Reducing Fall Risk with Perturbation-Based Balance Training (PBBT)

Mar 2

2 min read

Falls among older adults are, unfortunately, quite common. According to the CDC, one in three people over the age of 65 will experience a fall within the next year. Given this alarming statistic, researchers are constantly seeking effective ways to reduce fall risk.

In a previous post, I discussed various factors that contribute to falls, such as certain medications, environmental hazards (loose rugs, cords in walkways), and visual impairments. In this post, we’ll focus on the physical aspect of fall prevention—specifically, a novel training method that physical therapists (PTs) use to help improve balance and reduce the likelihood of falling.

The Role of Reaction Time and Power in Fall Recovery

As we age, our reaction time and power output decline at a faster rate than strength. These two elements are crucial for recovering from a loss of balance.

For example, imagine you're walking down the street and stepping up onto a curb. If you don’t lift your foot high enough, your toe might catch the edge, causing you to lose your balance forward. To prevent a fall, you need to:

React quickly and initiate a recovery step. The faster your reaction time, the more likely you are to regain balance.
Generate a strong, fast recovery step. It’s not just about moving your foot—it’s about producing enough power to take a large, forceful step that restores stability.

Since these two factors—reaction time and power—are so important, researchers have explored ways to train them simultaneously. This led to the development of Perturbation-Based Balance Training (PBBT).

What Is Perturbation-Based Balance Training (PBBT)?

PBBT is a specialized form of balance training that simulates real-life falls in a safe, controlled environment. Researchers define it as:

"Balance training that uses repeated, externally applied mechanical perturbations to trigger rapid reactions to regain postural stability."

In simpler terms, PBBT helps individuals practice recovering from falls in a safe setting. This training can be delivered in various ways, including:

Treadmills with sudden speed changes
Slip trainers that simulate slipping motions
Pushes and pulls applied by a therapist

For example, I often use a gait belt during training sessions to provide gentle, unexpected pushes or pulls at irregular intervals. This method helps my clients improve both reaction time and power output, making them better equipped to recover from real-life balance disruptions.

Is PBBT Right for You?

While PBBT is an effective tool, it should only be performed under the supervision of a trained therapist. It is not safe to attempt on your own at home.

If you're concerned about fall risk and think you might benefit from this training, feel free to give me a call to discuss whether PBBT could be right for you.