Dr Kim van Schooten

RESEARCHER PROFILE

HFSP Postdoctoral Researcher

+61 2 9399 1087


Kim van Schooten is a postdoctoral fellow at NeuRA and conjoint senior lecturer at UNSW supported by the Human Frontier Science Program. She obtained her Ph.D. in 2014 from the faculty of Human Movement Sciences, Vrije Universiteit Amsterdam (the Netherlands). She was a Mitacs & Michael Smith Foundation for Health Research postdoctoral fellow at the faculty of Biomedical Physiology and Kinesiology, Simon Fraser University and the Centre for Hip Health and Mobility, University of British Columbia (Canada). Her research focuses on balance control and fall risk in seniors. She is particularly interested in the underlying mechanisms of balance impairments, and methodologies for ambulatory monitoring of mobility using wearable sensors. Through a combination of experimental and epidemiological studies, she studies how people maintain and recover balance during daily-life activities, to improve our understanding of why falls occur and to reveal targets for the prevention of mobility impairments and falls.

Projects Dr Kim van Schooten is currently involved with

CURRENT PROJECTS

Own Your Balance

Research investigating the impacts of cognitive behavioural therapy and balance programs on fear of falling, funded by Mindgardens.

Falls and fear of falling affect many older people and can impose limitations upon daily activities. Over one third of community dwelling older people fall each year with about 15% of falls being injurious. However, two thirds of older people express a fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities, and subsequent deterioration of health and wellbeing.

Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy (CBT) and balance exercise programs. However, these face-to-face treatments are resource intensive and not readily accessible to people. Furthermore, the effects of these treatments on fear of falling are small and often do not last beyond the duration of the program.

By utilising technology and providing tailored physical activity guidance we are aiming to reduce a fear of falling in an accessible, efficient and lasting way.

A thee-arm randomised clinical trial will be conducted in 189 community-dwelling older adults with a substantial concern of falling. Participants will be randomly allocated into one of three groups in order to test whether a self-managed CBT intervention, alone or in combination with a graded balance activity program, can reduce concerns about falling in older adults when compared to usual care.

We are collaborating with the Black Dog institute to provide a home-based cognitive behavioural therapy program that addresses a fear of falling. We will also be utilising our cutting-edge balance program StandingTall to provide a graded balance program.

 

Related studies:
https://www.neura.edu.au/project/reducing-fear-of-falling-and-activity-avoidance-in-older-adults-with-disproportionate-levels-of-fear-of-falling/
https://www.neura.edu.au/project/standingtall-plus-a-multifactorial-program-to-prevent-falls-in-older-people/

https://www.neura.edu.au/project/standing-tall/

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Own Your Balance

Brain and Brawn in Balance: Disentangling central and peripheral contributions to balance control.

Falls are a major health and economic burden in our aging population. Falls occur when we lose our balance and are unable to recover. What limits our ability to maintain and restore balance? This ability is a complex interaction of rapid central processing of accurate sensory information in the brain and rapid peripheral execution of motor responses by the muscles. When one of these processes is impaired, the interplay between brain and muscle functions might allow for compensation or, contrastingly, may limit improvements of balance. This interplay between central and peripheral functions has been strikingly overlooked, while it may underlie balance problems with ageing and disease, and allows for targeted prevention.

The goal of this project is to determine, through detailed analysis of balance and activity behaviour in daily life, how the interplay of central and peripheral impairments contributes to balance problems. Specifically, the goal of the project will be reached by addressing two major aims: (#1 aim) establish how the interplay of central and peripheral impairments affects balance control, and (#2 aim) identify whether prefrontal brain areas govern this interplay.

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Brain and Brawn in Balance: Disentangling central and peripheral contributions to balance control.

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.

For our next research study, called “StandingTall-Plus”, we have added a cutting-edge brain training program to our original StandingTall program. The main goal is 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.

Falls in older people are often caused by a concomitant decline across three domains: mobility, cognition and affect; or in other words, across moving – thinking – feeling domains. The aim of this trial is to test a program that is individually tailored to various physical, cognitive and affective aspects (as opposed to medical pathologies) by taking a multifactorial profile approach to fall prevention. The use of technology will ensure that is easily accessible to do in the home and engaging to continue over a long period.

A randomised controlled trial will be conducted in 518 community-dwelling older adults at high-risk of falls. 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 hypothesise that our program will improve balance, cognitive function and mood, increase physical activity levels and reduce falls in older people, when compared to a health promotion program. This trial addresses a key gap in the understanding of falls interventions and application of personalized medicine and will provide direct evidence about the cost and effectiveness of a tailored multifaceted “best-bet” solution.

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

Health literacy on falls in older people

An informed and engaged older adult who values health promotion, protection, and preparedness is vital to promote uptake and adherence to any health and fall prevention programs.

According to the Australian Bureau of Statistics, about 60 per cent of Australians (15-74 years old) have less than adequate levels of health literacy and only 6% of the population have high health literacy. Health literacy was also found to be lower in old age. The majority of Australians with inadequate health literacy were aged 65 to 74 years. Similarly, in another Australian survey, only 8% of 1454 older adults were aware that balance training can prevent falls, or that falls could be prevented at all. This is indicative of poor health literacy among older Australians related to fall risk and fall prevention. With the increasing complexity of health information and services, health literacy is an issue for older Australians. Health literacy may affect individuals’ understanding of health information and in turn influence their health decisions and uptake of health preventive interventions such as engaging in physical activities to prevent falls.

