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Simbex develops world-class products using biofeedback for injury prevention, mobility and rehabilitation.

Frequently Asked Questions

1. Why do some people fall when they trip or slip and others recover? How can ActiveStep make a difference?
2. Why does ActiveStep work? What research is ActiveStep based on?
3. Is ActiveStep only a research tool?
4. Can ActiveStep be used to assess fall risk?
5. How long does an ActiveStep fall risk assessment take?
6. How does a simulated trip or slip on ActiveStep compare to a trip or slip in the environment?
7. Does the research demonstrate a carryover from ActiveStep simulator training to overground walking?
8. ActiveStep fall risk assessment and training is based on trips and slips from a static position rather than during walking. Is this a problem?
9. Does ActiveStep replace other interventions that may help reduce the risk of falling?
10. Is ActiveStep only for active, healthy elderly adults?
11. Does ActiveStep provide benefits for clinically impaired populations?
12. Can ActiveStep be used with assistive devices?
13. How can ActiveStep help me as a patient? Physician? Therapist? Insurer?
14. Are there objective measures that demonstrate ActiveStep's efficacy?

1. Why do some people fall when they trip or slip but other people recover?

Individuals fall when they are unable to respond quickly enough after a postural perturbation to maintain balance. In many cases, a recovery step is critical following large postural perturbations. The ability to recover from an imbalance with an adequate stepping response is something that we all do on a daily basis. However, this automatic response can diminish with age. ActiveStep is designed to help older adults retain their active lifestyle and to reduce the likelihood of falling following a trip or a slip event.

2. Why does ActiveStep work? What research is ActiveStep based on?

During the 1990’s, Dr. Mark Grabiner and his colleagues developed a novel experimental approach through which realistic trips could be unexpectedly induced under controlled laboratory conditions (Grabiner et al., 1993, 1996). When older adults were subjected to these trip conditions, several biomechanical variables, including trunk angle and trunk angle velocity, were found to be causally related to the success or failure of older adults in avoiding a fall (Pavol et al, 1999a; 1999b; 2001). This is important because these variables are modifiable, can be easily measured, and changes over time can be quantified as part of objective analysis. ActiveStep targets improvements in these variables known to reduce the incidence of falls.

In the early 2000’s, a treadmill-based method was developed to deliver repeatable postural disturbances that can mimic an actual trip or slip that occurs while walking. This concept was aimed at developing a clinically relevant intervention to specifically train the stepping response required to avoid falling after a trip or slip (Owings et al., 2001). ActiveStep is the direct descendant of that method; it is a unique simulator designed to deliver these task-specific postural perturbations in a rehabilitation environment (patents).

  • Dr. Grabiner’s research, funded by research grants from the National Institutes of Health and the Centers for Disease Control and Prevention, has demonstrated that:

  • Control of the trunk is a key factor in recovering from trips and slips (Pavol et al., 1999, 2001)

  • Successful recovery from a trip requires, in part, stopping the trunk flexion induced by the trip (Grabiner et al., 1993).

  • Older adults can rapidly learn to perform appropriate step responses to avoid falling using a treadmill-based simulator that induces trips and slips (Owings et al., 2001; Troy and Grabiner, 2005)

ActiveStep incorporates these research findings in a state-of-the-art clinical tool for falls assessment and fall prevention training. It helps to retrain stepping responses, which may be negatively affected by age, with the goal of reducing falls following a tripping or slipping event.

An excellent summary of the history of this research effort is found in (Grabiner et al., 2008).

3. Is ActiveStep only a research tool?

No, ActiveStep, based on 15 years of research, is a highly controllable simulator developed as a clinical intervention that focuses on training the critically important stepping response. ActiveStep provides:

  • TASK SPECIFIC TRAINING IN A REHABILITATION SETTING: ActiveStep delivers dynamic postural perturbations that require compensatory stepping responses to avoid falling after a trip. Improvements in compensatory stepping responses can be learned in as few as four training sessions over a two week period,

  • SKILL RETENTION: the stepping skills that are learned during ActiveStep training are retained for greater than one month (Gatts et al., 2008, unpublished).

  • CLINICALLY RELEVANT SKILL TRANSFER TO OVERGROUND WALKING: ActiveStep training reduced the incidence of laboratory-induced trip-related falls by more than 95% - which is both statistically significant and clinically important.

4. Can ActiveStep be used to assess fall risk?

Yes, ActiveStep is a valuable assessment tool that can identify individuals who have difficulty controlling the motion of their upper body following a trip or slip and who might benefit from the unique ActiveStep training program. An assessment of fall risk on ActiveStep provokes task-specific responses to actual falls situations, and is therefore quite different than other quasi-static and dynamic balance tests which are often used to assess fall risk. The data collected with ActiveStep is recorded automatically and is used as supporting documentation for reimbursement.

