Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial.

The study was a small pilot trial with no prior power calculation, limiting the certainty of the findings. Fall rates were not measured, so it is unclear if the improved balance scores translate to fewer actual falls. The split-belt treadmill used to create perturbations is specialized equipment that may not be available in many clinical settings. Participants in the NonPerturb group who refused the control intervention or crossed over were not fully accounted for in the primary comparison, potentially introducing bias. The intervention involved a high number of perturbations per session, which may be difficult to replicate in busy clinical environments due to session length.

The study was supported by non-U.S. government funding. The authors declared no competing interests.

Do not assume this training reduces falls. The study measured balance scores and gait speed, not actual fall incidence. Additionally, the significant benefits were driven by the perturbation group's improvement; the walking-only group did not worsen, they simply did not improve, so this is an efficacy finding for a specific advanced intervention, not a replacement for standard care.