Publications by authors named "Daina L Sturnieks"

61 Publications

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours.

Int J Environ Res Public Health 2021 09 17;18(18). Epub 2021 Sep 17.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW 2031, Australia.

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.
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http://dx.doi.org/10.3390/ijerph18189799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471785PMC
September 2021

Impact of a fall prevention education program for health and exercise professionals: a randomised controlled trial.

Public Health Res Pract 2021 Sep 8;31(3). Epub 2021 Sep 8.

Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, NSW, Australia.

Objectives and importance of study: Exercise prevents falls among community-dwelling older adults. Therefore, it is crucial that health and exercise professionals have the knowledge and skills to prescribe appropriate fall prevention exercise. This study evaluated the effect of a fall prevention education program, compared with a waitlist control group, on health and exercise professionals' fall prevention knowledge and behaviour, and their confidence to prescribe fall prevention exercises for older people.

Study Type: Randomised controlled trial.

Methods: Participants were 200 health and exercise professionals recruited in New South Wales (NSW), Australia. The intervention group participated in a 1-day face-to-face education workshop on exercise to prevent falls in older age. The waitlist control group received the education intervention after completion of the 3-month follow-up. Primary outcomes were self-reported fall prevention knowledge, and change in prescribing behaviour for fall prevention exercise. Secondary outcomes were: confidence to prescribe fall prevention exercise; proportion of people aged 60 years and older seen in the past month who were prescribed fall prevention exercise; and proportion of fall prevention exercises prescribed in the past month that were evidence based. Data were analysed using analysis of covariance models for continuously scored outcomes and the differences in proportions between groups (relative risk [RR]).

Results: The intervention significantly improved knowledge (between-group difference [BGD] 0.27 points out of a possible 6; 95% confidence interval [CI] 0.03, 0.51; p = 0.03), perceived clinical behaviour (RR 5.58; 95% CI 3.25, 9.59; p < 0.001), confidence (BGD 1.02/10 points; 95% CI 0.65, 1.39; p < 0.001) and the proportion of evidence-based exercise prescribed, in both the number of exercises (BGD 0.36; 95% CI 0.03, 0.68; p = 0.03) and percentage of participants who prescribed at least 2 hours/week of fall prevention exercise (RR 1.53; 95% CI 1.08, 2.15; p = 0.015).

Conclusion: The education workshop significantly improved participants' knowledge, confidence and behaviour regarding fall prevention exercise prescription.
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http://dx.doi.org/10.17061/phrp30342013DOI Listing
September 2021

Perturbation-Based Balance Training Using Repeated Trips on a Walkway vs. Belt Accelerations on a Treadmill: A Cross-Over Randomised Controlled Trial in Community-Dwelling Older Adults.

Front Sports Act Living 2021 20;3:702320. Epub 2021 Aug 20.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.

Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway. Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip. No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks ( < 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT ( < 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed ( < 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip. This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.
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http://dx.doi.org/10.3389/fspor.2021.702320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417700PMC
August 2021

Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis.

Ageing Res Rev 2021 11 25;71:101452. Epub 2021 Aug 25.

Falls and Balance Research Group, Neuroscience Research Australia, Randwick, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. Electronic address:

Purpose: This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community.

Results: A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high.

Conclusions: In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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http://dx.doi.org/10.1016/j.arr.2021.101452DOI Listing
November 2021

Cognitive and Motor Cortical Activity During Cognitively Demanding Stepping Tasks in Older People at Low and High Risk of Falling.

Front Med (Lausanne) 2021 12;8:554231. Epub 2021 Jul 12.

Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.

Choice stepping reaction time tasks are underpinned by neuropsychological, sensorimotor, and balance systems and therefore offer good indices of fall risk and physical and cognitive frailty. However, little is known of the neural mechanisms for impaired stepping and associated fall risk in older people. We investigated cognitive and motor cortical activity during cognitively demanding stepping reaction time tasks using functional near-infrared spectroscopy (fNIRS) in older people at low and high fall risk. Ninety-five older adults [mean (SD) 71.4 (4.9) years, 23 men] were categorized as low or high fall risk [based on 12-month fall history (≥2 falls) and/or Physiological Profile Assessment fall risk score ≥1]. Participants performed a choice stepping reaction time test and a more cognitively demanding Stroop stepping task on a computerized step mat. Cortical activity in cognitive [dorsolateral prefrontal cortex (DLPFC)] and motor (supplementary motor area and premotor cortex) regions was recorded using fNIRS. Stepping performance and cortical activity were contrasted between the groups and between the choice and Stroop stepping conditions. Compared with the low fall risk group ( = 71), the high fall risk group ( = 24) exhibited significantly greater DLPFC activity and increased intra-individual variability in stepping response time during the Stroop stepping task. The high fall risk group DLPFC activity was greater during the performance of Stroop stepping task in comparison with choice stepping reaction time. Regardless of group, the Stroop stepping task elicited increased cortical activity in the supplementary motor area and premotor cortex together with increased mean and intra-individual variability of stepping response times. Older people at high fall risk exhibited increased DLPFC activity and stepping response time variability when completing a cognitively demanding stepping test compared with those at low fall risk and to a simpler choice-stepping reaction time test. This increased hemodynamic response might comprise a compensatory process for postural control deficits and/or reflect a degree of DLPFC neural inefficiency in people with increased fall risk.
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http://dx.doi.org/10.3389/fmed.2021.554231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310929PMC
July 2021

Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study.

