Falls and balance

Prof Stephen Lord, Dr Jasmine Menant

Walking is not automatic and requires attention and brain processing to maintain balance and prevent falling over. Brain structure and function deteriorate with ageing and neurodegenerative disorders, in turn impacting both cognitive and motor functions.

This series of studies will investigate:

• How do age and/or disease- associated declines in cognitive functions affect balance control?
• How is this further impacted by psychological, physiological and medical factors (eg. fear, pain, medications)?
• How does the brain control these balance tasks?

Approach

The experiments involve experimental paradigms that challenge cognitive functions of interest (eg.visuo-spatial working memory, inhibitory function). I use functional near-infrared spectroscopy to study activation in superficial cortical regions of interest (eg. prefrontal cortex, supplementary motor area…). The studies involve young and older people as well as clinical groups (eg.Parkinson’s disease).

Studies

• Cortical activity during stepping and gait adaptability tasks
• Effects of age, posture and task condition on cortical activity during reaction time tasks
• Influence of balance challenge and concern about falling on brain activity during walking
• Influence of lower limb pain/discomfort on brain activity during stepping

This research will greatly improve our understanding of the interactions between brain capacity, functions and balance control across ageing and diseases, psychological, physiological and medical factors, allows to identify targets for rehabilitation.

It will also help identifying whether exercise-based interventions improve neural efficiency for enhanced balance control.

Prof Stephen Lord, Dr Phu Hoang, Dr Jasmine Menant

Gait dysfunction in Mulitple Sclerosis is an important risk factor for falls. Although there is detailed biomechanical evidence of impaired gait patterns in people with Multiple Sclerosis, there is a paucity of objective empirical data relating specific lower limb muscle strength deficits and gait impairments. Most studies to date have used manual muscle testing to investigate lower limb muscle strength and/or have only focused on knee flexors and extensors.

In this study, we aim to identify weak lower limb muscles contributing to gait impairment in Multiple Sclerosis.

Our experimental protocol involves a comprehensive assessment of isometric strength in eight major lower limb muscle groups using electronic strain gauges. We then conduct a full lower-limb gait analysis using motion capture and force platforms. We will conduct statistical analyses to determine which weak muscle groups are significantly associated with markers of gait impairment in Multiple Sclerosis (eg. knee range of motion during the gait cycle). We are also planning to use electromyography on the identified deficient muscle groups in a subset of participants.

Our research will identify the muscle groups contributing to poor gait, likely causing imbalance and trips in people with Multiple Sclerosis. This work is crucial for developing progressive resistance training programs that directly target weak muscle groups to improve gait in people with Multiple Sclerosis. 

A randomised controlled trial to reduce the risk of falling in people with Parkinson’s disease.

View the clinical trial page for more information and to express interest in volunteering for the study.

Catastrophizing thoughts about falls can trip people up. We are now looking for programs that can help reduce concern about falling in older people.

Falls and fear of falling affect many older adults and can impose limitations upon daily activities. Over one third of community dwelling older adults fall each year with about 15% of falls being injurious. However, over two thirds of older adults express fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities with consequent negative impacts on lower quality of life.

Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy and balance exercise programs. We are collaborating with Black Dog Institute to investigate the effectiveness of an online cognitive behavioural program (myCompass) versus a health education program for 6 weeks at reducing concerns about falling in community-dwelling older people. The intervention consists of a fully-automated cognitive behavioural therapy program (myCompass) delivered through a tablet or computer in people’s homes with no therapist input, including evidence-based and interactive psychological modules that users can complete via the internet on a tablet or computer in their homes.

An engaging self-managed neuro-rehabilitation program using eHealth technologies to improve mobility and enhance independence in people with Parkinson’s disease:

Parkinson’s disease is a multi-systems neurodegenerative disease with the severity of clinical symptoms (including postural instability, gait dysfunction an falls). With the population aging, the number of people affected by Parkinson’s disease is expected to double every 25 years presenting an increasing burden on health service and society as a whole. Falls are a common and devastating event in individuals with Parkinson’s disease and often precipitated by excessive gait variability, postural instability and freezing of gait.

Visual, attentional, haptic and auditory stimuli have been used to improve gait dysfunction in people with Parkinson’s disease. The aim of this project is to develop and evaluate a self-managed program using mHealth technology to improve mobility in people suffering from Parkinson’s disease. Dr Matthew Brodie was awarded a Michael & Elizabeth Gilbert Scholarship in Parkinson’s Disease Research.

An engaging self-management program and scalable intervention using mobile technology to enhance healthy ageing and reduce fall risk in people with intermittent claudication: a randomised trial.

Cardiovascular disease is the leading cause of death and hospital admissions in Australia. Intermittent claudication is an intense cramping leg pain triggered by exercise and a common symptom of Peripheral Arterial Disease. It often causes functional decline, high health service use and loss of independence. Vascular interventions are often used to treat peripheral arterial disease, but are expensive and have limited durability. There is strong evidence that supervised exercise mitigates symptoms and reduces surgery rates. However, compliance and motivation with existing programs is poor (>40% dropout) due to beliefs that exercise-induced pain is harmful.

Supported by the UNSW Medicine Neuroscience, Mental Health and Addiction Theme and SPHERE Clinical Academic Group, we have developed a scalable self-management program for peripheral arterial disease delivered through mobile technology. Our program includes evidence-based standing balance exercises, pain management and interval walking components. It provides individually-tailored tools to empower older people suffering from intermittent claudication to lead more active lives, manage their pain and thereby improving their health outcomes long-term.

An international alliance lays the groundwork for the widespread implementation of StandingTall. This study targets a major need for older people for whom falls are a real risk that can have debilitating impacts on quality of life. It has been developed with major input from all partners and constitutes a valuable, collaborative partnership between researchers, experts in health promotion, health care providers and policy makers. Our partners for this project are the NSW Office of Preventive Health, Ministry of Health; the Clinical Excellence Commission; and the Agency for Clinical Innovation; two NSW Local Health Districts; i.e. Northern NSW and mid-North Coast; Austin Health, Uniting and the Northern Health Science Alliance in the United Kingdom. PLEASE NOTE: recruitment has finished for Australia.

The study aims to accelerate the implementation of StandingTall. It will address the final steps needed to scale up this innovative technology for widespread use by older people across Australia and England with prospects for further international translation. The overall aim of this international project is to establish integrated processes and pathways to deliver StandingTall to older people and to provide ongoing support as required. The project provides scope for further broad scale implementation and a model for incorporating StandingTall into existing health services and routine care.

For more information:

If in the UK, email: StandingTaller@manchester.ac.uk

If in Australia, please be aware that recruitment has finished for all Australian sites. If you are already participating and need to contact us, please phone: 02 9399 1113 or email: standingtaller@neura.edu.au.

We will address loss of balance, a pressing health-related issue that affects quality of life in ~5% of the population. Once the balance organ is injured or degrades with age, no treatments restore function. We have identified a nerve-pathway crucial for balance system adjustment & self-repair. The sensitivity of this pathway can be increased with vitamin C. We will determine if vitamin C treatment can improve recovery after balance loss and potentially translate to the clinic.

Falls and functional decline are common in people with dementia. Falls are more likely to result in injury, death and institutionalisation when compared to older people without dementia. There is limited evidence that falls can be prevented in people with dementia. Strategies aimed at maintaining independence and preventing decline and falls are urgently needed. This research will a) further our understanding of fall risk and functional decline and b) explore novel fall and decline prevention programs, including the use of technology in older people with dementia.

There are approximately 17,000 new hip fractures in Australia and 4,000 in New Zealand annually. The cost of the event is enormous, both for the individual and their family, as well as the health care system. There is variation in models of hip fracture care within and between States and Territories (Aus) and District Health Boards (NZ). Much of what happens in the acute and rehabilitation settings impacts directly on the longer term outcomes for the person with the fracture. The ANZHFR allows for timely comparison of meaningful data that can be used by providers of care to understand clinical practice, and trigger a case for change in places where improvement can be made.

Find out more

• Download the ANZHFR 2018 Report
• Watch the NeuRAtalks miniseries on HIP FRACTURE care
• Download NeuRA Brochure: Hip Fracture Care Guide

The overall research objective of our ongoing research in this area is to develop a clearer understanding of inter-related underlying mechanisms of the effects across the triad of physical, psychological, cognitive and neural impairments on falls and healthy ageing.

We aim to identify determinants for the high prevalence of dementia in Indigenous Australians, and will now extend these findings by exploring determinants for the high prevalence of falls.

Physical exercise training has been the primary focus of single interventions trials to reduce falls and advance healthy ageing. However, high attrition rates suggest that current approaches are not sufficient to guarantee long-term adherence to exercise in the majority of older adults.

Technological advances have enabled less expensive ways to quantify physical fall risk in the homes of older people.

We are exploring whether unobtrusive monitoring of activities of daily living or regular unsupervised directed routine assessments using new sensor-based technologies can predict falls in older adults more accurately.

We are developing and validating a range of mobile apps to assess fall risk factors in research settings and clinical practice; i.e. questionnaires (fear of falling, physical activity, etc), sensorimotor assessments (balance, vision, etc) and cognitive assessments (executive functioning, processing speed, etc.).

We are also working on Smart home IT support for frail elderly people who live alone.

Investigating the role that sleep disruption plays in people with Multiple Sclerosis

Despite effective treatments being available, up to 40% of older people with reported dizziness remain undiagnosed and untreated. A multidisciplinary assessment battery, with new validated assessments of vestibular impairments is required for diagnosing and treating older people with dizziness. This project conducted a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and developed a multiple profile assessment of dizziness for use in Specialist Clinics.

“Healthy ageing is your mind staying young” – Koori Growing Old Well Study participant

Healthy Ageing calls for cognitively, physically and socially active lifestyles. The current project seeks to recognise existing community strengths but work to enhance participation and engagement, provide new resources specific to healthy ageing and develop an accessible platform for rolling out this intervention to diverse older people and communities, enabling widespread benefit. We will trial a cutting-edge approach to advance healthy ageing with implications for many Australians to benefit, particularly older Aboriginal people.

The project examines how to implement evidence based healthy ageing programs in urban and regional Aboriginal communities. Elders play a vital role in Indigenous communities, providing leadership, caring for family, and transmitting cultural knowledge and practices. However, the health, well-being and quality of life of the increasing numbers of older Indigenous people, are threatened by high rates of dementia, falls and depression. Novel culturally-safe approaches are needed to better engage and support Indigenous peoples in terms of healthy ageing. This research will develop and evaluate effective, culturally appropriate, and accessible strategies to promote healthy ageing in Aboriginal communities. It will also investigate whether and how resilience related to social and cultural cohesion can protect well-being in Indigenous communities.