Fall prevention: innovation and translation

Scientia Professor Stephen Lord, at Neuroscience Research Australia (NeuRA) and UNSW Sydney’s School of Population Health, is internationally renowned for his research into gait, balance and falls. He aims to prevent falls and the injuries that come with them.

“Falls are a significant health burden to older people, including those with neurodegenerative disorders, as well as their caregivers and the health care system,” Professor Lord said.

“These preventable incidences can have devastating impacts such as a loss of independence, poor quality of life—and death. In fact, falls are the second leading cause of unintentional injury deaths worldwide.”

Professor Lord says a third of Australians aged 65 years and over and two thirds of people living with Parkinson’s disease, multiple sclerosis or dementia fall at least once each year.

In older adults, falls lead to 1.2 million days of hospital care, costing up to $1 billion each year in Australia. By 2051, the total Australian annual health bill is projected to double and create demands on the health system that will be difficult to meet.

Professor Lord has shown that falls result from cumulative physical, cognitive and psychological deficits—which are often not manifesting as clinical disease.

“My impairment focus has led to a quantum change in the understanding of fall risk and revolutionised fall risk assessments and prevention strategies globally,” he said.

“My data is based on the key physiological systems essential for balance control: vision, sensation, muscle strength, processing speed, executive functioning, postural sway and functional mobility measures. It explains the roles of cognitive impairment, depression and fear of falling in fall risk.”

“Falls can be prevented in older people and clinical groups with balance impairments by interventions that address their identified impairments.”

This includes high intensity balance training, optimal glasses use to maximise vision, cognitive-motor exercise, reactive step training, pharmacological interventions to improve gait stability, and podiatric interventions to maximise foot and ankle stability.

Professor Lord’s work so far includes the development and evaluation of the SmartStep cognitive-motor step training program, which uses ‘exergame’ technology—the technology that tracks body movements in video games.

“Our trials found SmartStep promotes adherence and enjoyment and improves cognition, balance and stepping. It reduces fall rates by 26% in older people,” Professor Lord said.

“We now propose to roll out SmartStep to determine its ‘real world’ feasibility and usability in clinic, rehabilitation, aged care and home settings.”

Professor Lord’s National Health and Medical Research Council Investigator Grant will help him work towards more innovative treatments and implementing effective interventions.

“I hope to enhance our understanding of the causes of falls and evaluate the effectiveness of novel interventions in target populations,” Professor Lord said.

This includes plans to study innovative augmented reality and slip and trip reactive balance training programs for fall prevention for older people, a home-based cognitive-motor step training program for preventing falls in people with Parkinson’s disease, and an aerobic and balance exercise intervention to preserve neurological reserve in people with early multiple sclerosis.

 “Hopefully, my program will make a significant contribution at the public health level by improving the health and wellbeing of older people and clinical populations with balance impairments.”

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UNSW School of Population Health, Medicine