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From the age of 65 years and older, falls happen frequently and affect quality of life. About one in three older people fall at least once a year, and about half of the falls lead to injuries that can cause mobility restriction during daily activities. Older people are often aware of the consequences of falling, with over half reporting a fear of falling.
Clinical trials have taught us that falls can be prevented at all ages. The single most effective way to prevent falls is to do specific exercises. However, in order for exercises to reduce a person’s fall risk, the person must do challenging balance training for at least two hours per week for a minimum of 6 months.
Long-term participation with these types of exercise programs can be poor due to the often boring nature of repetitive exercises. Also, many older people are not aware that exercise is a proven effective strategy for preventing falls.
We are focussed on finding solutions to support active and healthy ageing. We want to help older people do the necessary exercises so they can live independently for longer. Our pioneering work has led to the development of various new technology-based solutions that we hope to release on the market soon.
We are using new technologies to design exercise programs, individualised for each person, as no one person is the same. Our programs seek to offer a greater choice of exercises for people to keep things interesting. We have already released a range of mobile apps that assist in the assessment of fall risk, therefore working towards reducing falls. The use of technology in this area has opened up a world of possibilities like the convenience of doing the right training in the comfort of your own home wherever you are. As long as you have occasional access to the Internet, you can use our programs.
We are particularly excited about one of our apps that is currently being tested, called Standing Tall. This unique program offers individually-tailored, progressive, high-intensity balance exercises, and includes an in-built coach and activity planner to encourage you to do your exercises more frequently. The activity planner lets you set your own goals and has optional reminders if you need to exercise more. The program also lets you to monitor your own progress.
So far, results show that the program is safe and easy for older people to use. Our participants have told us that they really enjoy doing the exercises Standing Tall offers and that it helps them to exercise more regularly. The next step for us is to conduct a randomised controlled trial (the gold standard for a clinical trial) to see if people keep using our program over a longer period and to test its effectiveness in falls prevention.
If successful, Standing Tall will increase the likelihood of older people taking part in, and benefiting from this type of fall prevention strategy.
Our aim is to promote healthy ageing by reducing falls, at a low cost for the health care sector. Following on from our trial, we aim to make the Standing Tall mobile app available to the general public. Watch this space…
Conditions that decrease a person’s ability to control their muscles, such as spinal cord injury and stroke, have devastating and debilitating consequences for individuals and their loved ones.
Imagine not being able to pick up your mug of coffee, or do up the button on your coat. Small daily tasks, that many take for granted, can prove impossible for those with damage to the neural pathways responsible for muscle control.
My PhD, being conducted within the Taylor Group here at NeuRA, is focused on the use of a variety of brain, spinal cord and nerve stimulation techniques to induce changes (plasticity) at the connections (synapses) between nerve cells in the spinal cord, with the ultimate goal of enhancing the control of muscles.
Two techniques our group uses are known as transcranial magnetic stimulation (TMS), and electrical peripheral nerve stimulation (PNS); both are non-invasive methods that can be used to stimulate parts of the nervous system.
We can use TMS to stimulate parts of the brain that control specific muscles of the arm, and PNS to excite peripheral nerves that supply the arm. Repetitive pairing of these two stimuli at specific timing intervals can induce synaptic plasticity in the spinal cord in pathways that control voluntary muscle activity.
This technique can enhance muscle activity of the biceps in able-bodied participants and can improve manual dexterity of the hand in participants with incomplete spinal cord injury.
The technique has the potential for enhancing activity at any remaining synapses in the spinal cord that can transmit commands from the brain to the muscles; therefore this protocol would be more relevant for those with incomplete spinal cord injuries, when some spinal nerve fibers are preserved. However, even with clinically diagnosed complete injuries where there is an absence of all sensory and muscle activity below the site of injury, there could be some nerve cells within the spinal cord that have the potential to respond to the technique.
