Prof Stephen Lord

TEAM LEADER PROFILE

Senior Principal Research Fellow, NHMRC Conjoint Professor, UNSW

+612 9399 1061


Professor Stephen Lord is a Senior Principal Research Fellow at Neuroscience Research Australia, Sydney, Australia. He has published over 400 papers in the areas of balance, gait and falls in older people and is acknowledged as a leading international researcher in his field. His research follows two main themes: the identification of physiological risk factors for falls and the development and evaluation of fall prevention strategies. Key aspects of this research have been the elucidation of sensorimotor factors that underpin balance and gait and the design and evaluation of exercise programs for older people including those at increased risk of falls, i.e. people with Parkinson’s disease, stroke, dementia and frailty. His methodology and approach to fall-risk assessment has been adopted by many researchers and clinicians across the world and he is actively engaged in initiatives aimed at implementing falls prevention evidence into policy and practice.

Projects Prof Stephen Lord is currently involved with

CURRENT PROJECTS

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 will therefore aim to conduct a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and develop a multiple profile assessment of dizziness for use in Specialist Clinics.

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Treating dizziness in older people

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.

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

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.

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

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.

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Understanding and preventing physical and cognitive decline and falls 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.

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Innovative approaches to prevent falls in older people

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.

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Novel methods for fall prediction in older people

Understanding the effects of sleep disruption in people with Multiple Sclerosis

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

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Understanding the effects of sleep disruption 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.

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Adapting the Physiological Profile Assessment (PPA) to assess upper limb function

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.

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Everyday fatigue and fall risk in older people

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.

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Development of wearable sensor assessment tools for clinic and remote (at-home) settings

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.

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An interactive step training RCT to reduce falls in people with multiple sclerosis

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.

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

NEURA FALLSCREEN

RESEARCH TEAM

Vicki Smith

VICKY SMITH Executive Assistant

Paulo Pelicioni

PAULO PELICIONI PhD student

Jessica Turner

JESSICA TURNER Research Assistant

Joanne Lo

JOANNE LO Research Assistant

Cameron Hicks

CAMERON HICKS Research Assistant

Esther Vance

DR ESTHER VANCE Senior Research Assistant

Daniela Meinrath

DANIELA MEINRATH Masters student

DR YOSHIRO OKUBO

Joana Caetano

JOANA CAETANO PhD student

Mayna Ratanapongleka

MAYNA RATANAPONGLEKA Research Assistant

Cathie Sherrington

PROF CATHIE SHERRINGTON Senior research officer

PUBLICATIONS

Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study.

Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen T, Webster IW, Eisman JA

To assess measures of postural stability in a large population of persons aged over 60 years in order to compare performance between fallers and non-fallers and relate postural stability to fracture prevalence. Tests of postural stability can identify, independently of age, individuals living in the community who are at risk of falls and fall-related fractures.

Physiological factors associated with falls in older community-dwelling women.

Lord SR, Ward JA, Williams P, Anstey KJ

To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community-dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls. These findings support previous results conducted in retirement village and institutional setting and indicate that the test procedure aids in the identification of older community-dwelling women at risk of falls.

Simple physiological and clinical tests for the accurate prediction of falling in older people.

Lord SR, Clark RD

A 1-year prospective study was conducted in an intermediate care institution to determine whether a combined assessment of physiological and clinical measures discriminates between elderly fallers and elderly nonfallers. Seventy persons aged between 72 and 96 years (mean 85.6), who were generally independent in activities of daily living, took part in the study, and 66 were available to follow-up. In the follow-up year, 24 subjects experienced no falls, 20 subjects fell one time only and 22 residents fell on two or more occasions. Discriminant analysis identified reaction time, body sway, quadriceps strength, tactile sensitivity, gait impairment, cognitive impairment, psychoactive drug use and age as the variables that significantly discriminated between subjects who experienced falls and those who did not. This procedure correctly classified 86% of subjects into faller and nonfaller groups. These findings suggest that an assessment that combines physiological and clinical factors provides excellent discrimination between elderly fallers and nonfallers.

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