Preventing Falls One Step at a Time: Reactive Balance Training for Spinal Cord Injury

Dr. Kristin Musselman receives Ontario Neurotrauma Foundation and Rick Hansen Institute grant.

Over 86,000 Canadians live with a spinal cord injury. 75% of these people will fall every year.

University of Toronto Department of Physical Therapy Professor Dr. Kristin Musselman is committed to changing this statistic.

Dr. Musselman has received a grant from the Ontario Neurotrauma Foundation and Rick Hansen Institute (ONF-RHI) to conduct a study that will examine the feasibility and effectiveness of reactive step training in people with incomplete spinal cord injury (iSCI).

“Walking is more than putting one foot in front of the other. For people with iSCl, falls are common, and most occur while walking. These accidents result in injuries, readmission to the hospital, and reduced participation in work and recreation” explains Dr. Musselman. “Balance and stability play a huge role in one’s ability to walk safely, and people with iSCI have difficulty taking the reactive steps needed to prevent a fall.”

K. Musselman Action shot 1

Photo: Dr. Musselmans’s Research Assistant Katherine Chan (left) and Clara Pujol, a visiting physical therapist from Spain, demonstrate reactive step training.

Collaborator and fellow status-only faculty member Dr. Avril Mansfield has previously shown that repetitive training of reactive steps in a safe environment can improve balance reaction and prevent falls for the elderly and people with stroke. Dr. Musselman’s study will examine reactive step training in people with iSCI. This training will entail “destabilizing” exercises, where patients learn to react and recover from gentle push/pull forces. Dr. Musselman’s work is unconventional, and has the potential to change current rehabilitation for iSCI, which presently has little emphasis on balance and fall prevention.

“By improving balance and reducing falls, people with iSCI will experience fewer injuries and be able to go about their day with greater confidence in their ability to walk” says Dr. Musselman. Her study will take place within her Spinal Cord Injury Mobility Lab at the Lyndhurst Centre in Toronto over the next three years.  “The strong clinical affiliations at University of Toronto enable me to do this type of unique research” says Dr. Musselman. “My co-investigators and I are thrilled to be running a trial that has the potential to create real change in the lives of people suffering from iSCl.”


  • Dr. Avril Mansfield, TRI-UHN and status appointment in the Department of Physical Therapy, U of T
  • Dr. Kei Masani, TRI-UHN, Institute of Biomaterials and Biomedical Engineering, U of T
  • Dr. Cathy Craven, TRI-UHN, Faculty of Medicine, U of T
  • Dr. Carol Scovil, TRI-UHN
  • Dr. Alison Oates, University of Saskatchewan
  • Dr. Joel Lanovaz, University of Saskatchewan


Dr. Kristin Musselman is a physical therapy professor at the University of Toronto. She is also Director of the Spinal Cord Injury Mobility Lab at the Lyndhurst Centre and a scientist with the Neural Engineering & Therapeutics Team and Mobility Team at the University Health Network’s Toronto Rehabilitation Institute.