Loss-of-balance (LOB) events, such as trips and slips, are frequent among community-dwelling older adults and are an indicator of increased fall risk. In a preliminary study, eight community-dwelling older adults with a history of falls were asked to perform everyday tasks in the real world while donning a set of three inertial measurement sensors (IMUs) and report LOB events via a voice-recording device. Over 290 h of real-world kinematic data were collected and used to build and evaluate classification models to detect the occurrence of LOB events. Spatiotemporal gait metrics were calculated, and time stamps for when LOB events occurred were identified. Using these data and machine learning approaches, we built classifiers to detect LOB events. Through a leave-one-participant-out validation scheme, performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPR). The best model achieved an AUROC ≥0.87 for every held-out participant and an AUPR 4-20 times the incidence rate of LOB events. Such models could be used to filter large datasets prior to manual classification by a trained healthcare provider. In this context, the models filtered out at least 65.7% of the data, while detecting ≥87.0% of events on average. Based on the demonstrated discriminative ability to separate LOBs and normal walking segments, such models could be applied retrospectively to track the occurrence of LOBs over an extended period of time.

Intensive balance and coordination training is the mainstay of treatment for symptoms of impaired balance and mobility in individuals with hereditary cerebellar ataxia. In this study, we compared the effects of home-based balance and coordination training with and without vibrotactile SA for individuals with hereditary cerebellar ataxia. Ten participants (five males, five females; 47 ± 12 years) with inherited forms of cerebellar ataxia were recruited to participate in a 12-week crossover study during which they completed two six-week blocks of balance and coordination training with and without vibrotactile SA. Participants were instructed to perform balance and coordination exercises five times per week using smartphone balance trainers that provided written, graphic, and video guidance and measured trunk sway. The pre-, per-, and post-training performance were assessed using the Scale for the Assessment and Rating of Ataxia (SARA), SARA_posture&gait sub-scores, Dynamic Gait Index, modified Clinical Test of Sensory Interaction in Balance, Timed Up and Go performed with and without a cup of water, and multiple kinematic measures of postural sway measured with a single inertial measurement unit placed on the participants’ trunks. To explore the effects of training with and without vibrotactile SA, we compared the changes in performance achieved after participants completed each six-week block of training. Among the seven participants who completed both blocks of training, the change in the SARA scores and SARA_posture&gait sub-scores following training with vibrotactile SA was not significantly different from the change achieved following training without SA ($p>0.05)$. However, a trend toward improved SARA scores and SARA_posture&gait sub-scores was observed following training with vibrotactile SA; compared to their pre-vibrotacile SA training scores, participants significantly improved their SARA scores ($mean=-1.21, p=0.02)$ and SARA_posture&gait sub-scores ($mean=-1.00, p=0.01)$. In contrast, no significant changes in SARA scores and SARA_posture&gait sub-scores were observed following the six weeks of training without SA compared to their pre-training scores immediately preceding the training block without vibrotactile SA ($p>0.05)$. No significant changes in trunk kinematic sway parameters were observed as a result of training ($p>0.05)$. Based on the findings from this preliminary study, balance and coordination training improved the participants’ motor performance, as captured through the SARA. Vibrotactile SA may be a beneficial addition to training regimens for individuals with hereditary cerebellar ataxia, but additional research with larger sample sizes is needed to assess the significance and generalizability of these findings.

With the rapid expansion of telehealth, understanding how video-based assessments influence clinical reasoning is critical for effective rehabilitation. While prior work has examined feasibility and clinician confidence, less is known about how assessment modality shapes observational features underlying decision-making. In this study, physical therapists (PTs) evaluated standing balance either in-person or via video and verbalized their reasoning using a retrospective think-aloud protocol. Transcripts ( n = 1,760) were thematically analyzed. Overall performance ratings were similar across assessment modalities, but observational content differed. Video assessments were associated with greater attention to temporal aspects of sway, including frequency and timing. In contrast, in-person assessments were associated with greater attention to lower-limb compensatory strategies, including ankle, knee, and hip mechanisms. These findings suggest assessment modality may redistribute attention across observable features rather than altering overall judgment, highlighting the opportunity for training and tools to account for modality-specific differences in clinical observation.