NeuRA Magazine #22

Research Portal

UNDERSTANDING THE RISK OF FALLS IN PEOPLE WITH PARKINSON’S DISEASE

Balance and walking impairments are disabling symptoms of Parkinson’s disease that adversely affect performance of daily activities, reduce independence and increase the risk of falls. Around 60% of people with Parkinson’s disease fall at least once a year, with a large proportion (50-86%) falling multiple times in this period. Decline in the ability to adapt stepping and walking behaviour, particularly under challenging conditions, may contribute to trips and slips; which are a frequently reported cause of falls in people with Parkinson’s disease.

To further our understanding of fall risk in people living with Parkinson’s disease, we conducted a study on the role of attention in stepping and the ability to adjust steps while walking in response to unexpected hazards. This involved a step mat test of reaction time and an obstacle course designed by PhD student Joana Caetano. Dr Menant said that great care was made in designing a test that could mimic everyday walking challenges, for example walking along in a busy street and at the last second noticing the slippery banana peel or the broken tile, that required a short, long or wide step to successfully avoid it.

The team found that compared with their healthy peers, people with Parkinson’s disease had slower and more variable stepping reaction times in a situation involving a distracting task and were less able to adapt their stepping while walking. The participants were, therefore, more likely to miss step targets and strike the obstacle on the pathway. Professor Lord considers that such impaired stepping and gait adaptability places people with Parkinson’s disease at an increased risk of falling when negotiating unexpected hazards in everyday life.

Our future work will investigate whether rehabilitation interventions aimed at improving stepping and walking adaptability can reduce fall risk in people with Parkinson’s disease.

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Abdominal Functional Electrical Stimulation for Orthostatic Hypotension in Spinal Cord Injury

Spinal cord injury (SCI) results in the loss of function to not only voluntary motor control, but also to the regulatory systems that control bodily processes. Orthostatic (postural) hypotension (OH) is a common clinical feature in SCI patients, affecting up to 73% of patients with cervical spine and upper thoracic spine injuries during mobilisation and postural changes. This often results in symptoms of dizziness, light-headedness, fatigue and confusion, in turn limiting individual participation in physical rehabilitation and restricting progress towards regaining function and independence. Therapeutic interventions are centred around ameliorating symptoms of OH; however, options for patients remain limited. Non-pharmacological treatments have had little success at treating hypotension in the long-term, while pharmacological interventions are used only when necessary as they may contribute to hypertension and even worsen episodes of autonomic dysreflexia, a life-threatening condition. Functional Electrical Stimulation (FES) is one of the only interventions that has been shown to display some benefit in improving OH. Recently, stimulation of the lower limbs has been shown to acutely increase blood pressure in patients with SCI. Our recent projects have involved the use of FES applied over the abdominal muscles, termed abdominal FES, for SCI patients at risk of respiratory complications with promising results. As this same population is at risk of orthostatic hypotension, this study aims to determine whether abdominal stimulation can also be used to help this condition. Based on our previous research, we believe that abdominal FES will increase blood pressure acutely during an orthostatic challenge in individuals with acute spinal cord injury, allowing for a longer time spent in a standing position. This will facilitate more effective rehabilitation, therefore improving quality of life and decreasing associated medical complications.
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