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CLINIC INFORMATION

FALLS AND BALANCE RESEARCH GROUP

The Falls and Balance Research Group, directed by Professor Stephen Lord, aims to enhance understanding of human balance and involves investigations of sensory and motor contributions.

Investigation of the role of different sensory and motor systems enhance our understanding of how humans maintain balance. Studies are being conducted to explore the effects of vision, sensation and vestibular function on balance while standing and walking in different groups of people. For example, our research into the vestibular system, involving galvanic vestibular stimulation while people are walking is elucidating the role of navigation during gait. Other research that involves shaking the head while completing a visual task is being conducted to better understand the vestibulo-ocular reflex, which allows vision to remain stable while the head is moving.

Identification of factors which increase an individual’s risk of falling is vital for prevention of falls and injuries. Current studies are designed to investigate the physiology and biomechanics of standing, walking, stepping reactions, trips and slips, and for the design safe footwear for older adults. Epidemiological and physiological research is also being conducted to enhance our understanding of various risk factors in older adults and clinical groups. Large studies are being conducted to understand the physiological and behavioural risk factors for falls in older individuals. Participants undergo a series of physiological (vision, strength, sensation, speed, balance) and behavioural (high versus low-risk taking tendencies) assessments. Understanding the physiological and psychological risk factors for falling allows for better informed intervention strategies for prevention of falls in different populations.

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.

The problem of falls

Falls are the leading cause of injury-related hospitalisation in persons aged 65 years and over and account for four percent of all hospital admissions in this age-group . Hospital admissions resulting from falls are uncommon in young adulthood but with advancing age, the incidence of fall-related admissions increases at an exponential rate. Beyond 40 years, the admission rate due to falls increases consistently by 4.5% per year for men (doubling every 15.7 years) and by 7.9% per year for women (doubling every 9.1 years). In those aged 85 years and over, the levels have climbed to 4% per annum in men and 7% per annum in women. Falls also account for 40% of injury-related deaths and one percent of total deaths in this age group.

Depending on the population under study, between 22-60% of older people suffer injuries from falls, 10-15% suffer serious injuries, 2-6% suffer fractures and 0.2-1.5% suffer hip fractures. The most commonly self-reported injuries include superficial cuts and abrasions, bruises and sprains. The most common injuries that require hospitalisation comprise femoral neck fractures, other fractures of the leg, fractures of radius, ulna and other bones in the arm and fractures of the neck and trunk.

In terms of morbidity and mortality, the most serious of these fall-related injuries is fracture of the hip. Elderly people recover slowly from hip fractures and are vulnerable to post-operative and bed rest complications. In many cases, hip fractures result in death and of those who survive, many never regain complete mobility. Another consequence of falling is the “long lie” – remaining on the ground or floor for more than an hour after a fall. The long lie is a marker of weakness, illness and social isolation and is associated with high mortality rates among the elderly. Time spent on the floor is associated with fear of falling, muscle damage, pneumonia, pressure sores, dehydration and hypothermia . Falls can also result in restriction of activity and fear of falling, reduced quality of life and independence. Even falls that do not result in physical injuries can result in the “post-fall syndrome” – a loss of confidence, hesitancy, tentativeness with resultant loss of mobility and independence. It has been found that after falling, 48% of older people report a fear of falling and 25% report curtailing activities.

Finally, falls can also lead to disability, decreased mobility which often results in increased dependency on others and hence an increased probability of being admitted to an institution. Falls are commonly cited as a contributing reason for an older person requiring admission to a nursing home.

What causes falls?

Human balance is thought to depend on the interaction of multiple sensory, motor and integrative systems. There is a growing body of evidence that indicates that functioning in sensory, motor and integration systems decline significantly with age and that impairment in these systems is associated with falling in elderly persons. In fact, in many sensorimotor systems, researchers have noted that even in the absence of any documented pathology, many people experience age-related declines in function. We have also found that on clinical examination, many older persons with a history of falls have no identifiable neurological or musculoskeletal pathology yet perform poorly in tests of sensori-motor function. Our approach to balance and falls is functional rather than disease-oriented, and the battery of simple sensori-motor tests developed by Dr Lord is capable of predicting elderly fallers with an accuracy of 80%. For a description of these tests, click here.

See what’s going on at NeuRA

FEEL THE BUZZ IN THE AIR? US TOO.

The RESTORE Trial: Immersive Virtual Reality Treatment for Restoring Touch Perception in People with Discomplete Paraplegia

Chief Investigators: Associate Professor Sylvia Gustin, Prof James Middleton, A/Prof Zina Trost, Prof Ashley Craig, Prof Jim Elliott, Dr Negin Hesam-Shariati, Corey Shum and James Stanley While recognition of surviving pathways in complete injuries has tremendous implications for SCI rehabilitation, currently no effective treatments exist to promote or restore touch perception among those with discomplete SCI. The proposed study will address this need by developing and testing a novel intervention that can provide touch restoration via the primary source of sensory perception: the brain.Complete spinal cord injury (SCI) is associated with a complete loss of function such as mobility or sensation. In a recent discovery we revealed that 50% of people with complete SCI still have surviving somatosensory nerve fibres at the level of the spine. For those with complete SCI this is hopeful news as it means -- contrary to previous belief that communication to the brain had been severed by injury -- that the brain is still receiving messages. This new SCI type is labelled “discomplete SCI” -- a SCI person who cannot feel touch, but touch information is still forwarded from the foot to the brain. The project will use virtual reality (VR) in a way it has never been used before. We will develop the first immersive VR interface that simultaneously enhances surviving spinal somatosensory nerve fibres and touch signals in the brain in an effort to restore touch perception in people with discomplete SCI. In other words, immersive VR is being used to re-train the brain to identify the distorted signals from toe to head as sensation (touch). For example, participants will receive touch simulation in the real world (e.g., their toe) while at the same time receiving corresponding multisensory touch stimuli in the virtual world (e.g., experiencing walking up to kick a ball). This project is the first effort worldwide to restore touch sensation in 50% of individuals with complete injuries. The outcomes to be achieved from the current study will represent a cultural and scientific paradigmatic shift in terms of what can be expected from life with a spinal cord injury. In addition, the project allows potential identification of brain mechanisms that may ultimately represent direct targets for acute discomplete SCI rehabilitation, including efforts to preserve rather than restore touch perception following SCI. RESTORE consolidates the expertise of scientists, clinicians, VR developers and stakeholders from NeuRA and UNSW School of Psychology (A/Prof Sylvia Gustin, Dr Negin Hesam-Shariati), John Walsh Centre for Rehabilitation Research, Kolling Institute and University of Sydney (Prof James Middleton, Prof Ashley Craig and Prof Jim Elliott), Virginia Commonwealth University (A/Prof Zina Trost), Immersive Experience Laboratories LLC (Director Corey Shum) and James Stanley. If you are interested in being contacted about the RESTORE trial, please email A/Prof Sylvia Gustin (s.gustin@unsw.edu.au) and include your name, phone number, address, type of SCI (e.g., complete or incomplete), level of injury (e.g., T12) and duration of SCI (e.g., 5 years).
PROJECT