Dr Jasmine Menant

SafeTrip – step training to reduce falls in older adults

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

Mechanistic studies investigating the role of visuo-spatial working memory in balance and gait contr

There is emerging evidence that visuo-spatial processing is involved in balance control during gait. Importantly, visuo-spatial processing may be key for fall avoidance as it enables one to precisely remember the position and physical characteristics of upcoming hazards; an essential skill for the safe navigation of everyday environments. Yet, investigations of visuospatial processing use for obstacle avoidance have been restricted to animal studies and young adults. No studies have been undertaken in older people or people with Parkinson’s Disease for whom visuo-spatial processing deficits are evident and associated with impaired postural control.

This series of studies will investigate visuo-spatial processing required for obstacle avoidance and navigation in older people, older people at high risk of falls and people with Parkinson’s Disease. We will use motion capture to investigate behavioural outcomes and a freely-worn brain imaging device, functional near-infrared spectroscopy to study cortical activation in regions of interest. We will conduct two experiments one involving an obstacle crossing task and another, a stepping task.

We hypothesize that older age, Parkinson’s Disease and increasing task complexity will result in increased risk of tripping and impaired visuo-motor performance, in the obstacle crossing task and in the stepping task, respectively.

This research will greatly improve our understanding of central mechanisms for fall risk and build on our recent behavioural work in this area.

Exercise rehabilitation for cancer survivors with chemotherapy-induced peripheral neuropathy: Impact

Prof David Goldstein (UNSW), Dr Susanna Park (U Sydney), Dr Matt McCrary (UNSW), Dr Jasmine Menant, Dr Carole Harris (UNSW), A/Prof David Simar (UNSW)

This randomised-controlled trial led by Professor David Goldstein (Director of the Translational Cancer Research Network, UNSW) and Dr Susanna Park (U Sydney) and funded by a CAG Seed Grant from UNSW, aims to investigate the benefits and mechanisms of exercise rehabilitation in people with chemotherapy-induced peripheral neuropathy and encompasses physical function assessments, nerve function studies, animal models and quality of life surveys.

Chemotherapy-induced peripheral neuropathy is a common and distressing complication in cancer survivors, leading to reduced quality of life, gait and balance deficits, and increased fall risk. No recommended treatment options for chemotherapy-induced peripheral neuropathy currently exist, although there is emerging evidence demonstrating that exercise may be an effective rehabilitation strategy to improve function and reduce symptom burden in chemotherapy-induced peripheral neuropathy.

The clinical component of the trial aims to investigate the effects of an 8-week exercise (balance, resistance, aerobic) program (versus usual care) on balance and gait in cancer survivors with chemotherapy-induced peripheral neuropathy.

Cancer survivors with chemotherapy-induced peripheral neuropathy first undertake a comprehensive assessment of chemotherapy-induced peripheral neuropathy symptoms, patients’ motor function and neurophysiologic parameters. They are then randomly allocated to one of two groups: an 8-week exercise intervention or usual care. Participants are re-assessed immediately following the intervention as well as 6 months later to assess the durability of effects of the intervention.

We hypothesize that the exercise intervention will lead to significant improvements in functional mobility, balance, and gait. Findings from this randomised-controlled trials will determine the merits of exercise as a treatment for cancer survivors with chemotherapy-induced peripheral neuropathy and provide a basis for future

optimisation of exercise treatment for implementation in clinical practice.

Muscle contributions to gait pattern in in people with Multiple Sclerosis

Miss Angeliki Stivactas (Masters student UNSW), Dr Phu Hoang, Prof Stephen Lord, 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.

 

 

Treating dizziness in older people

Despite effective treatments being available, up to 40% of older people with reported dizziness remain undiagnosed and untreated. A multidisciplinary assessment battery, with new validated assessments of vestibular impairments is required for diagnosing and treating older people with dizziness. This project conducted a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and developed a multiple profile assessment of dizziness for use in Specialist Clinics.

Training to prevent falls in older people

To date, no studies have examined the potential for cognitive or cognitive-motor training to prevent falls in older people, despite good evidence of fall-related cognitive and physical improvements following both intervention types. Building on our initial work, we have developed and validated a home-based computerised training intervention that can be delivered identically, either while seated (cognitive) or while standing and undertaking balance exercises (cognitive+motor). Our project will also uncover cognitive-motor interactions and their neural pathways related to falls, via state-of-the-art imaging techniques that measure brain structure and functional changes. This intervention addresses both physical and cognitive fall risk factors. It holds promise for a cost-effective fall prevention strategy with multiple health benefits for older people.

Interactive step training to reduce falls in people with MS

More than 50% of people with multiple sclerosis will fall over a 3 month period. A clinical trial is being conducted in 500 people with multiple sclerosis who have difficulties with mobility and balance. We hope results of this study will provide solid scientific evidence to include in fall management programs for people with this condition.

SAFE-PD (Stepping to avoid falls events in people with Parkinson’s disease)

A randomised controlled trial to reduce the risk of falling in people with Parkinson’s disease.

View the clinical trial page for more information and to express interest in volunteering for the study.

 

A RCT of cognitive-only and cognitive-motor training to prevent falls in older people

Dr Daina Sturnieks, Prof Stephen Lord, Dr  Jasmine Menant, Associate Professor Kim Delbaere, Prof Michael Valenzuela

This study aims to investigate the benefits of balance training and brain training on physical functions (balance and mobility), cognitive functions, general health and accidental fall events in people aged 65+ years.

The smartstep training system has been designed to enable you to undertake training in your own home, by playing engaging and enjoyable computer games. The system connects to a TV or computer monitor. The games are played with either a step mat (Figure 1) or a touch pad (Figure 2). These games have been designed to train important balance and cognitive functions, while also being fun. You may recognise some of the games, such as Space Invaders and Tetris (Figure 3).