A Balanced Reach Training Platform to Address Balance Disorders in Older and Neurologically Disabled Veterans

Falls are by far the leading cause of accidental injury and death in older adults. The Veteran population is
more severely affected by falls since it is significantly older than the overall population (45% over 65 years of
age vs. 13%); and Veterans would benefit substantially more from an accurate diagnosis and treatment of fall
propensity. Despite its importance, much is still unknown about the manner in which balance control is
compromised by age and disease. Therapeutic interventions for people who are at risk of falling have proven
to be of limited utility. Engineering methods are well suited to study and evaluate balance; but have to date
been applied to overly simplified scenarios that lack the complexity to probe the musculoskeletal and
neurophysiological bases for balance and falls.
The long term objective of this research, which began with a VA Rehabilitation Research & Development
(RR&D) Career Development Award (CDA-2), is to develop improved directives and protocols for the diagnosis
and treatment of balance-related posture and movement coordination problems. This proposal significantly
advances engineering methods to address existing gaps in the diagnosis and treatment of balance
impairments through the development of a Balanced Reach Training Protocol (BRTP). The BRTP
continuously challenges subjects to perform reaching tasks at the limits of their balance for an extended
period of time, and increases these limits as subjects demonstrate improved performance. The goal of this
tool is to quantitatively assess and improve at-risk individuals' ability to maintain balance when disturbed by
volitional movements of the body and its parts—an important class of balance disturbances integral to many
activities of daily living that can precipitate falls. The BRTP focuses on performance at and just beyond the
limits of balance, unlike most such tests and training protocols that do not challenge subjects in this way. The
BRTP's most immediate and salient metric is the limiting boundary of standing reach; and we hypothesize
that expanding this boundary, as the BRTP is designed to do, will improve balance and make individuals more
resistant to falls (in the context of expected balance disturbances).
Confirmation of this hypothesis could provide a new perspective on existing training protocols' modest
success rates, and direction for the design of new protocols with the potential to significantly improve these
rates. [Though the BRTP is a training platform, we also believe that the performance metrics and analytical
results produced by it can form the basis for new diagnostic measures that more reliably and precisely
quantify and explain balance performance problems; and track changes in them over time.] Such
diagnostic and treatment protocols would be particularly beneficial to the VA Health Care System, as it
would lead to improvements in: patient throughput, quality of care, and treatment costs. Though this
proposal targets the aging Veteran population, the BRTP is a general tool that can aid in the diagnosis and
treatment of balance disorders arising from conditions other than aging. These include obesity, diabetes
(which often leads to lower extremity muscle degeneration and peripheral neuropathy), sarcopenia,
vestibular disorders, and neurological disorders such as stroke. Veterans whose balance has been
compromised by Traumatic Brain Injury (TBI) (whether combat-related or not) may also benefit from the BRTP.

Grant Number: 5I01RX003096-05
NIH Institute/Center: VA
Principal Investigator: Joseph Barton