Falls Prevention For Stroke Patients Following Discharge Home: Contributory Factors And A Randomised Trial Intervention.
Funder
National Health and Medical Research Council
Funding Amount
$549,440.00
Summary
Falls are common after stroke, with over 50% of people being discharged home from hospital after stroke experiencing one or more falls in the subsequent six months. Despite a large focus on falls prevention in the community generally, and increasing research that a range of activities (such as exercise, medication review, home hazard modification) are effective in reducing falls among older people generally, there have been no randomised trials evaluating the effectiveness of falls prevention ac ....Falls are common after stroke, with over 50% of people being discharged home from hospital after stroke experiencing one or more falls in the subsequent six months. Despite a large focus on falls prevention in the community generally, and increasing research that a range of activities (such as exercise, medication review, home hazard modification) are effective in reducing falls among older people generally, there have been no randomised trials evaluating the effectiveness of falls prevention activities for people with stroke. This research will evaluate whether a detailed assessment and program of falls prevention activities (exercise, falls prevention information, bone strength recommendations, and other activities based on the assessment findings) will reduce falls in stroke patients with increased risk of falling. Two additional issues associated with falls among people with stroke will also be investigated. Detailed analysis of walking and stepping over obstacles will be evaluated to determine long term problems which might increase the risk of falling, and the effect of the falls prevention program will also be evaluated on the walking and stepping over the obstacle tasks. A third study will investigate the development of fear of falling firstly as a result of the stroke and resultant walking difficulties, and then how this changes when a fall occurs. The interaction between falls, fear of falling, and reduced activity and walking will be explored. The outcomes of this project will improve the understanding by health professionals of key factors contributing to increased risk of falling following stroke, and provide clear direction and resources for general application of the program in other stroke rehabilitation programs nationally. The main anticipated outcome is 33% reduction in falls, and improved balance, walking, and confidence for people returning home after stroke.Read moreRead less
Understanding Fear Of Falling And Risk Taking In Older People
Funder
National Health and Medical Research Council
Funding Amount
$355,877.00
Summary
Fear of falling is a very significant issue for many older people. Estimates of the prevalence of fear of falling in older community-dwelling people range from 29 to 92% in those who have suffered previous falls, and 12 to 65% in those have not. Fear of falling can lead to restriction and curtailment of activity, reduced quality of life, anxiety, depression and social isolation. To date, all studies addressing fear of falling have simply considered no fear to be good and presence of fear to be b ....Fear of falling is a very significant issue for many older people. Estimates of the prevalence of fear of falling in older community-dwelling people range from 29 to 92% in those who have suffered previous falls, and 12 to 65% in those have not. Fear of falling can lead to restriction and curtailment of activity, reduced quality of life, anxiety, depression and social isolation. To date, all studies addressing fear of falling have simply considered no fear to be good and presence of fear to be bad, and have not attempted to assess whether this fear is rational or irrational in relation to actual balance abilities or physical functioning. In this study, we aim to find out which psychological, physical, health and lifestyle factors distinguish between older people with and without an irrational fear of falling based on their actual physical falling risk. We also wish to understand the role that fear of falling and other psychological factors (anxiety, depression and avoidance) play in causing older people to fall; and to measure how falls can lead to increased fear of falling, anxiety and depression and reduced physical functioning. The complex nature of psychological risk factors of falling and the limited background information on this subject, hampers its integration in falls prevention programs. Although there is growing awareness of this problem among health care providers, additional research is needed about why older people develop a fear of falling in order to fully understand fear of falling and to tailor specific intervention and prevention strategies.Read moreRead less
Long Noncoding RNA In Space And Time, And The Regulation Of Fear Extinction
Funder
National Health and Medical Research Council
Funding Amount
$1,012,245.00
Summary
Most of our genome is made up noncoding RNA; however, nothing is known about why a special class of noncoding RNA would be expressed in synapses, and how this affects learning and memory related to neuropsychiatric disorders. Understanding the fundamental molecular machinery underlying the formation of fear extinction memory will enable the development of new treatment approaches for anxiety-related disorders that are characterised by memory deficits.
A Window Of Vulnerability: Impaired Fear Inhibition In Adolescent Rats
Funder
National Health and Medical Research Council
Funding Amount
$335,849.00
Summary
Adolescence is a period of increased vulnerability to anxiety disorders. The brain undergoes substantial maturation during adolescence, particularly the prefrontal cortex (PFC), a region critical for inhibiting fear. This project examines why fear inhibition is impaired in adolescents and compares the neural mechanisms mediating treatments that enhance fear reduction in adolescence. This research adds new knowledge about novel approaches for early interventions for adolescent anxiety.
A core feature of clinical anxiety is the inability to learn about safety and suppress fear. Impaired safety learning underpins excessive fear responding, overgeneralisation of fear, as well as treatment resistance in clinical anxiety. Very little is known about the brain mechanisms for learned safety. This project maps and manipulates these mechanisms to lay the basic science foundation for the next generation of treatments of anxiety.
Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessiv ....Disorders of fear and anxiety impose significant burdens on individual sufferers, their families, and communities. This project studies the brain mechanisms of fear and anxiety, with special focus on the role of the prefrontal cortex. It tests the novel hypothesis that prefrontal cortex is part of a neural pathway critical for regulating fear learning and ensuring that fear learning is adaptively guided by past experience. In the absence of this pathway, fear learning is maladaptive and excessive relative to the danger posed by a situation.Read moreRead less
Developmental Differences In The Role Of The Medial Prefrontal Cortex In Fear Regulation
Funder
National Health and Medical Research Council
Funding Amount
$354,481.00
Summary
This project explores the neural circuitry involved in fear expression early in life, and how early life experiences can affect this circuitry. A better understanding of the neural circuitry underlying fear regulation across development is essential given that the majority of anxiety disorders first appear in childhood or early adolescence.
Exploring DNA Methylation As A Mechanism For Long-term Memory For Fear Extinction
Funder
National Health and Medical Research Council
Funding Amount
$415,322.00
Summary
Traumatic experiences are well remembered. In some cases, fear-related memories become debilitating and require therapeutic intervention to diminish the impact of these kinds of memories on daily living. Such therapies engage a process of inhibitory learning called fear extinction. Since anxiety disorders are particularly sensitive to relapse even after extensive exposure therapy, a deeper understanding of the extinction process is crucial if we are to develop more effective treatment protocols ....Traumatic experiences are well remembered. In some cases, fear-related memories become debilitating and require therapeutic intervention to diminish the impact of these kinds of memories on daily living. Such therapies engage a process of inhibitory learning called fear extinction. Since anxiety disorders are particularly sensitive to relapse even after extensive exposure therapy, a deeper understanding of the extinction process is crucial if we are to develop more effective treatment protocols for a variety of anxiety disorders.Read moreRead less
Disorder in the circuits that process emotional stimuli are central in the pathogenesis of anxiety disorders. In this grant we will study the circuits that are inolved in fear learnng. Our results will provide the background to developing more effective therapies for a range of anxiety related disorders such as generalised anxiety and post traumatic stress disorder.
Fear Relapse: Neural Substrates Underlying Its Inhibition And Prevention
Funder
National Health and Medical Research Council
Funding Amount
$437,476.00
Summary
Exposure-based therapies are effective for anxiety disorders such as post traumatic stress, but two challenges remain: 1) patients that have learned to inhibit their fear are likely to relapse, requiring further therapy; 2) many drop out of therapy since it is aversive and anxiety provoking. We use an animal model to: 1) identify the neural substrates underlying fear inhibition; and 2) determine the conditions that prevent relapse and encourage participation in treatment.