J Geriatr Phys Ther 2021 Jul 26. Epub 2021 Jul 26.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia. UNSW Medicine, Sydney, New South Wales, Australia. Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.

Background And Purpose: Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips.

Methods: Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls.

Results: Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls.

Conclusion: Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
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http://dx.doi.org/10.1519/JPT.0000000000000312DOI Listing
July 2021

Predictors of development and persistence of musculoskeletal pain in community-dwelling older people: A two-year longitudinal study.

Geriatr Gerontol Int 2021 Jun 23;21(6):519-524. Epub 2021 Apr 23.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.

Aim: The aim of this prospective cohort study was to identify the predictors of the development and persistence of musculoskeletal pain (MSKP) in older people.

Methods: Participants comprised 431 community-dwelling older people aged 70+ years. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Participants were asked about the presence of MSKP in the neck/back, hip, knee/leg and/or feet at baseline and two-year follow-up. Logistic regression analyses were performed to identify predictors of the development and persistence of MSKP at two-year follow-up.

Results: Of 179 participants who reported no MSKP at baseline, 84 (46.9%) reported MSKP at two-year follow-up, which was associated with a higher body mass index (odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02-1.18), more reported depressive symptoms (OR 1.30, 95% CI 1.05-1.61) and lower physical activity levels (OR 0.92, 95% CI 0.84-1.00) at baseline. Of 252 participants who reported MSKP at baseline, 202 (80.2%) reported MSKP at follow-up, which was associated with a slower 6-m walking time (OR 1.27, 95% CI 1.08-1.49) and more reported depressive symptoms (OR 1.39, 95% CI 1.09-1.78). These associations remained significant after adjusting for age, sex, comorbidities and medication use.

Conclusions: This study suggests that higher body mass index, more depressive symptoms and less physical activity are predictors of developing MSKP, whereas slow gait speed and depressive symptoms are predictors of the persistence of MSKP among older people. The results highlight the importance of weight control, strategies to improve mental wellbeing and an active lifestyle for pain management among older people. Geriatr Gerontol Int 2021; 21: 519-524.
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http://dx.doi.org/10.1111/ggi.14172DOI Listing
June 2021

Individual factors that influence task performance on a straight ladder in older people.

Exp Gerontol 2020 12 24;142:111127. Epub 2020 Oct 24.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, AUS. Electronic address:

Older adults have the highest incidence of domestic ladder falls, but little investigation has been given to this important injury issue. There is therefore a need to understand the influence of individual factors like physical and cognitive ability and psychological status on safe and effective ladder use in this population. This study investigated associations between vision, lower and upper limb sensation, upper limb control, strength, balance, cognitive function and psychological status with task completion time and number of ladder moves taken in a simulated roof gutter clearing task on a straight ladder in 97 older adults. Several measures from upper limb control, strength, balance, processing speed, executive function and psychological domains were significantly associated with the two ladder task performance measures. Upper limb bimanual coordination, knee extension strength, coordinated leaning balance, and self-reported risk-taking were identified as independent and significant predictors of task completion time in a multiple regression model, predicting 56% of the variability in ladder task completion time. Upper limb bimanual coordination and proprioception, simple reaction time and coordinated leaning balance were independent and significant predictors of the number of ladder moves in a separate multiple regression model, predicting 38% of the variability in ladder moves taken. These findings help identify individuals at greater ladder fall risk and can guide ladder fall interventions, such as strength and balance training, ladder design and targeted safety instructions.
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http://dx.doi.org/10.1016/j.exger.2020.111127DOI Listing
December 2020

People With Parkinson's Disease Exhibit Reduced Cognitive and Motor Cortical Activity When Undertaking Complex Stepping Tasks Requiring Inhibitory Control.

Neurorehabil Neural Repair 2020 12 6;34(12):1088-1098. Epub 2020 Nov 6.

Neuroscience Research Australia, University of New South Wales, New South Wales, Australia.

Background: People with Parkinson's disease (PD) have difficulties generating quick and accurate steps in anticipation of and/or in response to environmental hazards. However, neural mechanisms underlying performance in cognitively demanding stepping tasks are unclear.

Objective: This study compared activation patterns in cognitive and motor cortical regions using functional near-infrared spectroscopy (fNIRS) between people with PD and age-matched healthy older adults (HOA) during stepping tasks.

Methods: Fifty-two people with PD and 95 HOA performed a simple choice stepping reaction time test (CSRT) and 2 cognitively demanding stepping tests (inhibitory CSRT [iCSRT] and Stroop stepping test [SST]) on a computerized step mat. Cortical activation in the dorsolateral prefrontal cortex (DLPFC), Broca's area, supplementary motor area (SMA), and premotor cortex (PMC) were recorded using fNIRS. Stepping performance and cortical activity were contrasted between groups and between the CSRT and the iCSRT and SST.

Results: The PD group performed worse than the HOA in all 3 stepping tests. A consistent pattern of interactions indicated differential hemodynamic responses between the groups. Compared with the CSRT, the PD group exhibited reduced DLPFC activity in the iCSRT and reduced SMA and PMC activity in the SST. The HOA exhibited increased DLPFC, SMA, and PMC activity when performing the SST in comparison with the CSRT task.

Conclusions: In contrast to the HOA, the PD group demonstrated reduced cortical activity in the DLPFC, SMA, and PMC during the more complex stepping tasks requiring inhibitory control. This may reflect subcortical and/or multiple pathway damage with subsequent deficient use of cognitive and motor resources.
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http://dx.doi.org/10.1177/1545968320969943DOI Listing
December 2020

Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study.

