The Effectiveness of Neurofeedback Training and Exercise Environmental Affordances on Static and ‎Dynamic Balance and The Fear of Falling in The Elderly

Document Type : Original Article

Authors

1 Dept. of Sports Science, University of Tehran Kish International Campus, Kish, Iran

2 Dept. of Motor Behavior, Faculty of Sports Science, University of Tehran, Tehran, Iran

Abstract

Balance ability is a critical component of independent daily activities among the elderly. Balance disorder is one of the major risk factors for falls and related complications. Therefore, this study was conducted with the aim of the the comparision of the effectiveness of neurofeedback training (NT) and exercise environmental affordances (EEA) on static and dynamic balance and the fear of falling in the elderly. This was a quasi-experimental study with pretest-posttest design with a control group. The statistical population of the current study included elderly men aged 60 to 80 years living in Ilam, Iran, among whom 36 people were selected based on inclusion and exclusion criteria, and randomly assigned into three 12-member groups of NT, EEA and control. In the pretest and posttest stages, the participants completed the Yardley et al.’s fall self-efficacy questionnaire-international form, and having completed the questionnaire, they performed the static (Carlsen et al.) and dynamic (Tsang et al.) balance task in 3 attempts. In the intervention phase (exercise), carried out in form of three 30-minute sessions per week for eight weeks, NT and EEA groups performed the relevant exercises, and control group carried out their usual and daily activities in this time. The data were analyzed using univariate analysis of covariance (ANCOVA) using SPSS-22 software. The results indicated that EEA and NT have a significant effect on posterior and central-lateral displacement of the center of pressure as well as the time to reach anterior-posterior, lateral stability and the time to reach total stability of elderly men. EEA had a significant effect on the risk of fear of falling, but NT did not have the same effect. Besides, the results revealed that EEA, compared to NT, had more effect on static balance (anterior-posterior displacement and central-lateral displacement of the center of pressure) and dynamic balance (the time to reach anterior-posterior stability, the time to reach lateral stability, and the time to reach total stability) in elderly men. According to the results of the present study, it is suggested to geriatric trainers and specialists to pay attention to the enrichment of the environment to improve the static and dynamic balance of the elderly and the risk of falling.
References
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Azarpaikan, A., & Torbati, H. T. (2018). Effect of Somatosensory and neurofeedback training on balance in older healthy adults: A Preliminary investigation. Aging clinical and experimental research30(7), 745-753. [Persian]
Clemson, L., Stark, S., Pighills, A. C., Torgerson, D. J., Sherrington, C., & Lamb, S. E. (2019). Environmental interventions for preventing falls in older people living in the Community. The Cochrane Database of Systematic Reviews. (2), 1-17. Article CD013258.
Cosio-Lima, L. M., Reynolds, K. L., Winter, C., Paolone, V., & Jones, M. T. (2019). Effects of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. The Journal of Strength & Conditioning Research17(4), 721-725.
Fernanda D., Vale R., Giani T., Bacellar S., & Dantas E. (2010).  Effects of a Physical activity program on static balance and functional autonomy in elderly women. Macedonian Journal of Medical Sciences, 3(1), 6-21.