Although there are a large number of studies that investigate plasticity in the brain, there is limited knowledge of the effects of magnetic and electrical stimulation on plasticity of spinal cord pathways. I am interested in optimising the methods we use. For example, I am asking, is more necessarily better? Indeed, in the most recent study for my PhD, we found that by doubling the number of stimulus pairs we could induce more reliable, longer lasting spinal cord plasticity.
What we are aiming for with these methods is small, but functionally relevant improvements in muscle control which, as an example, could be the difference between being able to pick up a cup or not.
Work in this area is still in its early days; however my vision for the future is that an optimised technique could be used clinically in conjunction with other forms of rehabilitation, such as physiotherapy, to improve motor control in those with conditions such as incomplete spinal cord injury and stroke.
Your donations to NeuRA this year have helped bring certainty to our research initiatives.
Funding for medical research is a roller coaster… sometimes you’re up and sometimes you’re down. Never knowing for certain where funding for the next trial or research initiative will come from is a very real concern for researchers and, frankly, patients and carers.
You often hear people say that ‘the Government should be doing more’, but the reality is the public purse as it stands cannot support every research opportunity. NeuRA applies for research grants predominately from the Australian Research Council (ARC) and the National Health and Medical Research Council (NHMRC); some applications are successful, others are not. Even when successful, the grants typically only cover a proportion of the true costs of running a research project. In addition, funding for the next generation of the brightest scientists working toward their PhD at NeuRA is a stipend of around $25,000, not enough for them to pay the rent, eat and concentrate on work.
Enter our loyal donors.
How your donations make a difference
In my role at the NeuRA Foundation, I am entrusted to share with our donors (via mail and email) the stories of patients and their carers who live with degenerative and chronic diseases. I see firsthand the generosity of people from all stages of life. I am as touched by the donor who gives thousands of dollars as I am by the one who gives five. Every dollar is important. Every donation helps. Every donor contributes to future discoveries.
Throughout this past year, funds raised through sharing these stories have served two primary purposes:
This way of distributing your donations means they have the potential to make an impact across the whole of NeuRA.
How you can get involved
Admittedly, when I started at NeuRA, I was surprised at the numerous ways people could support our research. In addition to one-off or regular donations, you can:
A final word from carer Wendy Smith
You may have read the story about George and Wendy Smith (pictured), who featured in our summer letter (missed it? read it here).
Wendy’s words are straight from the heart:
“When he was diagnosed with frontotemporal dementia, George said we had to help research as much as we could and try to get a breakthrough. With so many types of dementia, we need discoveries or cures so that other families do not have to go through what we had to.”
So, this Christmas, we say thank you to our donors for their loyal support. You are contributing to future breakthroughs and discoveries that we hope will dramatically change the outcomes for people, like George, who suffer from either degenerative brain and nervous system diseases or other chronic illnesses.
Dr Susanna Park is working on ways to prevent one of the lesser known side effects of chemotherapy: nerve damage.
One hundred years ago cancer was invariably fatal. Over the past century, however, we’ve made such huge advances in cancer treatment that today, more than two in three patients diagnosed with cancer will survive their cancer for five years or more. As a researcher, I regularly see patients complete treatment and go on to live their lives cancer free.
One thing I see often, however, as a direct result of more people surviving cancer and cancer treatment, is the long-term side effects of chemotherapy. While nausea and fatigue are well-known to patients, these other side effects seem to take people by surprise. One in particular, nerve damage, is the focus of my research.
Nerve damage first appears in the hands and feet as tingling, numbness and loss of sensation. This damage, known as chemotherapy-induced peripheral neuropathy, is caused by chemotherapy drugs used to treat a number of different cancer types, including colorectal, breast, ovarian and blood cancers.
We don’t yet understand the mechanisms underlying this damage and there is currently no known treatment or cure. The damage can be irreversible and limits the amount of treatment that patients can receive. Unfortunately, nerve damage sometimes develops late in treatment or even after the chemotherapy has stopped, making it harder to identify and treat.
Living with nerve damage
Neuropathy can become such a significant problem that patients have trouble with everyday activities such as walking and handling objects.
