A balance assessment and training protocol to address balance disorders in older and neurologically disabled adults

Falls are by far the leading cause of accidental injury and death in older adults. Despite its importance, much is still unknown about the manner in which balance is controlled, and how it is compromised by age, disease, and injury. Diagnostic instruments that assess balance and fall risk have proven to be of limited utility, as have therapeutic interventions. The Balance Assessment and Training Protocol (BATP) was developed to address these shortcomings. It incorporates separate Assessment and Training Modules that establish subjects' Limit of Balance (LoB), compute a target trajectory based on it that requires subjects to remain at their LoB in order to track it, and then assess or train balance performance in this task. The BATP continuously challenges subjects to perform reaching tasks at the limits of their balance, and increases these limits as subjects demonstrate improved performance. The goal of the BATP 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 BATP focuses on performance at and just beyond the LoB, unlike most such tests and training protocols that do not challenge subjects in this way. We hypothesize that expanding this boundary, as the BATP is designed to do, will improve balance and make individuals more resistant to falls in everyday activities.