NOW AVAILABLE: CPSR-funded Reactive Balance Training Toolkit

Available at:

After years of research and development, CPSR researchers have gone live with a valuable toolkit to help people practice and improve control of their balance reactions and prevent falls, especially after stroke. Development of the toolkit began in 2018, thanks to funding from CPSR. This toolkit is for health-care professionals who treat clients for problems with balance or increased falls risk.

Dr. Avril Mansfield of UHN describes the work behind this toolkit, why it’s needed and who use should it: 

Why did you develop the Reactive Balance Training Toolkit? 
When we lose our balance and start to fall, we can use rapid balance reactions, like taking a step or grasping a handrail, to prevent falling to the ground. Older people and people with neurologic injury, like stroke, often have difficulty controlling these balance reactions and preventing falling. Reactive balance training is a type of balance training where people repeatedly lose balance so that they can practice and improve control of their balance reactions. Previous research, including our own work, has shown that reactive balance training can improve the effectiveness of balance reactions and prevent falls in daily life in older adults, people with Parkinson’s disease, and people with stroke. When we present our study findings to clinicians, they have a lot of questions about how exactly they can implement this type of training in practice. So, we felt that there was a need for one central resource where clinicians could find information about reactive balance training, including a summary of research on the topic, what types of clients are appropriate for reactive balance training, how to assess reactive balance control, how to provide the balance perturbations used in training, and how to ensure client safety during training.

How long did it take to develop and test the toolkit?
We had a very simple version of a training manual that we developed for one of our studies over 7 years ago, and we’ve been collecting videos of real clients doing reactive balance training over the past 5 years or so. We didn’t start to put these resources together into one comprehensive toolkit until 2018, when we received funding from CPSR to develop the toolkit. Our first step was to survey about 400 physiotherapists and kinesiologists across Canada to find out their learning needs around reactive balance training. Based on the early version of our training manual, we then created a draft version of the toolkit and asked 10 clinicians who use reactive balance training regularly with their clients to provide feedback on this draft. We used this feedback to develop the final version of the toolkit, which was then reviewed by our development team for final edits. At the same time as consulting with clinicians, we also conducted a systematic review of reactive balance training to update the research evidence for the toolkit.

Who is your target audience?
The toolkit should be used by any healthcare professional who treats clients for problems with balance or increased fall risk. I imagine most of the users will be physiotherapists or kinesiologists, but other healthcare professionals, like occupational therapists or nurses, might also find the content useful. A lot of the toolkit content is focused on stroke rehabilitation, because that’s where our team’s expertise is. However, reactive balance training may be suitable for people with other conditions, like Parkinson’s disease or spinal cord injury.

What will they gain from using the toolkit?
They will learn how to implement reactive balance training in their settings. Topics include: contraindications and precautions for reactive balance training, assessing reactive balance control, safety considerations, how to deliver balance perturbations, and how to progress the challenge of training.

Who contributed to the development of this resource?
The core development team included me, Liz Inness, Cynthia Danells, Kristin Musselman, Nancy Salbach, and Jennifer Kochanowski. David Jagroop did a lot of the design work and consolidated feedback from clinicians. Lou Biasin, Vince DePaul, Svetlana Knorr, and Vivien Poon contributed to very early versions of the reactive balance training manual. Susan Gorski provided input on the safety harness requirements.