Australian research into falls prevention

Near the Prince of Wales Hospital in Sydney’s Eastern suburbs is a laboratory that, if you happened to visit without prior knowledge, might have you thinking you'd stumbled into a movie set.

The lab, with its many hazards — ladders of different shapes and sizes, suspended body harness, and booby-trapped walkway — could easily pass as some kind of studio, but it serves a much more important purpose. It’s here at the Falls, Balance and Injury Research Centre (FBIRC) at Neuroscience Australia (NeuRA) that Professor Stephen Lord and his team do most of their valuable research into falls prevention.

What is the purpose of the falls prevention lab?
There are many risk factors associated with falling. Research shows that the risk factors for falling increase with age, and that falls commonly occur when a number of risk factors are present. Some common risk factors for falling include:

  • Visual impairment
  • Reduced muscle strength
  • Poor reaction times
  • Impaired balance
  • Impaired gait
  • Use of multiple medications

By simulating hazards in a controlled setting, Lord’s team can study the sensory and motor systems involved in falling, and better identify these and other risk factors. The data collected from this research then helps the scientists develop strategies to prevent falls from occurring in high-risk individuals.

“A lot of the work we’ve undertaken already has looked at the physiology of falling — that is, trying to identify problems with sight, sensation, muscle weakness, balance, and mobility,” says Lord.

The team has also studied behavioural factors in falls risk. For example, in one test participants are asked to size up ladders of different heights and indicate which one they feel confident they can climb. The taller the height of ladder chosen, the greater the risk-taking potential of that individual and therefore the greater the risk of falling.

What research is the team focusing on this year?
This year’s research is focused on analysing two types of stepping — voluntary and reactive stepping, says Lord. “It’s thought that these two types of stepping are trainable and that strategies can be developed to lower someone’s risk of falling by training them,” says Lord.

Voluntary stepping
This is your ability to adapt your gait as you walk. “The classic case is when you’re walking along and very late you see an obstacle like a banana skin or a crack in the pavement, and you have to quickly modify your gait and walking pattern to miss that obstacle,” says Lord.

To measure voluntary stepping, the researchers have adapted an assessment called a choice stepping reaction time task that measures someone’s ability to take a quick and accurate step as well as a gait adaptability task.

For the gait adaptability task, participants walk along a walkway and need to strike or avoid striking light patches projected from the ceiling (depending on their colour: green to strike, red to avoid). The researchers can see how well people can adapt their gait to the stimuli as they’re walking. A series of cognitive tests are also used to measure that person’s decision making as they take their step.

“When you combine the stepping test and cognition tests together, you can understand falls risk better and identify people more likely to fall for those more difficult tasks,” says Lord.

Reactive stepping
This research is being spearheaded by Lord’s colleague, Dr Yoshiro Okubo. “It’s when you hit an obstacle, and you haven’t seen it but you have to deal with it quickly and try to find your balance,” says Okubo.

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Dr Okubo is trying to find solutions to the risk of falling, especially in older Australians

This is the test that involves the harness and the fascinating booby-trapped walkway, which is more scientifically known as the trip and slip walkway. “In this test, participants wear a suspended harness for their safety and as they walk, they either strike a random trip hazard that pops up from the floor and propels them forward, or they strike a random slippery surface where they flip backwards from the heel and have to quickly find their balance,” says Okubo.

How will this research be used?
The team is hoping to develop interventions that can train people to step better and therefore reduce their risk of falling. “These include exercise programs such as dance mat training and computer games called exergames for voluntary stepping that people can do in the comfort of their own homes. And, for reactive stepping, we’re hoping to use a modified version of the trip and slip walkway on a treadmill,” says Lord.

Why is this research is important?
Falls remain a serious health issue in Australia. They are the leading cause of injury-related death and hospitalisation in people aged 65 and over. It is estimated that if the current rate of falls in Australia continues, by 2051 fall-related injuries will cost the economy approximately $1.4 billion.

Of fall-related injuries, hip fractures are among the most serious. 25 per cent of falls cases where patients have fractured a hip don’t survive, and one-third of those that do survive don’t fully recover mobility.

If you’re aged 65 or over and live in Sydney, you could participate in important research into falls prevention. For more information, visit the Smartstep research study website, call 02 9399 1255, or email smartstep@neura.edu.au.

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