective fall prevention in elderly and potentially in patients with movement disorders.