smart±step – balance and brain training


What is smart±step?

  • smart±step is a system that uses a wireless step mat and a series of interactive computer games to reduce falls risk in older people. It was developed for people over the age of 65 years, using over 15 years of research from the Falls Balance and Injury Research Centre at NeuRA.
  • smart±step features eight fun and engaging games that challenge balance, as well as thinking, skills of attention, inhibition and visual-spatial. The system is designed to be played at home, and connects easily to a TV or computer monitor.
  • Two pilot randomised controlled trials of an early version of smart±step showed the intervention group had improved balance, step reaction times and central processing ability, compared to the control group.
  • We recently completed two large randomised controlled trials to examine the effects of smart±step on falls, physical and cognitive functions. One study involved 750 older people living in the community. Another multi-site trial involved almost 500 people with multiple sclerosis living in NSW, ACT, Vic and Tas. Results from these trials are now being analysed.
  • NeuRA is currently partnering with Allity to assess the usability of smart±step amongst aged care residents. NeuRA’s long-term goal is to partner with community and assisted living services, as well as hospital inpatient and outpatient departments.


How it works

  • smart±step comes with a wireless step mat and computer system which connect to a television screen or monitor. Players navigate the games, which appear on the screen in front of them, by stepping in the correct direction at the correct time. For example, in one of the games named Toad Runner, players must help their toad avatar to cross busy roads, footpaths and rivers whilst timing their moves to avoid obstacles. The quicker and more precise their steps are, the more likely users are to progress through the game.
  • Each of the eight games contains five levels of difficulty: very easy, easy and moderate through to hard and very hard – very hard is a challenge for a young and healthy person. There are a range of stepping activities to choose from, such as squashing cockroaches and shooting aliens. Each game challenges a different cognitive function, with some requiring more advanced processing ability and quicker reaction times. Players compete with themselves, and are encouraged to get the highest score they can before playing another game. While all games train the brain and body, players who complete multiple games will get the most diverse cognitive training.
  • Accurate and appropriately timed stepping is crucial for avoiding falls, as is sharp mental processing. By training balance and reaction, as well as attention, working memory and task execution, smart±step helps to prevent people from falling in the real world.


The smart±step games

     Smartstep Computer Games


Game title Description
Stepmania Players steps are guided by arrows and dance tracks to make them feel as if they aren’t exercising at all
La Cucaracha Set in a desert, players need to squash cockroaches and avoid the cacti, which zoom past at an increasingly speedy rate
Brick Stacker Players use their feet to rotate and align the falling bricks so that rows can be cleared before they build up to the top of the screen
Alien Invasion Just like the retro arcade game, players use their feet to fire lasers at fast-approaching aliens
Greek Village Players navigate a three dimensional village in Greece and are required to choose the correct path whilst avoiding obstacles as the pace quickens
Anaconda Players step to control the direction of the snake, taking care not to bump into walls or the snake’s own body
Toad Runner Players use their feet to guide the frog across the river, avoiding the obstacles
Dot Muncher Players guide the dot muncher through the maze, using their feet, with the aim to reach the cherry and avoid the four floating ghosts.


See what’s going on at NeuRA


Brain and Knee Muscle Weakness Study

Why Does Quadriceps Weakness Persist after Total Knee Replacement? An Exploration of Neurophysiological Mechanisms Total knee replacement is a commonly performed surgery for treating end-staged knee osteoarthritis. Although most people recover well after surgery, weakness of the quadriceps muscles (the front thigh muscles) persists long after the surgery (at least for 12 months), despite intensive physiotherapy and exercise. Quadriceps muscle weakness is known to be associated with more severe pain and greatly affect daily activities. This study aims to investigate the mechanisms underlying weakness of the quadriceps muscles in people with knee osteoarthritis and total knee replacement. We hope to better understand the relationship between the changes of the brain and a loss of quadriceps muscle strength after total knee replacement. The study might be a good fit for you if you: Scheduled to undergo a total knee replacement; The surgery is scheduled within the next 4 weeks; Do not have a previous knee joint replacement in the same knee; Do not have high tibial osteotomy; Do not have neurological disorders, epilepsy, psychiatric conditions, other chronic pain conditions; Do not have metal implants in the skull; Do not have a loss of sensation in the limbs. If you decide to take part you would: Be contacted by the researcher to determine your eligibility for the study Be scheduled for testing if you are eligible and willing to take part in the study Sign the Consent Form when you attend the first testing session Attend 3 testing sessions (approximately 2 hours per session): 1) before total knee replacement, 2) 3 months and 3) 6 months after total knee replacement. The testing will include several non-invasive measures of brain representations of the quadriceps muscles, central pain mechanisms, and motor function and questionnaires. Will I be paid to take part in the research study? You will be reimbursed ($50.00 per session) for travel and parking expenses associated with the research study visits. If you would like more information or are interested in being part of the study, please contact: Name: Dr Wei-Ju Chang Email: Phone: 02 9399 1260 This research is being funded by the Physiotherapy Research Foundation.