For example, one patient told me that during treatment she couldn’t hold a pen to write. She said her legs felt like they didn’t belong to her and she still has difficulty walking months after her chemotherapy treatment ended.
Another patient told me that he cut his finger on a razor but only noticed when he saw the blood on his finger.
One patient’s feet ached all the time and she couldn’t stand the pressure of shoes and socks.
I’ve also seen patients who have difficulties with typing, buttoning clothes, and many often report stumbling and tripping. The unfortunate reality is that these effects can continue for years after the completion of chemotherapy treatment.
Preventing nerve damage
As there is currently no way of reversing nerve damage, our research team at NeuRA and the Prince of Wales Hospital focus on prevention; we have recently developed a nerve assessment technique to detect and measure early signs of nerve damage, enabling clinicians to identify patients at risk of severe nerve damage early in their treatment. Up until now, clinicians have had to rely on patients reporting symptoms, by which point a great deal of nerve damage may have already occurred.
While this technique is promising, we still need to determine exactly how nerve damage affects the everyday lives of patients. We are only just now starting to look at improving quality of life after cancer; and as a result, the impact of nerve damage on patient function and daily life has been largely underestimated.
I’m currently looking at these day-to-day problems and how we can quantify the difficulties that patients experience. By developing these assessment tools, we will be able to better identify and measure nerve damage, which will hopefully lead to improved outcomes for cancer survivors following chemotherapy treatment in the future.
In 2002, Lydia Volek had a sudden onset of dizziness and was told she would probably never get better. After learning to live with it for over a decade, Lydia stumbled upon a study to treat dizziness at NeuRA. As our guest blogger this week, Lydia tells us how participating in this research turned her life around in just a few short minutes.
Lydia: My dizziness appeared suddenly and was extremely unpleasant. I couldn’t look up without everything spinning and when I bent down I felt like I was going to fall on my head. It’s not very pleasant, I can tell you that much. I had to be really careful getting in the bath or on the bus; I had to watch my steps and not do anything too quickly.
I was really frustrated to begin with and then I became worried about what it might mean. The specialist told me my condition was benign and probably wouldn’t get worse – but also may not get better. The treatment I received didn’t really help that much and so I started to learn to live with it. When you know that you don’t have a choice, you just wipe it from your mind and keep going – that’s all you can do.
I felt dizzy on and off for over 10 years – probably more on than off. This was how I lived until I heard about the study at NeuRA and thought ‘Ah! This might be the way for me!’
Lydia was assessed by the study team from the Falls and Balance Research Group at NeuRA. They recorded her medical history and levels of anxiety and depression; they tested her vision, strength and balance and measured her cardiovascular health, including blood pressure, and inner ear function.
The team determined that the cause of Lydia’s dizziness was a displacement of calcium crystals in her inner ear – a condition called Benign Paroxysmal Positional Vertigo. She was offered physiotherapy to remove the dislodged particles.
Lydia: The treatment I received was very easy and simple; the physiotherapist rolled my head in a certain way and was finished in a few minutes. I felt very good straight away; I could turn around with my eyes closed and not feel like falling. I was so surprised! To tell you the truth, in that moment I thought, my goodness, why didn’t anyone tell me about this before? But I suppose that’s why they’re doing this research.
Now, a few weeks later, my vertigo is still gone. I can look at the sky and see the birds in the tops of the trees and not feel like I’m going to fall over. It’s little things like this that make a big difference to my life. From now on, if I meet someone who’s been told to live with dizziness, I’m going to tell them to go and get treated. There is life beyond this!
We are still seeking volunteers for our study, so if you would like to participate, please contact Mayna from the Dizziness Research Team on (02) 9399 1255 or at email@example.com.
A comment from the NeuRA study team: We believe that Lydia’s condition was not properly treated when she first experienced symptoms. What probably happened was the dislodged particles in her ear canals were not completely removed, which led to a continuation of her symptoms.
