The goal of this clinical trial with an embedded observational phase is to evaluate whether a phenotype-guided, personalized rehabilitation program can improve fall risk and underlying neural control mechanisms in older adults aged ≥65 years, including both high and low fall-risk individuals.
The main questions it aims to answer are:
Do older adults at high fall risk exhibit altered neural, neurocognitive, and biomechanical profiles compared with low/no fall-risk individuals? Does personalized rehabilitation guided by neurophysiological and neurocognitive profiles result in greater reductions in fall risk and improvements in motor control compared with conventional rehabilitation?
Researchers will compare personalized phenotype-guided rehabilitation to conventional evidence-based fall-prevention exercise to determine whether targeted, mechanism-based intervention leads to superior clinical and mechanistic outcomes.
Participants will:
Undergo a comprehensive multimodal assessment including neurophysiological (EEG, EMG), neurocognitive (fNIRS, dual-task testing), and biomechanical (gait and balance) measures Be classified into fall-risk and neurophysiological control profiles based on assessment results (Phase 2 - high fall-risk participants only) be randomly assigned to either personalized rehabilitation or conventional rehabilitation Attend supervised exercise sessions 2-3 times per week for 8-12 weeks Complete gait, balance, and cognitive-motor assessments before and after the intervention Record falls prospectively using monthly fall diaries and follow-up monitoring over 3-6 months
Inclusion Criteria:
Participants must meet all of the following criteria:
Participants will be stratified into fall-risk categories based on established criteria:
Exclusion Criteria:
Participants will be excluded if they have:
U25100059@sharjah.ac.ae+971507373053
Participants aged ≥65 years classified as high fall risk (based on fall history and/or impaired functional performance) will undergo a comprehensive multimodal assessment to characterize neural, neurocognitive, and biomechanical determinants of fall risk. No therapeutic intervention will be administered. Assessments include: Neurophysiological recordings using electroencephalography and electromyography during standardized balance tasks Neurocognitive assessment using functional near-infrared spectroscopy during single- and dual-task conditions Quantitative gait and balance assessment using wearable smartphone-based sensors Functional clinical measures of mobility and balance The purpose of this arm is to identify mechanistic differences and support neurophysiological phenotyping.
Participants aged ≥65 years classified as low or no fall risk will undergo the same multimodal assessment protocol as the high-risk group. This arm serves as a reference group to establish normative ranges for neural, neurocognitive, and biomechanical variables Assessments include: * Neurophysiological recordings using electroencephalography and electromyography during standardized balance tasks * Neurocognitive assessment using functional near-infrared spectroscopy during single- and dual-task conditions * Quantitative gait and balance assessment using wearable smartphone-based sensors * Functional clinical measures of mobility and balance Data from this group will be used to define reference thresholds for neurophysiological classification and comparative analysis.
Participants classified as high fall risk will receive a personalized rehabilitation program tailored to their individual neurophysiological and neurocognitive profile, derived from Phase 1 assessments. The intervention targets underlying neural control mechanisms and is adapted based on identified control strategies (e.g., cortical-dominant, reflex-dominant, or integrated control). Intervention components may include: Task-specific balance and gait training under variable sensory conditions Dual-task training to improve cognitive-motor integration External focus and rhythm-based training to enhance movement automaticity Reaction-based and perturbation training to improve adaptability Progressive modulation of task complexity based on participant response Program details: Duration: 8-12 weeks Frequency: 2-3 supervised sessions per week Session length: 45-60 minutes The intervention is dynamically progressed based on neurophysiological and functional responses.
Participants classified as high fall risk will receive a standard evidence-based fall-prevention exercise program consistent with current clinical guidelines. The intervention focuses on general physical improvements rather than individualized neural mechanisms. Intervention components include: Balance training (static and dynamic postural control exercises) Lower-limb strengthening exercises (e.g., sit-to-stand, step-ups, resistance training) Gait and functional mobility training (walking, turning, obstacle negotiation) Flexibility and mobility exercises Education on fall prevention strategies Program details: Duration: 8-12 weeks Frequency: 2-3 supervised sessions per week Session length: 45-60 minutes Progression is based on standard clinical criteria such as safety, tolerance, and performance.
iabuamr@sharjah.ac.ae+972565057513
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