Professor Stephen Lord

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

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.

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/

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.

Muscle contributions to gait pattern in in people with Multiple Sclerosis

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. 

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.

 

Neuro-rehabilitation to prevent freezing in Parkinson’s Disease

An engaging self-managed neuro-rehabilitation program using eHealth technologies to improve mobility and enhance independence in people with Parkinson’s disease:

Parkinson’s disease is a multi-systems neurodegenerative disease with the severity of clinical symptoms (including postural instability, gait dysfunction an falls). With the population aging, the number of people affected by Parkinson’s disease is expected to double every 25 years presenting an increasing burden on health service and society as a whole. Falls are a common and devastating event in individuals with Parkinson’s disease and often precipitated by excessive gait variability, postural instability and freezing of gait.

Visual, attentional, haptic and auditory stimuli have been used to improve gait dysfunction in people with Parkinson’s disease. The aim of this project is to develop and evaluate a self-managed program using mHealth technology to improve mobility in people suffering from Parkinson’s disease. Dr Matthew Brodie was awarded a Michael & Elizabeth Gilbert Scholarship in Parkinson’s Disease Research.

International implementation study of StandingTall

An international alliance lays the groundwork for the widespread implementation of StandingTall. This study targets a major need for older people for whom falls are a real risk that can have debilitating impacts on quality of life. It has been developed with major input from all partners and constitutes a valuable, collaborative partnership between researchers, experts in health promotion, health care providers and policy makers. Our partners for this project are the NSW Office of Preventive Health, Ministry of Health; the Clinical Excellence Commission; and the Agency for Clinical Innovation; two NSW Local Health Districts; i.e. Northern NSW and mid-North Coast; Austin Health, Uniting and the Northern Health Science Alliance in the United Kingdom. PLEASE NOTE: recruitment has finished for Australia.

The study aims to accelerate the implementation of StandingTall. It will address the final steps needed to scale up this innovative technology for widespread use by older people across Australia and England with prospects for further international translation. The overall aim of this international project is to establish integrated processes and pathways to deliver StandingTall to older people and to provide ongoing support as required. The project provides scope for further broad scale implementation and a model for incorporating StandingTall into existing health services and routine care.

For more information:

If in the UK, email: StandingTaller@manchester.ac.uk

If in Australia, please be aware that recruitment has finished for all Australian sites. If you are already participating and need to contact us, please phone: 02 9399 1113 or email: standingtaller@neura.edu.au.

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.

Preventing further falls in people who call an ambulance as a result of a fall – a randomised contro

Many older people suffer a fall and it is not uncommon for older fallers to require paramedic care following such events. Routine transportation to hospital is of questionable value and may not be an effective or efficient use of resources. This randomised controlled offered non-transported fallers a new model of care following fall-related paramedic care.

Patterns of use and cost to the ambulance service of fall-related injury in older people

While the pattern of ambulance use have been studied extensively, the associated costs which are influenced by a variety of factors are still being explored. This program of research aims to better understand what is driving costs within the ambulance service, explore pathways to optimise resource use and evaluate models of care to streamline health care provided to older adults.

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

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.

Innovative approaches to prevent falls in older people

Physical exercise training has been the primary focus of single interventions trials to reduce falls and advance healthy ageing. However, high attrition rates suggest that current approaches are not sufficient to guarantee long-term adherence to exercise in the majority of older adults.

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.

Causes of sleep apnoea in people with and without multiple sclerosis (MS)

Investigating the role that sleep disruption plays in people with Multiple Sclerosis

Adapting the Physiological Profile Assessment to assess upper limb function

This study will produce simple tests that can be used in population studies and patient group clinics. It will provide normative data for documenting the type and severity of upper limb Motor Impairments and provide the impetus to develop strategies to improve function in ageing and other disorders, such as stroke, Parkinson’s disease, arthritis and peripheral neuropathy.

Everyday fatigue and fall risk in older people

This study will determine whether a busy day of physical activity (‘real world’ fatigue) impacts balance and mobility measures in older people. It will determine the importance of fatigue as a fall risk factor in older people, and provide significant information with respect to the value of mitigating fatigue as a fall prevention strategy.

Development of wearable sensor assessment tools

Many fall risk assessment tools are available for use in clinical settings. However, the predictive accuracy is limited. This study has assembled the largest wearable sensor data library of “freezes” in people with Parkinson’s disease. It provides great scope for identifying pre-freeze gait characteristics which ultimately may be used to trigger cues for freeze prevention.

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.

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.