Dizziness can be physically debilitating and extremely distressing. Despite being relatively common in middle-aged and older people, we don’t fully understand its causes and, as a result, sufferers often receive a wrong diagnosis or inappropriate treatment, with little or no relief of their symptoms.
With this study, we hope to come to a better understanding of the causes of dizziness. We are also assessing the effectiveness of individually tailored treatment plans that include one or more therapies; currently, many patients are offered only one of these therapies and continue to experience symptoms because their dizziness has not been completely treated.
The therapies we offer the participants in our study, depending on their assessment, are:
We hope that by improving how we diagnose the causes of dizziness, and by offering an individualised selection of treatments, we can improve the quality of life for the many Australians like Lydia who have been told that they just have to learn to live with the condition.
Read more about the study here on Australian Ageing Agenda.
Dr Jason Bruggemann is investigating new ways of identifying children at risk of developing schizophrenia.
I am relatively new to schizophrenia research, so I was surprised by the sheer diversity of people I have met who have schizophrenia – men and women from a wide variety of backgrounds with distinct personalities who don’t conform to any particular stereotype. While the disease affects them in different ways, however, they have all described the significant challenges that schizophrenia has posed for them and their families.
Schizophrenia is a neurodevelopmental disorder that typically begins during late adolescence or early adulthood. Healthy development during adolescence involves large-scale reorganisation and restructuring of the brain, including changes to the delicate excitatory/inhibitory balance of the brain’s neurotransmitter systems and underlying brain structure. This process seems to go awry for people with schizophrenia. Environmental factors like stress also appear to contribute to the onset of the disease.
We know that early diagnosis and treatment can significantly improve long-term outcomes and help minimise the damaging effects of schizophrenia. Hence, current research is focused on potential ways of identifying children at risk of developing schizophrenia. Our colleague Dr Kristin Laurens and her team from Kings College London are currently evaluating a combination of factors as potential early markers, including subtle peculiarities of speech and movement, lower IQ and poorer academic achievement, disturbances in social, emotional, and behavioural functioning, and subclinical psychotic-like experiences such as occasionally hearing voices that nobody else can hear.
At NeuRA, we are conducting research into another potential marker of schizophrenia risk called the mismatch negativity (MMN). The MMN is an index of the brain’s electrical response to changing patterns of sounds. It’s derived from a measure of the electrical activity of the brain called the electroencephalograph (EEG), more commonly known as ‘brainwaves’. The raw EEG signal may look like just a bunch of squiggly lines running across the computer screen but, once analysed, the resulting data can help us better understand patterns of normal and abnormal brain function.
In adults with schizophrenia, the size of the MMN has been related to disease severity, ability to function in the wider-community (functional outcome), and grey matter volume loss in the frontal and temporal brain regions. The MMN is usually smaller in adults with chronic schizophrenia compared with typical individuals. In light of this, we recently investigated whether a group of children who may be at increased risk of schizophrenia (based on having some of the risk factors described above or having a first-degree relative with schizophrenia) also have a smaller MMN relative to typically developing children.
Our results showed that although the MMN exhibited by the children at risk of schizophrenia was unlike that of their typically developing peers, it also differed from the smaller MMN observed in adults with schizophrenia. In fact, we found a relative increase in the MMN over the frontal brain region, rather than a decrease!
“If we can reliably identify at-risk children then perhaps we can reduce the burden of schizophrenia for future generations.”
It was difficult for us to interpret this result in the context of what we know about MMN in adults with chronic schizophrenia. We looked at MRI data from an overlapping sample of children, which revealed differences in grey and white matter volume in the same brain regions that produce the electrical activity seen in the MMN. Also, the developmental literature indicates that the MMN tends to be larger in young children compared to adults. This has led us to speculate that perhaps the ‘at-risk’ children are on a different developmental trajectory than their peers. It is possible that this unusual MMN result may reflect the complex interplay between developmental changes and the factors placing these children at higher risk of developing schizophrenia.