Age Ageing 2020 10;49(6):982-988

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.

Background: pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known.

Objective: to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults.

Design: 12-month prospective cohort study.

Setting: community.

Subjects: 242 community-dwelling older adults aged 70+ years.

Methods: participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months.

Results: participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures.

Conclusions: older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.
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http://dx.doi.org/10.1093/ageing/afaa070DOI Listing
October 2020

Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.

J Am Med Dir Assoc 2020 05;21(5):597-603.e8

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia.

Objectives: Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults.

Design: Systematic review and meta-analysis.

Setting And Participants: Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles.

Methods: Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included.

Results: Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different.

Conclusions And Implications: Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.
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http://dx.doi.org/10.1016/j.jamda.2020.02.011DOI Listing
May 2020

The Relationship Between Daily Physical Activity and Pain in Individuals with Knee Osteoarthritis.

Pain Med 2020 10;21(10):2481-2495

School of Medical Sciences, University of New South Wales, Sydney, Australia.

Objective: Investigate the association between physical activity and pain severity in individuals with knee osteoarthritis.

Design: Cross-sectional; systematic review with meta-analyses.

Methods: Thirty-one participants with knee osteoarthritis underwent assessment of symptoms via self-report questionnaires and quantitative sensory testing. Following testing, physical activity and symptoms were monitored for seven days using accelerometers and logbooks. Cross-correlation analyses were performed on fluctuations in symptoms and physical activity across the week to detect the relative timing of the strongest association between pain and activity. These data were complemented by meta-analyses of studies that examined correlations between pain from knee osteoarthritis and physical activity or fitness.

Results: Pain severity at baseline correlated with moderate to vigorous physical activity (r2 = 0.161-0.212, P < 0.05), whereby participants who were more physically active had less pain. Conversely, the peak of the cross-correlation analyses was most often positive and lagging, which indicated that pain was increased subsequent to periods of increased activity. These superficially discrepant findings were supported by the results of a meta-analysis of 13 studies and 9,363 participants, which identified significant heterogeneity for associations between physical activity and pain (I2 = 91%). Stronger inverse associations were found between fitness and pain.

Conclusions: Associations between physical activity and pain in people with knee osteoarthritis are variable and dynamic. These results reflect the beneficial impact of an active lifestyle and accompanying higher fitness. Yet, the side effect of acute periods of physical activity to transiently exacerbate pain may influence the behavior of some people to avoid activity because of pain.
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http://dx.doi.org/10.1093/pm/pnaa096DOI Listing
October 2020

Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people.

BMC Geriatr 2020 03 6;20(1):94. Epub 2020 Mar 6.

Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, Sydney, New South Wales, 2031, Australia.

Background: Pain is an independent risk factor for falling. One in two older community-dwelling people with musculoskeletal pain fall each year. This study examined physical, psychological and medical factors as potential mediators to explain the relationship between knee pain and falls.

Methods: Three hundred and thirty-three community-dwelling people aged 70+ years (52% women) participated in this cohort study with a 1-year follow-up for falls. Participants completed questionnaires (medical history, general health and concern about falls) and underwent physical performance tests. Participants were classified into 'pain' and 'no pain' groups based on self-reported knee pain. Poisson Regression models were computed to determine the Relative Risk (RR) of having multiple falls and potential mediators for increased fall risk.

Results: One hundred and eighteen (36%) participants were categorised as having knee pain. This group took more medications and had more medical conditions (P < 0.01) compared to the no pain group. The pain group had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (20%) reported ≥2 falls, with the pain group twice as likely to experience multiple falls over the 12 month follow up (RR = 2.0, 95% confidence interval (CI) = 1.27-3.13). Concern about falls, knee extension torque and postural sway with eyes closed were identified as significant and independent mediators of fall risk, and when combined explained 23% of the relationship between knee pain and falls.

Conclusion: This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.
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http://dx.doi.org/10.1186/s12877-020-1487-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059317PMC
March 2020

Identifying Key Risk Factors for Dizziness Handicap in Middle-Aged and Older People.

J Am Med Dir Assoc 2020 03 17;21(3):344-350.e2. Epub 2019 Oct 17.

Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia. Electronic address:

Objectives: More than 10% of people aged 50 years and older report dizziness. Despite available treatments, dizziness remains unresolved for many people due in part to suboptimal assessment. We aimed to identify factors associated with dizziness handicap in middle-aged and older people to identify targets for intervention to address this debilitating problem. A secondary aim was to determine whether factors associated with dizziness differed between middle-aged (<70 years) and older people (≥ 70 years).

Design: Secondary analysis of baseline and prospective data from a randomized controlled trial.

Setting And Participants: In total, 305 individuals aged 50 to 92 years reporting significant dizziness in the past year were recruited from the community.

Methods: Participants were classified as having either mild or no dizziness handicap (score <31) or moderate/severe dizziness handicap (score: 31‒100) based on the Dizziness Handicap Inventory. Participants completed health questionnaires and underwent assessments of psychological well-being, lying and standing blood pressure, vestibular function, strength, vision, proprioception, processing speed, balance, stepping, and gait. Participants reported dizziness episodes in monthly diaries for 6 months following baseline assessment.

