Fall prevention in people with Parkinson’s disease

Stephen Lord

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

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

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

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

Fall prevention in Parkinson’s disease

Exercise interventions in PD

53% reduction in falls overall

Lancet 2016; 388: 1170–82

New approaches

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)

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.

Falls

• 51% reduction in the PD participants

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)

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

TRIPS

SLIPS

Home-based system

Smart±Step Interventions

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

NHMRC application– with everyday falls as the main outcome measure

Thank you