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


Abdominal muscle stimulation to improve bowel function in spinal cord injury

Bowel complications, resulting from impaired bowel function, are common for people living with a spinal cord injury (SCI). As a result, people with a SCI have high rates of bowel related illness, even compared with those with other neurological disorders. This includes high rates of abdominal pain, constipation, faecal incontinence and bloating. These problems lower the quality of life of people with a SCI and place a financial burden on the health system. A treatment that improves bowel function for people with a SCI should reduce illness, improve quality of life and lead to a large cost saving for health care providers. Bowel problems have traditionally been managed with manual and pharmacological interventions, such as digital rectal stimulation, enemas, and suppositories. These solutions are usually only partially effective, highlighting the need for improved interventions. The abdominal muscles are one of the major muscle groups used during defecation. Training the abdominal muscles should improve bowel function by increasing abdominal pressure. During our previous Abdominal FES research with people with a SCI, we observed that Abdominal FES appeared to lead to more consistent and effective bowel motion. However, this evidence remains anecdotal. As such, we are going to undertake a large randomised controlled trial to investigate the effectiveness of Abdominal FES to improve the bowel function of people with a SCI. This study will make use of a novel measurement system (SmartPill, Medtronic) that can be swallowed to measure whole gut and colonic transit time. We will also assess whether Abdominal FES can change constipation-related quality of life and the use of laxatives and manual procedures, as well as the frequency of defecation and the time taken. A positive outcome from this study is likely to lead to the rapid clinical translation of this technology for people living with a SCI.