Results: Dizziness Handicap Inventory scores ranged from 0 to 86 with 95 participants (31%) reporting moderate/severe dizziness handicap. Many vestibular, cardiovascular, psychological, balance-related, and medical/medications measures were significantly associated with dizziness handicap severity and dizziness episode frequency. Binary logistic regression identified a positive Dix Hallpike/head-roll test for benign paroxysmal positional vertigo [odds ratio (OR) 2.09, 95% confidence interval (CI) (1.11‒3.97)], cardiovascular medication use [OR 1.90, 95% CI (1.09‒3.32)], high postural sway when standing on the floor with eyes closed (sway path ≥160 mm) [OR 2.97, 95% CI (1.73‒5.10)], and anxiety (Generalized Anxiety Disorder Scale 7-item Scale score ≥8) [OR 3.08, 95% CI (1.36‒6.94)], as significant and independent predictors of moderate/severe dizziness handicap. Participants aged 70 years and over were significantly more likely to report cardiovascular conditions than those aged less than 70 years old.

Conclusions And Implications: Assessments of cardiovascular conditions and cardiovascular medication use, benign paroxysmal positional vertigo, anxiety, and postural sway identify middle-aged and older people with significant dizziness handicap. A multifactorial assessment including these factors may assist in tailoring evidence-based therapies to alleviate dizziness handicap in this group.
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http://dx.doi.org/10.1016/j.jamda.2019.08.016DOI Listing
March 2020

Effect of cognitive-only and cognitive-motor training on preventing falls in community-dwelling older people: protocol for the smart±step randomised controlled trial.

BMJ Open 2019 08 2;9(8):e029409. Epub 2019 Aug 2.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia.

Background: Physical and cognitive impairments are important risk factors for falls in older people. However, no studies have been adequately powered to examine whether cognitive or cognitive-motor training can prevent falls in older people. This is despite good evidence of improvements in fall-related cognitive and physical functions following both intervention types. This manuscript describes the study protocol for a three-arm randomised controlled trial to evaluate the effectiveness of home-based cognitive and cognitive-motor training interventions, compared to a minimal-intervention control group, in preventing falls in older people. This trial was prospectively registered with the Australia New Zealand Clinical Trial Registry, number ACTRN12616001325493.

Methods And Analysis: Community-dwelling adults aged 65 years and over, residing in Sydney Australia, will be recruited. Participants (n=750) will be randomly allocated to (1) cognitive-only training, (2) cognitive-motor training or (3) control groups. Both training interventions involve the use of the  home-based computerised game playing system for a recommended 120 min/week for 12 months. Cognitive training group participants will use a desktop electronic touch pad to play games with the  system while seated and using both hands. The cognitive-motor training group participants will use a wireless electronic floor step mat that requires accurate stepping using both legs for playing the same games, hence incorporating balance exercises. All groups will receive an education booklet on fall prevention. The primary outcome will be rate of falls, reported by monthly diaries during the 12-month duration of the study and analysis will be by intention-to-treat. Secondary outcomes include the proportion of fallers, physical and cognitive performance in 300 participants, and brain structure and function in 105 participants who will undertake MRI scans at baseline and 6 months. Cost-effectiveness will be determined using intervention and health service costs.

Ethics And Dissemination: Ethical approval was obtained from UNSW Ethics Committee in September 2015 (ref number HC15203). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.

Trial Registration Number: ACTRN12616001325493.
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http://dx.doi.org/10.1136/bmjopen-2019-029409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687022PMC
August 2019

Evaluating Balance Recovery Techniques for Users Wearing Head-Mounted Display in VR.

IEEE Trans Vis Comput Graph 2021 01 24;27(1):204-215. Epub 2020 Nov 24.

Room-scale 3D position tracking enables users to explore a virtual environment by physically walking, which improves comfort and the level of immersion. However, when users walk with their eyesight blocked by a head-mounted display, they may unexpectedly lose their balance and fall if they bump into real-world obstacles or unintentionally shift their center of mass outside the margin of stability. This paper evaluates balance recovery methods and intervention timing during the use of VR with the assumption that the onset of a fall is given. Our experiment followed the tether-release protocol during clinical research and induced a fall while a subject was engaged in a secondary 3D object selection task. The experiment employed a two-by-two design that evaluated two assistive techniques, i.e., video-see-through and auditory warning at two different timings, i.e., at fall onset and 500ms prior to fall onset. The data from 17 subjects showed that video-see-through triggered 500 ms before the onset of fall can effectively help users recover from falls. Surprisingly, video-see-through at fall onset has a significant negative impact on balance recovery and produces similar results to those of the baseline condition (no intervention).
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http://dx.doi.org/10.1109/TVCG.2019.2927477DOI Listing
January 2021

A pilot study of reactive balance training using trips and slips with increasing unpredictability in young and older adults: Biomechanical mechanisms, falls and clinical feasibility.

Clin Biomech (Bristol, Avon) 2019 07 10;67:171-179. Epub 2019 May 10.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; The Japan Society for the Promotion of Science, Tokyo, Japan.

Background: Exposure to unpredictable trips and slips can improve balance recovery responses but it was not known if older adults can tolerate such high intensity training. The study aim was to determine if reactive balance in both young and older adults could be trained in a single day through exposure to slip and trip hazards hidden in unpredictable walkway locations.

Methods: Ten young (20-40 yr) and ten older adults (65 + yr) completed 32 trials on a 10-meter trip and slip walkway; 14 slip trials, 14 trip trials and 4 no-perturbation trials presented in a pseudo-random order. Participant usual gait speed was regulated using a metronome and stepping tiles at fixed distances. Gait kinematics (Vicon motion capture), falls (> 30% body weight into the harness), anxiety and confidence to avoid falling were assessed.

