Fall prevention in people with Parkinson’s disease · •The rate is higher for people with...
Transcript of Fall prevention in people with Parkinson’s disease · •The rate is higher for people with...
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Fall prevention in people with Parkinson’s disease
Stephen Lord
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Why are falls a problem?
• One in three people 65 years and older living in the community fall at least once per year
• The rate is higher for people with Parkinson’s disease (50-60%)
• Falls account for 4% of all hospital admissions in people aged 65+
• By 2051 one quarter of the Australian population will be aged 65 years and over
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Consequences of falls• 10-15% of falls result in major injuries - soft tissue
damage, head trauma, dislocations and fractures
• Reduced quality of life and independence- due to disability, loss of confidence and activity restriction
• Can result in need for residential aged care
• Can result in death - more than 1000 people in Australia each year
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Established fall risk factors in PD
• Having had a fall in the past
• Being concerned about falls
• More PD symptoms – greater disease severity
• Cognitive impairment
• Loss of arm swing
• More episodes of freezing
• More stooped posture
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Fall risk in Parkinson’s disease: What we have found so far
• Reduced strength and power
• Slower reaction time
• Impaired executive functioning
• Poorer controlled leaning balance
• Less smooth walking pattern
• Slow choice stepping reaction time
• Impaired gait adaptability
• Reduced ability to respond appropriately to perturbations while standing or walking
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Fall prevention in Parkinson’s disease
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Exercise interventions in PD
53% reduction in falls overall
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Lancet 2016; 388: 1170–82
New approaches
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Methods
• 202 participants assigned to either treadmill training plus virtual reality or treadmill training alone
• Both groups aimed to train three times per week for 6 weeks, with each session lasting about 45 min and structured training progression individualised to the participant's level of performance
• Stratified by subgroups: history of falls (109), mild cognitive impairment (43), Parkinson’s disease (130)
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The Virtual Reality intervention
The Virtual Reality system consisted of a motion-capture camera and a computer-generated simulation projected on to a large screen, including challenges such as obstacles, multiple pathways, and distracters that required continual adjustment of steps.
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Falls
• 51% reduction in the PD participants
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Safe-PD Voluntary and reactive step training in people with PD
• 44 people with PD (> 40 years);
• Community dwellers; idiopathic PD;
• Exclusion criteria: visual, cognitive or other neurological impairments and
insufficient English skills
• Randomised controlled trial ACTRN12618001515280
Aims: to examine the effects of combined voluntary and reactive step training
on:
• Falls in the laboratory and stepping responses
• Balance, gait and mobility
• Neuropsychological function (i.e. cognitive performance)
• Neural plasticity (i.e. changes in brain function assessed with fNIRS)
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The slipping tile
The tripping board
Damper Weight scaleSafety harness
Infrared camerasCeiling rail
Stepping tiles MetronomeControl PC
Foot detection sensor
Unpredictable trip and slip training
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TRIPS
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SLIPS
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Home-based system
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Smart±Step Interventions
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Study progress
• Recruitment completed May 2019
• Study completed as of 20 September 2019
• Dropout < 10%
• Both interventions feasible and acceptable
• Analysis underway
• Trip and slip training may be better on a programmable perturbation treadmill
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NHMRC application– with everyday falls as the main outcome measure
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Thank you