Gillespie, L., & Handoll, H. (2009). Prevention of falls and fall-related injuries in older people. Injury Prevention, 15(5), 354-355.
Gruzelier, J. H., Foks, M., Steffert, T., Chen, M. L., & Ros, T. (2014). Beneficial outcome from EEG-neurofeedback on creative music performance, attention and well-being in school children. Biological Psychology, 95, 86-95.
Hertel, J., Gay, MR., & Denegar, CR. (2002). Differences in postural control during single–Leg stance among healthy individuals with different foot types. Journal of Athletic Training, 37(2), 129-132
Karlsson, A., & Frykberg, G. (2000). Correlations between force plates measures for assessment of balance. Clinical Biomechanics, 15(5), 365-369.
Khajavi, D., Farokhi, A., Jaberimoghadam, A., & Kazemnejad, A. (2014). Effect of a training intervention program on fallrelated psychological factors of community-doweling men older adults. Salman, 9(32), 10-25. [Persian]
Mansfield, A., & Inness, EL. (2015). Force plate assessment of quiet standing balance control: Perspectives on clinical application within stroke rehabilitation. Rehabilitation Process and Outcome, 4, Article e RPO-S20363.
Mihara, M., Fujimoto, H., Hattori, N., Otomune, H., Kajiyama, Y., Konaka, K., ... & Mochizuki, H. (2021). Effect of neurofeedback facilitation on poststroke gait and balance recovery: a randomized controlled trial. Neurology96(21), 2587-2598.
Park, J.-H. (2017). The Effects of eyeball exercise on balance ability and falls efficacy of the Elderly who have experienced a Fall. Archives of Gerontology and Geriatrics, 68, 181-185.
Pérez-Elvira, R., Oltra-Cucarella, J., Carrobles, J. A., Moltó, J., Flórez, M., Parra, S., ... & Neamtu, B. (2021). Enhancing the Effects of Neurofeedback Training: The Motivational Value of the Reinforcers. Brain Sciences11(4), Article 457.
Pighills, A., Ballinger, C., Pickering, R., & Chari, S. (2016). A Critical review of the Effectiveness of environmental assessment and modification in the Prevention of falls amongst community dwelling older people. British Journal of Occupational Therapy, 79(3), 133-143.
Province, M. A., Hadley, E. C., Hornbrook, M. C., Lipsitz, L. A., Miller, J. P., Mulrow, C. D., & Weiss, S. (1995). The effects of exercise on falls in elderly patients: A Preplanned meta-analysis of the FICSIT trials. Journal of the American Medical Association, 273(17), 1341-1347.
Rezaei, K., Nami, M., Sinaei, E., Bagheri, Z., & Yoosefinejad, A. K. (2021). A Comparison between effects of neurofeedback and balance exercise on Balance of healthy older adults. Journal of Biomedical Physics & Engineering, 11(6), Article 713. [Persian]
Ruhe, A., Fejer, R., & Walker, B. (2011). Center of pressure excursion as a Measure of balance performance in patients with non-specific low back pain compared to healthy controls: A Systematic review of the Literature. European Spine Journal, 20(3), 358-68.
Shafizadeh, M., Manson, J., Fowler-Davis, S., Ali, K., Lowe, A. C., Stevenson, J., Parvinpour, S., & Davids, K. (2020). Effects of enriched physical activity environments on balance and fall prevention in older adults: AScoping review. Journal of Aging and Physical Activity, 29(1), 178-191.
Shahrbanian, S., Hashemi, A., & Hemayattalab, R. (2021). The Comparison of the Effects of physical activity and neurofeedback training on postural stability and risk of fall in elderly women: A Single-blind randomized controlled trial. Physiotherapy Theory and Practice, 37(2), 271-278. [Persian]
Tsang, WW., Lee, KY., & Fu AS. (2008). Effects of concurrent cognitive task on pre-landing muscle response latency during stepping down activity in older adults with and Without a History of falls. Disability and rehabilitation, 30(15), 1116-22.

