NeuRA Magazine #22

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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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Cortical activity during balance tasks in ageing and clinical groups using functional near-infrared spectroscopy

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.
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