Living well with Parkinson’s disease
More than 80,000 people are living with Parkinson’s disease in Australia, and of these, approximately two thirds will fall each year. Ensuing injuries, hospitalisations, fear of falling and caregiver burden are devastating, widespread and costly. As the prevalence of Parkinson’s disease will double between 2010 and 2040, the associated human and economic burden will also grow. Innovative therapies to improve balance and prevent falls in Parkinson’s disease are therefore urgently needed.
“People with Parkinson’s disease particularly struggle with taking secure steps, avoiding hazards at short notice or recovering their balance after unexpected slips or trips or if they are knocked or bumped when walking,” says Professor Stephen Lord, NHMRC Senior Principal Research Fellow at NeuRA.
To further our understanding of fall risk in people living with Parkinson’s disease, researchers at NeuRA conducted a study on the role of attention in stepping and the ability to adjust steps while walking in response to unexpected hazards. This involved a step mat test of reaction time and an obstacle course designed by Joana Caetano, as part of her PhD studies.
This research showed that compared with their healthy peers, people with Parkinson’s disease had slower and more variable reaction times in situations that involved a distracting task. They were also less able to adapt their stepping while they were walking. The participants were therefore, more likely to miss step targets and strike the obstacle in their path.
“This impaired stepping and gait adaptability in people with Parkinson’s disease increases their risk of falling when negotiating unexpected hazards in everyday life,” says Professor Lord. Professor Lord and his team, Dr Jasmine Menant, Dr Daina Sturnieks, Dr Yoshiro Okubo and PhD student Mr Paulo Pelicioni, are now commencing a study to investigate whether a step training intervention can improve stepping and balance and reduce fall risk in people with Parkinson’s disease.
As part of this four-month randomised controlled trial, participants will be allocated at random into a control group, and continue their daily activities as usual, or in a training group.
Participants in the training group will train in stepping while playing games on an electronic mat connected to their television or computer, for 80 to 120 minutes per week.
“The games are training not only stepping but also thinking abilities. They are inspired from video games such as Tetris, Pacman etc, are fun and their difficulty can be easily adjusted,” says Dr Jasmine Menant.
Training group participants will also attend four sessions in the gait laboratory at NeuRA to train their ability to recover from slips and trips. Participants will be fitted with a comfortable harness and asked to walk several times on a special walkway designed at NeuRA which can provide unexpected slips or trips.
“We hope the stepping training program done at home and at NeuRA will result in improvements in people with Parkinson’s disease and subsequently reduce fall risk. This study will provide the ground work for a future, larger study that we hope will prevent falls in people with Parkinson’s disease,” says Professor Lord.
The advances in fall prevention made in this project and the team’s future work have the potential to reduce personal and financial costs to individuals, their families, healthcare resources and the community.
Watch Professor Stephen Lord’s NeuRAtalk: