HFSP Postdoctoral Researcher
+61 2 9399 1087
Kim van Schooten is a postdoctoral fellow at NeuRA and conjoint 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.
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.
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 are currently recruiting for the StandingTall-Plus research study, for more information visit: https://www.neura.edu.au/clinical-trial/standingtall-plus/
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.
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.
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.
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 Associate Professor Kim Delbaere, has worked with over 500 community-dwelling older people since 2015, implementing a home-based balance exercise program delivered through a tablet computer. The program has been a success with our participants, evidenced by unprecedented levels of sustained adherence to prescribed balance exercises over two years. A clinical trial is currently underway to investigate whether StandingTall can prevent falls 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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LILLIAN MILES Research Assistant
These data provide a valuable reference and may call for more age- and gender-specific activity interventions.