STEPPING OUT - Understanding the ground truth and mechanisms of falls and balance instability in community dwelling older people.

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In Europe the costs of falls are 25 billion euros each year (2015 prices) and will rise with population ageing. Interventions to prevent falls have a small and short-lived effect and virtually no impact on serious injuries.We desperately need better solutions. Research has been held back by an inability to study falls whilst they happen in ecologically valid situations. Advances are now made possible by new, beyond state of the art facilities at the University of Exeter. The VSimulator is a 3.7m x 3.7m force plate array mounted on a motion platform with six degrees of freedom of movement allowing the creation of underfoot perturbations which have high ecological validity for falls. Coupled with integrated motion capture with or without Virtual Reality the facility generates life like scenarios including hazards during unconstrained walking (total walk distance including the force plate 15m). We will generate empirical evidence about what is happening within the balance systems to overcome or succumb to perturbations, and develop novel sensory dependency tests. We will use advanced mathematical analysis to unlock the secrets of balance control in older adults.There are 5 work programmes (WPs). WP1 will maximise knowledge about the situations in which falls commonly occur by analysing 220 falls recorded in real life situations using a crude method (inertial measurement units). This will inform the design and implementation of perturbation scenarios in later stages of the project (WP2). The centre piece is a large experiment in which 228 older people will undergo VSimulator tests (WP3). WP4 will develop analytical approaches, and WP5 will focus on the translational opportunities including new treatments and tests. The project will lay the foundation for radical improvements in fall prevention and develop the next generation of fall and balance researchers. The PI has a strong record in falls and rehabilitation research, and a distinguished leadership record.