Falls and balance

EXTRA INFORMATION

Understanding human balance to prevent falls

WHAT WE KNOW

About our research

We aim to enhance understanding of human balance through investigations of the sensory and motor systems.

Identification of factors that increase an individual’s risk of falling is vital for prevention of falls and injuries. Our current studies in this area investigate the physiology (vision, strength, sensation, speed, balance) of standing, walking, stepping reactions, trips and slips, and for the design safe footwear for older adults. We are also looking at behavioural (high versus low risk-taking tendencies) factors.

Research is underway to develop, implement and systematically evaluate falls and injury prevention strategies for hospital patients and other groups of people known to be at an increased risk of falls.

We have developed and tested a battery of physiological tests to identify those at risk of falling which is capable of predicting elderly fallers with an accuracy of 75%. This physiological profile assessment (FallScreen) is now used widely both clinically and in fall prevention trials throughout Australia and across the world.

Current research

Understanding balance and fall risk factor identification

Not much is known about how cognitive function affects balance and gait and subsequent fall risk. Dementia and mild cognitive impairment are strong risk factors for falls and within cognitively intact older people, more subtle executive functioning and working memory impairments increase fall risk. Importantly, visuo-spatial (VS) working memory is crucial for fall avoidance as it enables us to precisely remember the position and physical characteristics of upcoming hazards; an essential skill for the safe navigation of everyday environments. However, investigations of VS working memory use for navigation have been restricted to animal studies (quadrupeds) and young adults.

Prof Stephen Lord and associates will conduct the first research studies in VS and obstacle avoidance in older people – the population group with reduced physical and cognitive function and consequent increased fall risk. This research will greatly improve our understanding of central mechanisms for fall risk in older people. It will provide proof of principle evidence for VS cognitive-motor training improving gait adaptability and lay the groundwork for a definitive VS cognitive training randomised control trial for preventing falls in older people.

Adapting the Physiological Profile Assessment (PPA) to assess upper limb function

Prof Stephen Lord’s Physiological Profiling Assessment (PPA) is widely recognised as the “gold standard” diagnostic tool for quantifying the physiological capacity of the lower limb. I now plan to adapt this ground-breaking physiological profiling approach to measure the performance of the upper limbs in the population over the adult lifespan. This study will produce simple tests that can be used in population studies and patient group clinics. It will provide normative data for documenting the type and severity of upper limb Motor Impairments and provide the impetus to develop strategies to improve function in ageing and other disorders, such as stroke, Parkinson’s disease, arthritis and peripheral neuropathy.

Everyday fatigue and fall risk in older people

Systematic review evidence indicates muscle fatigue can impair balance and functional task performance in older people. However, it is not known whether fatigue, induced by regular daily life activities, may similarly impair balance and gait and increase the risk of falling in older people. This study will determine whether a busy day of physical activity (‘real world’ fatigue) impacts balance and mobility measures in older people. By specifically investigating everyday fatigue, this study will advance our knowledge from what is known from laboratory studies using “artificial” fatiguing protocols to document the effects of real world fatigue on balance, gait and cognition. It will determine the importance of fatigue as a fall risk factor in older people, and provide significant information with respect to the value of mitigating fatigue as a fall prevention strategy.

An interactive step training RCT to reduce falls in people with multiple sclerosis

More than 50% of people with multiple sclerosis will fall over a 3-month period. This project will evaluate potential fall-related and health benefits of a home-based step training intervention. The intervention will target key underlying causes of falls including slow and inaccurate stepping performance, poor controlled leaning balance and impaired executive functioning. This project will evaluate a promising home-based exercise strategy for preventing falls in people with multiple sclerosis. The results will provide solid scientific evidence to include in fall management programs for people with this condition.

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