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Understanding and preventing physical and cognitive decline and falls in older people with dementia

Alzheimer’s disease Balance training Dementia Falls prevention Falls and balance

DR MORAG TAYLOR, PROFESSOR JACQUELINE CLOSE, PROFESSOR STEPHEN LORD

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.

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


PROFESSOR STEPHEN LORD, DR JASMINE MENANT

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.

SafeTrip – step training to reduce falls in older adults


PROFESSOR STEPHEN LORD, DR YOSHIRO OKUBO, DR DAINA STURNIEKS, DR JASMINE MENANT, DR MATTHEW BRODIE

The SafeTrip study will to investigate how older adults learn protective stepping skills to avoid falls when encountering obstacles, trips and slips. With NeuRA’s cutting-edge motion capture system and other wearable devices, the SafeTrip team will be able to observe and analyse movement and muscle activity during reactive or proactive step training.

The SafeTrip team are looking for older volunteers aged 65 years and over who:

  • Have not been advised by a medical practitioner not to exercise
  • Have no existing conditions that may prevent them from exercising (e.g. severe pain, heel ulcers, exercise intolerance)
  • Have no neurological conditions (e.g. Parkinson’s Disease, Multiple Sclerosis, Dementia, etc.)
  • Have no history of lower limb, pelvis or vertebral fracture(s) or lower limb joint replacement(s) in the past 6 months.
  • Are able to walk 500m comfortably without mobility aids or rest
  • Living independently in the Sydney metropolitan community
  • Are not currently participating in any other falls prevention research studies

Eligible volunteers will be invited to NeuRA for some baseline assessments before being randomly allocated to either the intervention or control group. Only the intervention group will undertake 3 weekly reactive balance training sessions followed by 3-monthly retraining sessions, while the control group assume their usual activity. All participants will receive a fall prevention information booklet and will be invited back to NeuRA for a 12-month re-assessment.

For more information or to get involved, please contact the SafeTrip team on 02 9399 1067 or safetrip-study@neura.edu.au. HC190952

Muscle contributions to gait pattern in in people with Multiple Sclerosis


DR PHU HOANG, PROFESSOR STEPHEN LORD, DR JASMINE MENANT

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.