5. How long does an ActiveStep fall risk assessment take?

Approximately 15-20 minutes, and can be incorporated into existing falls risk assessment paradigms. ActiveStep augments and strengthens other information gathered by the medical team, such as balance, sensory, and cognitive function, and other risk factors (e.g. medications, home environment, etc) that are used to develop a comprehensive training plan for each individual.

6. How does a simulated trip or slip on ActiveStep compare to a trip or slip in the environment?

The way the body responds to trips or slips on ActiveStep is very much the same as in a situation that might occur at home or at the mall. The biomechanics of a recovery step following a large postural perturbation delivered from a standing position on a treadmill simulator like ActiveStep were highly correlated with the biomechanics of the stepping response when individuals are tripped during over-ground walking. Inducing trips and slips with ActiveStep from a static position rather than during walking allows for a more controlled environment for training the step recovery response. Most importantly, Dr. Grabiner’s research has demonstrated that stepping response training using ActiveStep reduced the likelihood of falling following a large postural perturbation in a simulated overground trip or slip situation. This means that training on ActiveStep is transferrable to real tripping and slipping events.

7. Does the research demonstrate a carryover from ActiveStep simulator training to overground walking?

Yes, Dr. Grabiner’s research demonstrated that step recovery training using ActiveStep carried over to over-ground walking. Specifically, when a group of healthy, elderly adults were tested after the last training session, the rate of falls in an over-ground tripping situation was reduced from 25% to <1% (n=53) following 4 sessions of ActiveStep training over 2 weeks.

8. ActiveStep fall risk assessment and training is based on trips and slips from a static position rather than during walking. Is this a problem?

No, the biomechanics of a stepping response following a large postural perturbation delivered from a standstill position on a treadmill simulator are highly correlated with the biomechanics of step response when individuals are tripped during over-ground walking. Inducing trips and slips with ActiveStep from a standing position allows for a more controlled environment for training the step recovery response. Most importantly, Dr. Grabiner’s research demonstrated that step recovery response training using ActiveStep reduced the likelihood of falling following a large postural perturbation in a simulated overground trip or slip situation. This means that training on ActiveStep is transferrable to real tripping and slipping events.

9. Does ActiveStep replace other interventions that may help reduce the risk of falling?

Not at all. ActiveStep synergizes with various interventions including strength and flexibility training, balance training, tai chi, and more. ActiveStep adds a unique task-specific dynamic stability component to the rehabilitation regimen that cannot be readily accomplished with other existing techniques or equipment.

10. Is ActiveStep only for active, healthy elderly adults?

No, ActiveStep training and assessment profiles are designed for a wide range of physical fitness levels and disabilities. The physical therapist guides the intensity and effort required to complete the ActiveStep protocols based on their comprehensive assessment of the individual. ActiveStep treatment has been provided to patients with a variety of disabilities, including but not limited to stroke, Parkinson’s disease, peripheral neuropathy, and dementia. ActiveStep training is readily performed using assistive devices.

The goal of the ActiveStep fall prevention and assessment program is to help the individual to maintain a healthy, active lifestyle by improving the ability to recover from a potentially injurious fall event through a dynamic stepping response. This is true for healthy adults, older adults with disabilities, and for frail elderly individuals who are at even higher risk of falling. Preventing the fall is the key.

11. Does ActiveStep provide benefits for clinically impaired populations?

Yes, ActiveStep treatment has been provided to patients with a variety of disabilities, including but not limited to stroke, Parkinson’s disease, peripheral neuropathy, and dementia. Active training and assessment profiles are designed for a wide range of physical fitness levels and disabilities. The physical therapist guides the intensity and effort required to complete the ActiveStep protocols based on their comprehensive assessment of the individual. ActiveStep training is readily performed using assistive devices.

For example, researchers have demonstrated the positive effects of treadmill specific training on balance and reduction in falls for patients diagnosed with Parkinson’s disease.

12. Can ActiveStep be used with assistive devices?

Yes, ActiveStep training allows for the use of assistive devices such as canes and walkers and to simulate situations that might elicit imbalances or fall risks directly related to the use of assistive devices

13. How can ActiveStep help me as a patient? Physician? Therapist? Insurer?

ActiveStep has significant value for patients, physicians, therapists and their clinics and insurers.

14. Are there objective measures that demonstrate ActiveStep's efficacy?

Timed Up and Go (TUG) tests are accepted measures of mobility. The following chart shows the improvement in a small sample of ActiveStep patients who improved their TUG scores enough to change their classification for a high risk of falls to normal fall risk.