It’s essential to conduct long-term follow-up of these potentially at-risk children to establish who goes on to develop schizophrenia and how their MMN changes as they mature. This follow-up work, being completed by our colleague Dr Kristen Laurens, will tell us whether the increased MMN we found in this study may indeed be a useful way of identifying children at risk of developing schizophrenia.
The unique people with schizophrenia that I have met currently live their lives as best they can despite the challenges raised by this condition. If we can reliably identify at-risk children then, with appropriate early treatment, perhaps we can reduce the burden of schizophrenia for future generations.
If you want to reduce your risk of Alzheimer’s disease, says Dr Scott Kim, be mindful of your cholesterol levels.
Notwithstanding the recent debate in the media, most of us understand that high cholesterol is harmful to your health because it can negatively affect your heart and arteries.
What you may not know, however, is that high cholesterol can also affect your brain; specifically, there’s growing evidence leading neuroscientists like me to suspect that high cholesterol may increase your risk of developing Alzheimer’s disease.
The growing evidence
Why do we suspect this? Firstly, we know that factors that increase your risk of developing heart disease – specifically, high blood cholesterol levels but also high blood pressure and a history of stroke and diabetes – also increase your risk of developing Alzheimer’s disease. Furthermore, there’s evidence that taking cholesterol-lowering drugs, called statins, decreases your likelihood of developing Alzheimer’s disease.
Another red flag is data from several animal studies suggesting a link between cholesterol and the production of amyloid-beta, the protein that accumulates abnormally in the brains of people with Alzheimer’s disease.
So how is it that high cholesterol increases your risk of Alzheimer’s disease? At NeuRA, we are trying to answer that question.
Cholesterol in the brain
Cholesterol is abundant in our brains; although the brain makes up only two per cent of body’s weight, it contains nearly a quarter of all the body’s cholesterol stores. Cholesterol has important jobs in the brain such as storing energy, acting as a structural component of the cell membrane and acting as a signalling (communication) molecule.
Cholesterol is transported out of cells by transporter proteins, and it’s these proteins – known as ABC transporters – that are the main focus of our research.
Our work has shown that ABC transporters are key regulators of how much cholesterol is inside brain cells. Just recently, we demonstrated that deleting a specific ABC transporter, called ABCA7, in a mouse model of Alzheimer’s disease caused significant increases in amyloid-beta levels. We suspect that the ABCA7 transporter facilitates the clearing of amyloid-beta from the brain. This is direct evidence that ABCA7 is crucial in the development of Alzheimer’s disease.
It’s important to understand what’s happening at a molecular level in Alzheimer’s disease so that we can discover new targets for drug treatments. By understanding the role of ABCA7, we may be able to learn how to inhibit the build-up of amyloid-beta protein and therefore provide potential therapeutic avenues for the treatment of Alzheimer’s disease.
In the meantime…
In the meantime, what can you do in terms of cholesterol to decrease your risk of developing Alzheimer’s disease?
Although controlling cholesterol levels in the brain by altering what you eat is generally very difficult, you can lead a healthy lifestyle and reduce foods in your diet that contain high levels of saturated fat. This will help to reduce the risk factors associated with Alzheimer’s disease that I mentioned earlier on.
Apart from healthy eating and regular exercise, keeping your brain active is also helpful. If playing games, writing a letter or simply interacting with others sounds easy (and it is!), then don’t delay – as the saying goes, ‘use it or lose it’!
I’ve been conducting research at NeuRA into injuries sustained by children in car crashes for many years, and I shudder when I see a mother travelling in a car with a baby on her lap or a father putting the shoulder part of the seatbelt under his child’s arm instead of across the shoulder.
About 70 Australian children die each year in car crashes and thousands more are seriously injured. We can prevent the vast majority of these deaths and injuries if all children are optimally restrained every time they travel in a car.
From 2010, new laws came into effect in Australia that require all children up to the age of seven to use a child restraint or booster seat. But while these laws are a great step forward, they are the bare minimum and we can do better.