This project will address a crucial gap in empowering older adults to take care of their own health and increase the uptake and efficacy of evidence-based fall prevention programs. An informed and engaged older adult who values health promotion, protection, and preparedness is vital to promote uptake and adherence to any health and fall prevention programs.

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Health literacy on falls in older people

Reducing Fear of Falling and Activity Avoidance in Older Adults with disproportionate levels of fear

Catastrophizing thoughts about falls can trip people up. We are now looking for programs that can help reduce concern about falling in older people.

Falls and fear of falling affect many older adults and can impose limitations upon daily activities. Over one third of community dwelling older adults fall each year with about 15% of falls being injurious. However, over two thirds of older adults express fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities with consequent negative impacts on lower quality of life.

Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy and balance exercise programs. We are collaborating with Black Dog Institute to investigate the effectiveness of an online cognitive behavioural program (myCompass) versus a health education program for 6 weeks at reducing concerns about falling in community-dwelling older people. The intervention consists of a fully-automated cognitive behavioural therapy program (myCompass) delivered through a tablet or computer in people’s homes with no therapist input, including evidence-based and interactive psychological modules that users can complete via the internet on a tablet or computer in their homes.

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Reducing Fear of Falling and Activity Avoidance in Older Adults with disproportionate levels of fear of falling

Standing Tall: a novel technology-based balance exercise program

An unsupervised, home-based balance exercise program delivered through a tablet computer to prevent falls in older adults.

StandingTall is an engaging balance training program that is designed specifically for use by older people. It was developed using the latest insights in geriatric and translational neuroscience, and employs mobile (tablet) technology to deliver an effective method for improving balance and reducing fall risk. StandingTall includes: effective, individually-tailored exercise prescription to improve balance ability and reduce fall risk in older people; and behavioural change techniques to enhance exercise uptake and long-term adherence, with optimal usability for older people to use independently at home. By combining technology with research in fall prevention, StandingTall provides a radically new solution to support older adults to stay independent for longer and lower healthcare-related costs caused by falls.

The StandingTall team, led by Professor Kim Delbaere, has worked with over 1500 community-dwelling older people since 2015, implementing a home-based balance exercise program delivered through a tablet computer.

A conclusive randomised controlled trial in 503 individuals aged 70+ over 2 years showed a 16% lower falls rate, and a 20% lower rate of injurious falls over 2-years in the intervention group compared to controls. Particularly encouraging were the unprecedented adherence rates. 80% of participants continued to use the program for 6 months, 68% for 1 year and 52% remained to engage with the program for 2 years. Participant response to the program was highly positive, and feedback received is being used to further improve future versions of the program.

The first StandingTall trial has paved the way for future research projects, furthering our understanding of healthy ageing and reducing the risk of falls across the community. A follow-on study, StandingTall-Plus, which added a brain training element, is now at its tail end. We are also testing StandingTall with a psychological program aimed at improving confidence in daily activities that involve balance in our Own Your Balance study. We have had the opportunity to use StandingTall in other research areas including Aboriginal and Māori communities, Parkinson’s Disease, Cardiovascular Health, home and residential aged care, and within a multinational implementation study across select health districts in New South Wales, Victoria, and Northern England.

We are now working with collaborators to redevelop StandingTall to improve our user experience and include a larger range of exercise activities.

If you would like to read the full results published in the British Medical Journal, you can access the paper at the following website: https://doi.org/10.1136/bmj.n740

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Standing Tall: a novel technology-based balance exercise program

Novel methods for fall prediction in older people

Technological advances have enabled less expensive ways to quantify physical fall risk in the homes of older people.

We are exploring whether unobtrusive monitoring of activities of daily living or regular unsupervised directed routine assessments using new sensor-based technologies can predict falls in older adults more accurately.

We are developing and validating a range of mobile apps to assess fall risk factors in research settings and clinical practice; i.e. questionnaires (fear of falling, physical activity, etc), sensorimotor assessments (balance, vision, etc) and cognitive assessments (executive functioning, processing speed, etc.).

We are also working on Smart home IT support for frail elderly people who live alone.

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Novel methods for fall prediction in older people

WEBSITE

LINKEDIN PROFILE

TWITTER

RESEARCH TEAM

SARAH LUDOWICI Research Assistant : 9399 1422
: s.ludowici@neura.edu.au

GARTH MCINERNEY Research Assistant : 9399 1008
: g.mcinerney@neura.edu.au

JESSICA CHOW Research Assistant : 9399 1057
: j.chow@neura.edu.au

CARLY CHAPLIN Research Assistant : c.chaplin@neura.edu.au

LILLIAN MILES Research Assistant

PUBLICATIONS

Quality of Daily-Life Gait: Novel Outcome for Trials that Focus on Balance, Mobility, and Falls.

van Schooten KS, Pijnappels M, Lord SR, van Dieën JH

A taxonomy of cognitive tasks to evaluate cognitive-motor interference on spatiotemoporal gait parameters in older people: a systematic review and meta-analysis.

Wollesen B, Wanstrath M, van Schooten KS, Delbaere K

CMI was not significantly different between fallers and non-fallers or people with and without CoF; however, our taxonomy revealed a large variety of cognitive conditions and a higher number of studies using mental tracking tasks, which make it impossible to draw firm conclusions. Future studies should use a more standardised and ecologically valid approach when evaluating the validity of DT gait performance in the prediction of falls, CoF or other age-related conditions.

Inertial wearables as pragmatic tools in dementia.

Godfrey A, Brodie M, van Schooten KS, Nouredanesh M, Stuart S, Robinson L
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