Keywords


References
Aranda-Gallardo, M., Morales-Asencio, J. M., de Luna-Rodriguez, M. E., Vazquez-Blanco, M. J., Morilla-Herrera, J. C., Rivas-Ruiz, F., Toribio-Montero, J. C., & Canca-Sanchez, J. C. (2018). Characteristics, consequences and prevention of falls in institutionalised older adults in the Province of Malaga (Spain): A Prospective, cohort, multicenter study. BMJ open, 8(2), 1-8. Article e020039.
Azarpaikan, A., & Torbati, H. T. (2018). Effect of Somatosensory and neurofeedback training on balance in older healthy adults: A Preliminary investigation. Aging clinical and experimental research30(7), 745-753. [Persian]
Clemson, L., Stark, S., Pighills, A. C., Torgerson, D. J., Sherrington, C., & Lamb, S. E. (2019). Environmental interventions for preventing falls in older people living in the Community. The Cochrane Database of Systematic Reviews. (2), 1-17. Article CD013258.
Cosio-Lima, L. M., Reynolds, K. L., Winter, C., Paolone, V., & Jones, M. T. (2019). Effects of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. The Journal of Strength & Conditioning Research17(4), 721-725.
Fernanda D., Vale R., Giani T., Bacellar S., & Dantas E. (2010).  Effects of a Physical activity program on static balance and functional autonomy in elderly women. Macedonian Journal of Medical Sciences, 3(1), 6-21.
Gillespie, L., & Handoll, H. (2009). Prevention of falls and fall-related injuries in older people. Injury Prevention, 15(5), 354-355.
Gruzelier, J. H., Foks, M., Steffert, T., Chen, M. L., & Ros, T. (2014). Beneficial outcome from EEG-neurofeedback on creative music performance, attention and well-being in school children. Biological Psychology, 95, 86-95.
Hertel, J., Gay, MR., & Denegar, CR. (2002). Differences in postural control during single–Leg stance among healthy individuals with different foot types. Journal of Athletic Training, 37(2), 129-132
Karlsson, A., & Frykberg, G. (2000). Correlations between force plates measures for assessment of balance. Clinical Biomechanics, 15(5), 365-369.
Khajavi, D., Farokhi, A., Jaberimoghadam, A., & Kazemnejad, A. (2014). Effect of a training intervention program on fallrelated psychological factors of community-doweling men older adults. Salman, 9(32), 10-25. [Persian]
Mansfield, A., & Inness, EL. (2015). Force plate assessment of quiet standing balance control: Perspectives on clinical application within stroke rehabilitation. Rehabilitation Process and Outcome, 4, Article e RPO-S20363.
Mihara, M., Fujimoto, H., Hattori, N., Otomune, H., Kajiyama, Y., Konaka, K., ... & Mochizuki, H. (2021). Effect of neurofeedback facilitation on poststroke gait and balance recovery: a randomized controlled trial. Neurology96(21), 2587-2598.
Park, J.-H. (2017). The Effects of eyeball exercise on balance ability and falls efficacy of the Elderly who have experienced a Fall. Archives of Gerontology and Geriatrics, 68, 181-185.
Pérez-Elvira, R., Oltra-Cucarella, J., Carrobles, J. A., Moltó, J., Flórez, M., Parra, S., ... & Neamtu, B. (2021). Enhancing the Effects of Neurofeedback Training: The Motivational Value of the Reinforcers. Brain Sciences11(4), Article 457.
Pighills, A., Ballinger, C., Pickering, R., & Chari, S. (2016). A Critical review of the Effectiveness of environmental assessment and modification in the Prevention of falls amongst community dwelling older people. British Journal of Occupational Therapy, 79(3), 133-143.
Province, M. A., Hadley, E. C., Hornbrook, M. C., Lipsitz, L. A., Miller, J. P., Mulrow, C. D., & Weiss, S. (1995). The effects of exercise on falls in elderly patients: A Preplanned meta-analysis of the FICSIT trials. Journal of the American Medical Association, 273(17), 1341-1347.
Rezaei, K., Nami, M., Sinaei, E., Bagheri, Z., & Yoosefinejad, A. K. (2021). A Comparison between effects of neurofeedback and balance exercise on Balance of healthy older adults. Journal of Biomedical Physics & Engineering, 11(6), Article 713. [Persian]
Ruhe, A., Fejer, R., & Walker, B. (2011). Center of pressure excursion as a Measure of balance performance in patients with non-specific low back pain compared to healthy controls: A Systematic review of the Literature. European Spine Journal, 20(3), 358-68.
Shafizadeh, M., Manson, J., Fowler-Davis, S., Ali, K., Lowe, A. C., Stevenson, J., Parvinpour, S., & Davids, K. (2020). Effects of enriched physical activity environments on balance and fall prevention in older adults: AScoping review. Journal of Aging and Physical Activity, 29(1), 178-191.
Shahrbanian, S., Hashemi, A., & Hemayattalab, R. (2021). The Comparison of the Effects of physical activity and neurofeedback training on postural stability and risk of fall in elderly women: A Single-blind randomized controlled trial. Physiotherapy Theory and Practice, 37(2), 271-278. [Persian]
Tsang, WW., Lee, KY., & Fu AS. (2008). Effects of concurrent cognitive task on pre-landing muscle response latency during stepping down activity in older adults with and Without a History of falls. Disability and rehabilitation, 30(15), 1116-22.