Prevent injuries by teaching people to fall, or not to fall

Clive Pai, professor of physical therapy, studies falling

“We have never learned how to fall,” says UIC researcher Clive Pai. Also working in the lab are (L-R) Crystal Xuan Liu, Emma Yiru Wang and Anna Lee. Photo: Roberta Dupuis-Devlin/UIC Photo Services

Clive Pai believes people can be trained not to fall.

With a five-year, $1 million grant from the National Institute on Aging, the professor of physical therapy is building on previous research by developing a computerized treadmill program that could be used in physical therapy offices to prevent falls and fall-related injuries in older adults.

Each year, one in three adults over 65 falls at least once, according to the Centers for Disease Control and Prevention. Falls are the leading cause of injury in older adults and make it harder for them to get around and live independently. In 2010, more that 21,000 older adults died from injuries related to falls.

Pai has been studying how people fall for over 20 years. Everyone falls in a unique way because it’s unrehearsed and unexpected.

“We have never learned how to fall,” he said.

His research led him to a remarkable discovery — people can be trained relatively quickly and easily how not to fall.

In a recent study, Pai enlisted adults, aged 65 to almost 90, who live independently. The subjects were never told when or how they might fall, as they trod a special walkway in his lab, strapped safely into a harness. Suddenly, like stepping on a banana peel, the footing surface slid out from under them.

“For the first time, the second time, and maybe the third time, they experienced falling. And then, all of sudden, they stopped falling,” Pai said. “They were so quick to adapt — that was the real fascination to me.”

The quickness with which his study subjects (young and old) adapted and learned not to fall as the rug was pulled out from under them was unlike any other motor-learning Pai had seen.

“No one masters playing the piano or even a simple dance step after only two or three tries,” he said.

Pai discovered that his subjects retained what they had learned for as long as 12 months. Not only were they less likely to fall when they returned to the lab six months to a year later, in their daily lives they were 50 percent less likely to fall in the year after training than in the year before.

Pai’s team also found that the tests and training were even for people with reduced bone density. He hopes it will prove safe even for people with osteoporosis, the most severe bone thinning, who are most at risk for a poor outcome after a fall.

Pai’s lab set-up is too bulky for the typical physical therapy office, so he developed a computer-controlled treadmill program that replicates the training device in his lab. The new NIH grant will help him determine if the treadmill training can be as effective.

Pai said he would like to see the day when annual preventive care for older adults would include a half hour on a treadmill, strapped into a safety harness, learning to not fall.

“We want to inoculate people against falls,” he said.

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