Findings: Margin of stability for balance recovery after slips substantially improved at training completion for older adults (effect size = 1.13, P = 0.019). Falls from slips also decreased: 44.4% to 0% in the young adults; and 28.6% to 14.3% in the older adults. Although confidence to avoid falling did not change, anxiety increased during training with one young and three older participants withdrawing during training.

Interpretations: The findings indicate exposure to unpredictable perturbations improves reactive balance in young and older adults. However, improvements of balance recovery from trips were not significant. Elevated anxiety levels and a high dropout rate suggest the need for more individualised training over multiple days.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.05.016DOI Listing
July 2019

Effect of Reactive Balance Training Involving Repeated Slips and Trips on Balance Recovery Among Older Adults: A Blinded Randomized Controlled Trial.

J Gerontol A Biol Sci Med Sci 2019 08;74(9):1489-1496

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.

Background: This study examined whether reactive balance training (exposures to slips and trips) could improve balance recovery and reduce perturbation-induced falls among older adults.

Methods: Forty-four community-dwelling older adults participated in a parallel, blinded randomized controlled trial conducted in a research institute in Sydney, Australia in 2017-2018 (ACTRN12617000564358). The intervention group (n = 22) underwent three 40 minutes sessions (total 120 minutes) that exposed them to (1) 20 trips, (2) 20 slips, and (3) 10 trips and 10 slips in mixed order, over 2 days. The control group (n = 22) received one 40 minutes session of sham training. The primary outcome was falls (>30% body weight in harness) when exposed to trips and slips at post-assessment.

Results: At post-assessment, a total of 51 falls (23 and 27 falls from induced slips and trips, respectively) were recorded in the laboratory. Relative to the control group, the intervention group experienced fewer total falls (rate ratio [RR] = 0.40, 95% confidence interval [CI] = 0.22-0.76), slip falls (RR = 0.33, 95% CI = 0.12-0.90) and trip falls (RR = 0.49, 95% CI = 0.21-1.12). Eight participants reported adverse events (5 in the intervention group and 3 in the control group) which were related mainly to discomfort caused by a suboptimal harness used in the initial stages of the trial.

Conclusions: The reactive balance training reduced perturbation-induced falls by 60% indicating improved balance recovery from trips and slips. A comfortable safety harness system is essential to prevent discomfort. Reactive balance training may complement traditional exercise programs in fall prevention interventions.
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http://dx.doi.org/10.1093/gerona/glz021DOI Listing
August 2019

Aging.

Handb Clin Neurol 2018 ;159:157-171

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia.

This chapter reviews studies that have examined age-related anatomic and functional changes in sensory, neuromuscular, and cognitive systems that impair the control of balance and gait. Specifically, we examine age-related changes in peripheral systems: lower-limb sensation, visual functions such as contrast sensitivity and depth perception, vestibular sense, strength, and power in the lower-limb muscle groups, as well as central factors including processing speed and executive functioning. Significant impairments in any one of the above systems can predispose older people to falls, with the risk of falling increasing substantially with the number of impairments present. There is increasing evidence that interventions aimed at addressing specific sensory and neuromuscular impairments can improve balance control and reduce fall risk. In particular, task-specific exercise can improve muscle strength, balance, gait and mobility and prevent falls in older people.
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http://dx.doi.org/10.1016/B978-0-444-63916-5.00010-0DOI Listing
March 2019

Exposure to trips and slips with increasing unpredictability while walking can improve balance recovery responses with minimum predictive gait alterations.

PLoS One 2018 18;13(9):e0202913. Epub 2018 Sep 18.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.

Introduction: The primary study aim was to determine if repeated exposure to trips and slips with increasing unpredictability while walking can improve balance recovery responses when predictive gait alterations (e.g. slowing down) are minimised. The secondary aim was to determine if predictive gait alterations acquired through exposure to perturbations at a fixed condition would transfer to highly unpredictable conditions.

Methods: Ten young adults were instructed to step on stepping tiles adjusted to their usual step length and to a metronome adjusted to their usual cadence on a 10-m walkway. Participants were exposed to a total of 12 slips, 12 trips and 6 non-perturbed trials in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) random leg and location. Kinematics during non-perturbed trials and pre- and post-perturbation steps were analysed.

Results: Throughout the three conditions, participants walked with similar gait speed, step length and cadence(p>0.05). Participants' extrapolated centre of mass (XCoM) was anteriorly shifted immediately before slips at the fixed location (p<0.01), but this predictive gait alteration did not transfer to random perturbation locations. Improved balance recovery from trips in the random location was indicated by increased margin of stability and step length during recovery steps (p<0.05). Changes in balance recovery from slips in the random location was shown by reduced backward XCoM displacement and reduced slip speed during recovery steps (p<0.05).

Conclusions: Even in the absence of most predictive gait alterations, balance recovery responses to trips and slips were improved through exposure to repeated unpredictable perturbations. A common predictive gait alteration to lean forward immediately before a slip was not useful when the perturbation location was unpredictable. Training balance recovery with unpredictable perturbations may be beneficial to fall avoidance in everyday life.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202913PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143193PMC
February 2019

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

PLoS Med 2018 07 24;15(7):e1002620. Epub 2018 Jul 24.

Neuroscience Research Australia, Sydney, New South Wales, Australia.

Background: Dizziness is common among older people and is associated with a cascade of debilitating symptoms, such as reduced quality of life, depression, and falls. The multifactorial aetiology of dizziness is a major barrier to establishing a clear diagnosis and offering effective therapeutic interventions. Only a few multidisciplinary interventions of dizziness have been conducted to date, all of a pilot nature and none tailoring the intervention to the specific causes of dizziness. Here, we aimed to test the hypothesis that a multidisciplinary dizziness assessment followed by a tailored multifaceted intervention would reduce dizziness handicap and self-reported dizziness as well as enhance balance and gait in people aged 50 years and over with dizziness symptoms.

