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

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.

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Neuro-rehabilitation to prevent freezing in Parkinson’s Disease

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.

The study aims to accelerate the implementation of StandingTall. [ADD LINK TO PROJECT 1] 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.

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International implementation study of StandingTall

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.

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

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

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

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

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

INTERVIEW WITH PROFESSOR STEPHEN LORD

RESEARCH TEAM

Vicki Smith

VICKY SMITH Executive Assistant

Jessica Turner

JESSICA TURNER Research Assistant

JOANNE LO Research Assistant

Cameron Hicks

CAMERON HICKS Research Assistant

Esther Vance

DR ESTHER VANCE Senior Research Assistant

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

White matter hyperintensities are associated with falls in older people with dementia.

Taylor ME, Lord SR, Delbaere K, Wen W, Jiang J, Brodaty H, Kurrle SE, Stefanie Mikolaizak A, Close JCT

White Matter Hyperintensities (WMHs) are associated with impaired gait, balance and cognition and increased fall risk in cognitively healthy older people. However, few studies have examined such relationships in older people with dementia. Understanding the role of WMHs in falls may assist in developing effective fall prevention strategies. We investigated the relationship between baseline WMHs, cognitive and sensorimotor function and prospective falls in older people with dementia. Twenty-eight community-dwelling older people with mild-moderate dementia (MMSE 11-23; ACE-R < 83) underwent magnetic resonance imaging and assessment of sensorimotor and cognitive (global and processing speed) function at baseline. WMHs, were quantified using a fully automated segmentation toolbox, UBO Detector ( https://cheba.unsw.edu.au/group/neuroimaging-pipeline ). Falls were ascertained prospectively for 12-months using monthly calendars with the assistance of carers. The median age of the participants was 83 years (IQR 77-86); 36% were female; 21 (75%) fell during follow-up. Using Generalized Linear Models, larger volumes of total WMHs were found to be significantly associated with poorer global cognitive and sensorimotor function. Using modified Poisson regression, total, periventricular and deep WMHs were each associated with future falls while controlling for age, sex, intracranial volume and vascular risk. Each standard deviation increase in total and periventricular WMH volume resulted in a 33% (RR 1.33 95%CI 1.07-1.66) and 30% (RR 1.30 95%CI 1.06-1.60) increased risk of falling, respectively. When the deep WMH volume z-scores were dichotomized at the median, individuals with greater deep WMH volumes had an 81% (RR 1.81 95% CI 1.02-3.21) increased risk of falling. WMHs were associated with poorer sensorimotor and cognitive function in people with dementia and total, periventricular and deep WMHs were associated with falls. Further research is needed to confirm these preliminary findings and explore the impact of vascular risk reduction strategies on WMHs, functional performance and falls.

Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial.

Menant JC, Migliaccio AA, Sturnieks DL, Hicks C, Lo J, Ratanapongleka M, Turner J, Delbaere K, Titov N, Meinrath D, McVeigh C, Close JCT, Lord SR

A multifactorial tailored approach for treating dizziness was effective in reducing dizziness handicap in community-living people aged 50 years and older. No difference was seen on the other primary outcomes. Our findings therefore support the implementation of individualized, multifaceted evidence-based therapies to reduce self-perceived disability associated with dizziness in middle-aged and older people.

The role of cognitive function and physical activity in physical decline in older adults across the cognitive spectrum.

Taylor ME, Boripuntakul S, Toson B, Close JCT, Lord SR, Kochan NA, Sachdev PS, Brodaty H, Delbaere K

The aim of this study was to investigate physical decline over 1-year in a cohort of older people across the cognitive spectrum.

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