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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StandingTall-Plus: a multifactorial program to prevent falls in older people

A cutting-edge research study on the effectiveness of a multifaceted program including balance exercise, brain training and cognitive behavioural therapy towards reducing falls. The StandingTall team, led by Associate Professor Kim Delbaere, has worked with over 500 community-dwelling older people since 2015, implementing a home-based balance exercise program delivered through a tablet computer. By embracing technology, we are providing an alternative exercise opportunity, which is engaging and using all the latest evidence to prevent falls. The program has been a success with our participants, evidenced by unprecedented levels of sustained adherence to prescribed balance exercises over two years. For our next research study, called “StandingTall-Plus”, we have added a cutting-edge brain training program to help people think faster on their feet during daily activities. We are also collaborating with the Black Dog Institute to offer online cognitive behavioural therapy to address depressive thoughts and low mood. All participants will be assessed using a comprehensive test battery of known falls risk factors across physical, cognitive and affective domains. This will then be used to offer each participant a fully tailored program that is suited to their abilities and circumstances. Our primary aim is to reduce the number of falls over a 12-month follow-up period when compared to a health promotion program. We are currently recruiting for the StandingTall-Plus research study, for more information visit: https://www.neura.edu.au/clinical-trial/standingtall-plus/
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