Methods And Findings: We conducted a 6-month, single-blind, parallel-group randomized controlled trial in community-living people aged 50 years and over who reported dizziness in the past year. We excluded individuals currently receiving treatment for their dizziness, those with degenerative neurological conditions including cognitive impairment, those unable to walk 20 meters, and those identified at baseline assessment with conditions that required urgent treatment. Our team of geriatrician, vestibular neuroscientist, psychologist, exercise physiologist, study coordinator, and baseline assessor held case conferences fortnightly to discuss and recommend appropriate therapy (or therapies) for each participant, based on their multidisciplinary baseline assessments. A total of 305 men and women aged 50 to 92 years (mean [SD] age: 67.8 [8.3] years; 62% women) were randomly assigned to either usual care (control; n = 151) or to a tailored, multifaceted intervention (n = 154) comprising one or more of the following: a physiotherapist-led vestibular rehabilitation programme (35% [n = 54]), an 8-week internet-based cognitive-behavioural therapy (CBT) (19% [n = 29]), a 6-month Otago home-based exercise programme (24% [n = 37]), and/or medical management (40% [n = 62]). We were unable to identify a cause of dizziness in 71 participants (23% of total sample). Primary outcome measures comprised dizziness burden measured with the Dizziness Handicap Inventory (DHI) score, frequency of dizziness episodes recorded with monthly calendars over the 6-month follow-up, choice-stepping reaction time (CSRT), and gait variability. Data from 274 participants (90%; 137 per group) were included in the intention-to-treat analysis. At trial completion, the DHI scores in the intervention group (pre and post mean [SD]: 25.9 [19.2] and 20.4 [17.7], respectively) were significantly reduced compared with the control group (pre and post mean [SD]: 23.0 [15.8] and 21.8 [16.4]), when controlling for baseline scores (mean [95% CI] difference between groups [baseline adjusted]: -3.7 [-6.2 to -1.2]; p = 0.003). There were no significant between-group differences in dizziness episodes (relative risk [RR] [95% CI]: 0.87 [0.65 to 1.17]; p = 0.360), CSRT performance (mean [95% CI] difference between groups [baseline adjusted]: -15 [-40 to 10]; p = 0.246), and step-time variability during gait (mean [95% CI] difference between groups [baseline adjusted]: -0.001 [-0.002 to 0.001]; p = 0.497). No serious intervention-related adverse events occurred. Study limitations included the low initial dizziness severity of the participants and the only fair uptake of the falls clinic (medical management) and the CBT interventions.

Conclusions: 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.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000379819.
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http://dx.doi.org/10.1371/journal.pmed.1002620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057644PMC
July 2018

Health professional student education related to the prevention of falls in older people: A survey of universities in Australia and New Zealand.

Australas J Ageing 2018 Sep 15;37(3):E116-E119. Epub 2018 May 15.

Neuroscience Research Australia, Sydney, New South Wales, Australia.

Objective: To determine the amount and nature of health professional education related to fall prevention for older adults in Australian and New Zealand universities.

Methods: Universities offering medicine, nursing and allied health courses were invited to complete an online survey enquiring about fall prevention course-related information: topics; delivery mode; and time dedicated.

Results: One hundred and five respondents, 11 disciplines and 43 universities completed the survey. Courses were primarily undergraduate level (90%) and delivered face-to-face (93%). Time dedicated to fall prevention was usually one to three hours of lectures (>65% of courses) and 1-3+ hours of tutorials/practical sessions (>80% of courses).

Conclusions: Survey results indicate that education of health professionals across a range of disciplines in Australia and New Zealand does include older adult fall prevention. Education of all health and exercise professionals about falls is vital given their critical role in the prevention and management of falls in our rapidly ageing population.
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http://dx.doi.org/10.1111/ajag.12543DOI Listing
September 2018

A busy day has minimal effect on factors associated with falls in older people: An ecological randomised crossover trial.

Exp Gerontol 2018 06 12;106:192-197. Epub 2018 Mar 12.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. Electronic address:

Fatigue is a common complaint in older people. Laboratory-induced muscle fatigue has been found to affect physical functions in older populations but these protocols are rigorous and are unlikely to accurately reflect daily activities. This study used an ecological approach to determine the effects of a busy day on self-reported fatigue and fall-related measures of physical and cognitive function in older people. Fifty community-dwelling adult volunteers, aged 60-88 (mean 73) years participated in this randomised crossover trial. Participants undertook assessments of balance, strength, gait, mobility, cognitive function and self-reported fatigue, before and after a planned rest day and a planned busy day (randomly allocated) at least one week apart. Participants wore an activity monitor on both the rest and busy days. On average, participants undertook twice as many steps and 2.5 times more minutes of activity on the busy, compared with the rest day. Participants had a significant increase in self-reported fatigue on the afternoon of the busy day and no change on the rest day. Repeated measures ANOVAs found no significant day (rest/busy) × time (am/pm) interaction effects, except for the timed up and go test of mobility, resulting from relatively improved mobility performance over the rest day, compared with the busy day. This study showed few effects of a busy day on physical and cognitive performance tests associated with falls in older people.
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http://dx.doi.org/10.1016/j.exger.2018.03.009DOI Listing
June 2018

Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people.

