Does Cognitive Restructuring Improve Postural Control in Older Adults?




Papa, Evan
Watson, Taylin
Bugnariu, Nicoleta


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Purpose: Falls are a major source of disability in the aging population. The cause of falls is multifactorial, but components such as fear of falling are often overlooked.1 Older adults that have a fear of falling also have an increased risk for future falls.2-3 Physical therapists use cognitive-behavioral therapy techniques such as cognitive restructuring, to enhance treatment and reverse the fear of falling.4-5 However, there is a paucity of evidence regarding the effects of cognitive restructuring on postural control. The purpose of this investigation was to determine if an 8-week cognitive restructuring program, designed to reduce the fear of falling, can improve postural control in older adults. Methods: 4 healthy older adults (avg age 73.3 + 8.5 yrs) who passed a screening test underwent postural control testing before (T0) and after (T1) an 8-week cognitive restructuring program. Clinical balance testing included the Activities-Specific Balance Confidence (ABC) Scale, Timed-Up and Go (TUG), and Four Square Step (FSST) tests. The experimental balance testing included static and dynamic balance using a 12-camera Motion Analysis system that tracked markers on the body for calculation of temporal and spatial kinematic movements. A V-GAIT CAREN system with dual-belt treadmill motion platform was used to create perturbations to balance. Paired samples t tests were used to compare before and after variables of each of the clinical and experimental tests. Significance was set at p Results: Clinical balance testing of the ABC (p=.672), TUG (p=.179), and FSST (p=.748), found no statistically significant differences. Statistical significance was found for experimental testing of dynamic backward-directed balance perturbations in two phases. The center of pressure-center of mass difference (COP-COM) was significantly increased at 1/3rd (p=.003) and 2/3rd (p=.009) of the recovery step from before (T0) to after (T1). The mean difference in scores was -.014mm for 1/3rd, -.027mm for 2/3rd, and -.065mm for 3/3rd of the recovery step. Conclusions: Experimental testing showed significant increases in COP-COM in two of three phases of stepping and approached significance for the complete task. Large differences in COP-COM are indicative of robust postural control.6 Our results demonstrate that a cognitive restructuring program can improve stability and control over falls in older adults.


Research Appreciation Day Award Winner - 2018 School of Health Professions, Physical Therapy Program Poster Award - 1st Place