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Falling in Numbers

Falling In Numbers

When it comes to preventing falls among the most fragile among us, the science is in.

It's a sobering, undeniable fact of life in America today—the country is falling down. Literally.

No idle political punditry this—as a people, we Americans are older than we've ever been, and we're losing our balance and falling every year in record numbers, and often with disastrous results.

If history is any judge, in 2010 at least 16,000 of us who are 65 or older likely will kill ourselves by falling. The most recent figures (from 2005) published by the Centers for Disease Control, tallied 15,800 people in this age group dying from deadly tumbles. Nonfatal falls that year put another 1.8 million seniors into hospitals or emergency rooms. The direct medical costs for treating those fall victims is predictably staggering—with estimates in 2006 running upwards of $20 billion.

With the so-called "graying of America"—the inevitable by-product of the post-WWII baby-boom phenomenon—the epidemic of bad falls is only going to get worse, say sociologists who study the issue. Through at least the first half of this century, falls are predicted to remain the leading cause of injury-related deaths among older adults.

The problem is bad enough for healthy seniors (the CDC says more than a third of adults 65 and older hurt themselves by falling each year) but it's far worse for those suffering from certain motor-control diseases, such as Parkinson's or multiple sclerosis. Studies show that in a given year, falls will send seven out of 10 people with Parkinson's disease to emergency rooms around the country.

At first glance, the reason for this might seem obvious. Parkinson's patients often can't make their muscles move when their brains order them to, much less expect them to perform the myriad, involuntary tasks involved in maintaining balance.

But there's more to the story, and that's the focus of an intriguing line of research between an FSU expert in brain-based communications disorders and a medical neurologist. Leonard "Chick" LaPointe , within FSU's School of Communication Science & Disorders, has built a distinguished, 40-year career studying the effects of brain damage—either through injury or disease—on speech, memory and movement. His newest partnership is with Dr. Gerry Maitland, a Tallahassee neurologist who also is a professor within the Department of Clinical Sciences in the FSU College of Medicine.

In 2004, Maitland and LaPointe established the Neurolinguistic/Neurocognitive Research Center at Tallahassee's largest hospital, Tallahassee Memorial Healthcare, whose foundation helps fund it. The center's basic objective is to explore creative new ways to study the consequences of brain-based disorders, such as Parkinson's and multiple sclerosis, with an eye toward coming up with practical ways to help sufferers.

"There's a natural tie-in to what we do and Florida, with its elderly population, of course," said LaPointe. "The beauty of this work is that it has both basic and applied aspects."

Just in its first five years, the center has produced a remarkable body of research, evidenced by 14 peer-reviewed papers published and nearly 70 presentations at conferences both here and abroad. Much of the work has attempted to answer a single question—what effect do ordinary, everyday distractions, such as background noise or trying to follow a conversation either on the phone or with someone near you have on the abilities of people afflicted with brain disorders to walk, talk, or even think?

Deadly Distractions

In a culture where workers take pride in their abilities to "multi-task," or juggle several balls at once without dropping any, it's no surprise to anyone paying attention that we're dropping a lot of them, often with deadly results.

Alarm over drivers being distracted by cell phones has now been trumped by the national outcry over those who text while behind the wheel. In September 2008, the engineer of a commuter train in California killed himself and 25 passengers while texting at the controls.

LaPointe and his colleagues are among many researchers who have looked at cell-phone distraction and performance. One of their recently published studies suggests that cell-phone distraction slows reaction times by as much as 30 percent among healthy people. LaPointe said other evidence suggests that people who text while driving are 28 times more likely to crash than those who don't. A frightening rise in texting-related highway fatalities has now prompted 19 states to ban the practice.

But multi-tasking doesn't necessarily involve the use of cell phones or computers, nor is it the sole province of young people. Older adults multi-task, too, albeit at different levels and speed, and, for those with neurological problems, the results can be even more dangerous, LaPointe said.

"If you're walking and talking, you're multi-tasking. For most of us, that's not a problem. But what we've discovered is that people with Parkinson's, multiple sclerosis and other movement disorders, if you're talking to them while they're walking, they get unbalanced."

LaPointe, Maitland and another FSU colleague, Julie Stierwalt, an associate professor of communication science and disorders, designed a set of experiments to test their hypothesis that the more you demand of people with movement disorders, the more you put them at risk for losing their balance and falling.

Walking & Talking

The team assembled an all-volunteer study group of 27 individuals with Parkinson's disease, most patients of Maitland's in his practice at Tallahassee Memorial Healthcare. Nineteen of the members were men, and ages ranged from 41 to 91, with an average of 67.4.

At the center, patients were asked to walk down a special, 14-foot-long carpet studded with thousands of electronic sensors linked to a computer. These sensors instantly measured up to 33 different aspects of the patients' gait, including stride length, step velocity and the amount of "double support" time, or the time patients spent standing solidly on both feet for balance. Each individual's normal walking habits, with no distractions, were assessed to set a baseline, or control, for the experiment.

"Then we asked them to walk the carpet and count at the same time," LaPointe said. "Gradually, we ramped up the cognitive load on them and the effect was dramatic."

At first, patients were asked to walk and count by ones, beginning with 24. Next, they were asked to walk and begin counting backwards from 95 by threes, a tougher task. The last test was the hardest—patients were asked to walk and count in a sequence of letters and numbers, for example, H-1, I-2, J-3, K-4 and so forth.

As the mental tests got more difficult, all of the patients, regardless of age, took drastically shorter steps, took more of them and slowed down (see page 17). All the indicators showed that the higher the cognitive load borne by patients, the greater difficulty they had in balancing themselves.

LaPointe said the results demonstrate a phenomenon that neuroscientists call cognitive resource allocation. Essentially, our brains can only allocate so much attention and thinking power, or resources, for multiple tasks. When tasks call for more cognition than can be allocated, performance breaks down. People who start out with compromised cognitive resources therefore get taxed much more easily by even simple tasks—such as walking and talking at the same time.

A Lesson for Caregivers

What the study shows, LaPointe said, is that anyone who is in charge of providing care to people with Parkinson's disease should be cautious about talking to their subjects during walks. Even light conversation can make it more difficult for patients to keep their balance.

"Here at the hospital, the physical therapists have heard the preaching to the choir, and they're now training caregivers at home as well as here to not talk and ask questions while they are doing physical gait therapy. It may slow their patients' recovery and put them at risk for falling."

In future tests, LaPointe said he might want to look at the effect of other distractions, such as a radio or an iPod, on the walking performance of people with movement disorders.

"That's something we haven't tested yet. As it turns out, there have been earlier studies that suggest that some (Parkinson's) patients show some improvement (in walking) if they can get into a rhythm, get synchronized with it.

"But it would have to be a fairly light (cognitive) load for them," he cautioned. "Anything much more, and they can lose balance, slow up, even stop altogether."

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