Gait Posture 2018 01 16;59:188-192. Epub 2017 Oct 16.

Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.

Background: Reduced ability to adapt gait, particularly under challenging conditions, may be an important reason why older adults have an increased risk of falling. This study aimed to identify cognitive, psychological and physical mediators of the relationship between impaired gait adaptability and fall risk in older adults.

Methods: Fifty healthy older adults (mean±SD: 74±7years) were categorised as high or low fall risk, based on past falls and their performance in the Physiological Profile Assessment. High and low-risk groups were then compared in the gait adaptability test, i.e. an assessment of the ability to adapt gait in response to obstacles and stepping targets under single and dual task conditions. Quadriceps strength, concern about falling and executive function were also measured.

Results: The older adults who made errors on the gait adaptability test were 4.76 (95%CI=1.08-20.91) times more likely to be at high risk of falling. Furthermore, each standard deviation reduction in gait speed while approaching the targets/obstacle increased the odds of being at high risk of falling approximately three fold: single task - OR=3.10,95%CI=1.43-6.73; dual task - 3.42,95%CI=1.56-7.52. Executive functioning, concern about falling and quadriceps strength substantially mediated the relationship between the gait adaptability measures and fall risk status.

Conclusion: Impaired gait adaptability is associated with high risk of falls in older adults. Reduced executive function, increased concern about falling and weaker quadriceps strength contribute significantly to this relationship. Training gait adaptability directly, as well as addressing the above mediators through cognitive, behavioural and physical training may maximise fall prevention efficacy.
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http://dx.doi.org/10.1016/j.gaitpost.2017.10.017DOI Listing
January 2018

Transfer effects of step training on stepping performance in untrained directions in older adults: A randomized controlled trial.

Gait Posture 2017 05 21;54:50-55. Epub 2017 Feb 21.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Barker Street Randwick, Randwick, NSW 2031, Australia; School of Medical Sciences, University of New South Wales, Sydney, 2052 NSW, Australia. Electronic address:

Background: Although step training improves the ability of quick stepping, some home-based step training systems train limited stepping directions and may cause harm by reducing stepping performance in untrained directions. This study examines the possible transfer effects of step training on stepping performance in untrained directions in older people.

Methods: Fifty four older adults were randomized into: forward step training (FT); lateral plus forward step training (FLT); or no training (NT) groups. FT and FLT participants undertook a 15-min training session involving 200 step repetitions. Prior to and post training, choice stepping reaction time and stepping kinematics in untrained, diagonal and lateral directions were assessed.

Results: Significant interactions of group and time (pre/post-assessment) were evident for the first step after training indicating negative (delayed response time) and positive (faster peak stepping speed) transfer effects in the diagonal direction in the FT group. However, when the second to the fifth steps after training were included in the analysis, there were no significant interactions of group and time for measures in the diagonal stepping direction.

Conclusions: Step training only in the forward direction improved stepping speed but may acutely slow response times in the untrained diagonal direction. However, this acute effect appears to dissipate after a few repeated step trials. Step training in both forward and lateral directions appears to induce no negative transfer effects in diagonal stepping. These findings suggest home-based step training systems present low risk of harm through negative transfer effects in untrained stepping directions.

Trial Registration: ANZCTR 369066.
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http://dx.doi.org/10.1016/j.gaitpost.2017.02.014DOI Listing
May 2017

Tailored multifactorial intervention to improve dizziness symptoms and quality of life, balance and gait in dizziness sufferers aged over 50 years: protocol for a randomised controlled trial.

BMC Geriatr 2017 02 15;17(1):56. Epub 2017 Feb 15.

Neuroscience Research Australia, University of New South Wales, Sydney, Australia.

Background: Dizziness is a frequently reported symptom in older people that can markedly impair quality of life. This manuscript presents the protocol for a randomised controlled trial, which has the main objective of determining the impact of comprehensive assessment followed by a tailored multifaceted intervention in reducing dizziness episodes and symptoms, improving associated impairments to balance and gait and enhancing quality of life in older people with self-reported significant dizziness.

Methods: Three hundred people aged 50 years or older, reporting significant dizziness in the past year will be recruited to participate in the trial. Participants allocated to the intervention group will receive a tailored, multifaceted intervention aimed at treating their dizziness symptoms over a 6 month trial period. Control participants will receive usual care. The primary outcome measures will be the frequency and duration of dizziness episodes, dizziness symptoms assessed with the Dizziness Handicap Inventory, choice-stepping reaction time and step time variability. Secondary outcomes will include health-related quality of life measures, depression and anxiety symptoms, concern about falling, balance and risk of falls assessed with the physiological fall risk assessment. Analyses will be by intention-to-treat.

Discussion: The study will determine the effectiveness of comprehensive assessment, combined with a tailored, multifaceted intervention on dizziness episodes and symptoms, balance and gait control and quality of life in older people experiencing dizziness. Clinical implications will be evident for the older population for the diagnosis and treatment of dizziness.

Trial Registration: The study is registered with the Australia New Zealand Clinical Trials Registry ACTRN12612000379819 .
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http://dx.doi.org/10.1186/s12877-017-0450-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312521PMC
February 2017

Sensorimotor and Cognitive Predictors of Impaired Gait Adaptability in Older People.

J Gerontol A Biol Sci Med Sci 2017 Sep;72(9):1257-1263

Neuroscience Research Australia.

Background: The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This study investigated whether impaired gait adaptability in a task including obstacle and stepping targets is associated with cognitive and sensorimotor capacities in older adults.