You see, it’s not just when you put a child in a restraint inappropriate for their size (such as using a seatbelt before the child is really big enough) or don’t use a restraint at all that causes serious injury in a crash; using a restraint incorrectly (such as putting the shoulder part of a seatbelt under your child’s arm or behind their back, or not strapping a baby in tightly enough) also significantly increases their risk.
This was our incentive for developing these new guidelines; we want to advise parents that they should not be in a hurry to move their children to the next type of child restraint before the child is tall enough – even if it’s technically legal. It’s also important to use their restraint correctly, so it can do its job properly.
Here are a few examples of how the new guidelines go further than the current law:
So at what age will your child be tall enough? There’s no one ‘magic’ age, because children vary so much in height, and cars are also different sizes. You can use the ’5 step test’ to check (see right).
You might be surprised to hear that most children won’t pass this test until they are about 11 or 12 years old (or 145-150cm tall). Instead, they tend to slouch down in the seat, and the seatbelt sits across their tummy or neck, increasing their risk of serious abdominal and spinal injuries. While using a booster for this long this may seem inconvenient to parents, and uncool to children, it’s what the evidence tells us is safest.
We also hope that having the best evidence-based information about child restraint use in one place will reduce confusion and make it less likely that parents will receive conflicting advice from different sources.
NeuRA and Kidsafe, together with Australia’s leading child road safety experts, have developed these national guidelines to cover all aspects of keeping kids safe in cars. They have been approved by the National Health and Medical Research Council.
The bottom line is to always use the right type of restraint for your child’s size until they are really too big for it, make sure that you install it correctly, and buckle your child in correctly, every trip. The full details are available from our website.
The inability to understand facial expressions can have a profound effect on the lives of people with dementia and their families, says Dr Fiona Kumfor.
Recently I met a lady who, despite only being in her 50s, was suspected of having dementia. Susan* and her family had come to the dementia clinic at NeuRA (where I conduct research) to get help with a diagnosis.
Susan wasn’t forgetting things; in this sense, her mind was very sharp. But in the last year she had become far less socially engaged and caring, even towards her teenage children. For example, she had started telling private things about her children to people outside the family; she didn’t seem to recognise that it was embarrassing for her children. This was very distressing for her family, even though Susan herself felt that nothing was wrong.
While this may not sound like the dementia you’re familiar with, the effects of this disease are in fact much broader than the confusion and memory problems of Alzheimer’s disease. People with the type of dementia we saw in Susan, called frontotemporal dementia, show profound changes in their behaviour and personality. One of the most difficult changes that families must cope with is a loss of empathy that occurs, at least in part, because of an inability to interpret facial expressions.
Understanding what a frown means
For a healthy adult, interpreting facial expressions happens automatically and rapidly. Our research focuses on how this complex skill is affected in patients with frontotemporal dementia. Our research has revealed that people with this disease are unable to distinguish between facial expressions very well at all. Because they might mistake a sad expression for an angry one, they also have difficulty understanding how other people are feeling and responding appropriately.
So what happens in the brain to cause this change? Importantly, our study has revealed for the first time that shrinkage in the frontal and temporal parts of the brain, in regions called the amygdala and insula in particular, is responsible for this loss of emotional understanding. Previous studies have shown that these regions activate in healthy people when they view emotional faces.
This loss of emotional understanding undoubtedly makes interacting with others challenging; people with frontotemporal dementia are no longer able to understand the subtle social cues that healthy people take for granted. It can cause conflict if they misinterpret their friends and family’s emotional expressions. This was certainly the case for Susan; her family told us that she didn’t seem to understand when they were feeling upset or frustrated anymore.
Improving quality of life
Unfortunately at present no cure exists for frontotemporal dementia. We do hope, however, that our findings will help in the development of techniques to improve the quality of life for people with this disease and their families.
In fact, we’ve already had some heartening results. A second study we conducted showed that, in some cases, exaggerating the emotional expression improved how well patients recognised the emotion. For me, this finding is particularly encouraging because it suggests that even simple techniques may have a direct and positive impact on how people with frontotemporal dementia and their families can continue to communicate and connect.