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Standing up to falls
By merging world class care with research and artificial intelligence, St. Joseph’s Health Care London is catching falls before they happen.
They wreak havoc on independence and well-being, making them one Canada’s most pressing health challenges: falls.
A leading cause of injury-related hospitalizations, even death, among older adults, a fall can happen anytime, anywhere – with 50 per cent occurring at home. But what if we could predict and prevent falls before they happen?
A pioneering initiative at St. Joseph’s Health Care London (St. Joseph’s) is doing just that. The 3FM Clinic, short for Falls, Fractures, Frailty and Mobility, at St. Joseph’s Parkwood Insitute is at the leading edge of falls prevention in Canada, integrating research with clinical practice to offer hope and practical solutions to older adults.
Led by St. Joseph’s geriatrician Dr. Jaspreet Bhangu and Western University rehabilitation scientist and physiotherapist Janelle Unger, PhD, the visionary 3FM Clinic is working to prevent falls before they happen.
“We know there are a number of factors that can cause an older adult to fall such as illness, medication side effects, balance and gait issues, cognitive impairment, visual changes and environmental hazards,” says Bhangu. “What we’re working to understand is how those factors together impact individual patients and their risk of falling.”
To do so, the 3FM Clinic team – one of the largest, most diverse teams of its kind in the country – completes a multi-step evaluation of patients:
- Nurses gather their medical history, current medications, functional abilities and personal goals.
- Physical therapists measure the patient’s gait (how they walk) and balance to understand their physical capabilities.
- Occupational therapists test their vision, cognitive function and identify issues that might hinder the individual’s ability to perform routine tasks safely.
- A geriatrician focuses on medical risk factors such as bone health, medications and cardiovascular health to help manage risks associated with aging. The team then creates a customized care plan that incorporates exercises, therapeutic interventions and educational strategies.
On the research side, Unger and her team in the RED Neuro Lab at St. Joseph’s Gray Centre for Mobility and Activity are leveraging artificial intelligence (AI) to predict falls more accurately.
“Traditional fall prediction models often rely on limited data and lack real-world input from clinicians and patients,” explains Unger. “By partnering with Bhangu and the clinical team, as well as the patients in the 3FM Clinic, we’re able to integrate clinical information with biomechanical data collected from wearable sensors known as inertial measurement units (IMUs).”
An IMU is a device that tracks and measures a person’s movement and orientation and provides valuable data on how that person moves and stays stable.
“We plan to use AI to analyze the data collected through the IMU’s and are working to create accurate fall prediction models,” says Unger. “This research, funded by Western’s Bone and Joint Institute, has the potential to improve care decisions, enhance preventive strategies and ultimately reduce the incidence of fall-related injuries and hospitalizations for our patients and people across the globe.”
By embracing innovative research and compassionate care, the 3FM Clinic is a model for future efforts in fall prevention and geriatric care, offering a safer, more independent future for older adults.
You can prevent falls too:
- Use assistive devices: Properly fitted walkers or canes provide essential support and stability.
- Fitted footwear: Shoes (not slippers or flip-flops) with appropriate tread and low heels help prevent slips and falls. They should also fit your feet.
- Home improvements: Improved lighting, clear walkways and assistive bathroom fixtures.
- Exercise: Participate in strength and balance exercises to enhance physical fitness.
- Medication reviews: Regularly have your medications reviewed to identify if you are at risk of falling.
Steven Macaluso
Steven Macaluso, MD
Associate Professor, Schulich School of Medicine and Dentistry
Implementation Science and Education
Dr. Steven Macaluso is a physiatrist at Parkwood Institute and an Associate Professor and the current Residency Program director in the Department of Physical Medicine and Rehabilitation in the Schulich School of Medicine and Dentistry at Western University. He completed a Bachelor of Science degree in Kinesiology prior to completing his medical degree at Western University in 2007. He went on to complete residency training in Physical Medicine and Rehabilitation at Western University in 2012.
He is currently a consultant physiatrist on the Stroke and Neuro rehabilitation unit at Parkwood Institute and has outpatient clinics at Parkwood Institute, and the Fowler Kennedy Sports Medicine Clinic. His current academic endeavors are focused on promotion of physical activity amongst individuals with impairment and disability, including formation of physical activity guidelines the design and implementation of an online evidence-based resource and clinical skills guide for the management of musculoskeletal disorders. Dr. Macaluso also has a special interest in Sports Medicine, has provided medical coverage for Team Canada at national and international levels, and is currently serving as a team physician for the Canadian Wheelchair Curling Team.
Stroke can be the first presenting symptom of younger patients with COVID-19
LONDON, ONTARIO - Since the start of the COVID-19 pandemic, researchers have been working to better understand and characterize the varied symptoms of the disease. One of the most concerning symptoms is the development of large blood clots that can cause blockages in the arteries that lead to the brain causing stroke.
Researchers at Western University and Lawson Health Research Institute led by Dr. Luciano Sposato have been investigating the relationship between COVID-19 and stroke to better understand the risk in patients and aid in treatment planning. In a new study published in the September 15, 2020 online issue of Neurology, the medical journal of the American Academy of Neurology, the research team reports that approximately two in every 100 patients admitted to hospital with COVID-19 will suffer a stroke, and 35 per cent will die as a result of both conditions.
The researchers reported that in patients under 50 years old, nearly 50 per cent had no other visible symptoms of the virus at the time of stroke onset. They also found that the interplay of older age, other chronic conditions and the severity of COVID-19 respiratory symptoms are associated with an extremely elevated risk of death.
“One of the most eye-opening findings of this study is that for patients under 50 years old, many were totally asymptomatic when they had a stroke related to COVID-19. This means that for these patients, the stroke was their first symptom of the disease,” said Dr. Sposato, Associate Professor and the Kathleen and Dr. Henry Barnett Chair in Stroke Research at Western’s Schulich School of Medicine & Dentistry, and Scientist at Lawson.
Sposato says understanding the interplay between COVID-19 and stroke is important for treatment planning, especially in areas where COVID-19 is actively circulating in the community.
“The take-home message here for health care providers is that if you are seeing a patient with a stroke, particularly in those under 50 years old with large clots, you need to think of COVID-19 as a potential cause even in the absence of respiratory symptoms,” said Dr. Sposato.
The research team completed a systemic review of published cases of COVID-19 and stroke and pooled that data with another 35 unpublished cases from Canada, the USA and Iran. In total, the team examined 160 cases, looking at both clinical characteristics and in-hospital mortality.
“COVID-19 has changed the stroke landscape worldwide. As stroke neurologists, we need a new mindset to be able to promptly diagnose and treat patients with COVID-19 related strokes,” said Dr. Sebastian Fridman, Assistant Professor, Clinical Neurological Sciences at Schulich Medicine & Dentistry, research fellow at Lawson and first author on the study.
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Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. To learn more, visit www.lawsonresearch.ca.
The Schulich School of Medicine & Dentistry at Western University is one of Canada’s preeminent medical and dental schools. Established in 1881, it was one of the founding schools of Western University and is known for being the birthplace of family medicine in Canada. For more than 130 years, the School has demonstrated a commitment to academic excellence and a passion for scientific discovery.
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