Methods: Fifty healthy older adults (74±7 years) were instructed to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. Participants also completed cognitive and sensorimotor function assessments.

Results: Stroop test and reaction time performance significantly discriminated between participants who did and did not make stepping errors, and poorer Trail-Making test performance predicted shorter penultimate step length in the obstacle avoidance condition. Slower reaction time predicted poorer stepping accuracy; increased postural sway, weaker quadriceps strength, and poorer Stroop and Trail-Making test performances predicted increased number of steps taken to approach the target/obstacle and shorter step length; and increased postural sway and higher concern about falling predicted slower step velocity.

Conclusions: Superior executive function, fast processing speed, and good muscle strength and balance were all associated with successful gait adaptability. Processing speed appears particularly important for precise foot placements; cognitive capacity for step length adjustments; and early and/or additional cognitive processing involving the inhibition of a stepping pattern for obstacle avoidance. This information may facilitate fall risk assessments and fall prevention strategies.
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http://dx.doi.org/10.1093/gerona/glw171DOI Listing
September 2017

The influence of age, anxiety and concern about falling on postural sway when standing at an elevated level.

Hum Mov Sci 2016 Oct 16;49:206-15. Epub 2016 Jul 16.

Neuroscience Research Australia, University of New South Wales, Sydney, Australia. Electronic address:

Psychological processes may influence balance and contribute to the risk of falls in older people. While a self-reported fear of falling is associated with increased postural sway, inducing fear using an elevated platform can lead to reduced sway, suggesting different underlying mechanisms whereby fear may influence balance control. This study examined changes in postural sway, muscle activity and physiological measures of arousal while standing on a 65cm elevated platform, compared to floor level, in young and older adults. The older adults were classified as fall concerned or not fall concerned based on the Falls Efficacy Scale-International and anxious or not anxious based on the Goldberg Anxiety Scale. Fall concern did not affect the physiological and sway response to the elevated platform. In response to the postural threat, the anxious participants increased their sway frequency (p=0.001) but did not reduce sway range (p=0.674). Conversely, non-anxious participants showed an adaptive tightening of balance control, effectively reducing sway range in the elevated condition (p<0.001). Generalised anxiety in older adults appears to differentially affect postural control strategies under threatening conditions.
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http://dx.doi.org/10.1016/j.humov.2016.06.014DOI Listing
October 2016

Age-related changes in gait adaptability in response to unpredictable obstacles and stepping targets.

Gait Posture 2016 05 22;46:35-41. Epub 2016 Feb 22.

Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia. Electronic address:

Background: A large proportion of falls in older people occur when walking. Limitations in gait adaptability might contribute to tripping; a frequently reported cause of falls in this group.

Objective: To evaluate age-related changes in gait adaptability in response to obstacles or stepping targets presented at short notice, i.e.: approximately two steps ahead.

Methods: Fifty older adults (aged 74±7 years; 34 females) and 21 young adults (aged 26±4 years; 12 females) completed 3 usual gait speed (baseline) trials. They then completed the following randomly presented gait adaptability trials: obstacle avoidance, short stepping target, long stepping target and no target/obstacle (3 trials of each).

Results: Compared with the young, the older adults slowed significantly in no target/obstacle trials compared with the baseline trials. They took more steps and spent more time in double support while approaching the obstacle and stepping targets, demonstrated poorer stepping accuracy and made more stepping errors (failed to hit the stepping targets/avoid the obstacle). The older adults also reduced velocity of the two preceding steps and shortened the previous step in the long stepping target condition and in the obstacle avoidance condition.

Conclusion: Compared with their younger counterparts, the older adults exhibited a more conservative adaptation strategy characterised by slow, short and multiple steps with longer time in double support. Even so, they demonstrated poorer stepping accuracy and made more stepping errors. This reduced gait adaptability may place older adults at increased risk of falling when negotiating unexpected hazards.
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http://dx.doi.org/10.1016/j.gaitpost.2016.02.003DOI Listing
May 2016

Wearable pendant device monitoring using new wavelet-based methods shows daily life and laboratory gaits are different.

Med Biol Eng Comput 2016 Apr 6;54(4):663-74. Epub 2015 Aug 6.

Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, Sydney, NSW, 2031, Australia.

Morbidity and falls are problematic for older people. Wearable devices are increasingly used to monitor daily activities. However, sensors often require rigid attachment to specific locations and shuffling or quiet standing may be confused with walking. Furthermore, it is unclear whether clinical gait assessments are correlated with how older people usually walk during daily life. Wavelet transformations of accelerometer and barometer data from a pendant device worn inside or outside clothing were used to identify walking (excluding shuffling or standing) by 51 older people (83 ± 4 years) during 25 min of 'free-living' activities. Accuracy was validated against annotated video. Training and testing were separated. Activities were only loosely structured including noisy data preceding pendant wearing. An electronic walkway was used for laboratory comparisons. Walking was classified (accuracy ≥97 %) with low false-positive errors (≤1.9%, κ ≥ 0.90). Median free-living cadence was lower than laboratory-assessed cadence (101 vs. 110 steps/min, p < 0.001) but correlated (r = 0.69). Free-living step time variability was significantly higher and uncorrelated with laboratory-assessed variability unless detrended. Remote gait impairment monitoring using wearable devices is feasible providing new ways to investigate morbidity and falls risk. Laboratory-assessed gait performances are correlated with free-living walks, but likely reflect the individual's 'best' performance.
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http://dx.doi.org/10.1007/s11517-015-1357-9DOI Listing
April 2016
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