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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.
Stephanie Marrocco recognized for exceptional student leadership
Stephanie Marrocco is the 2020 recipient of the Leadership Award for Fellows and Students. She is a PhD candidate working with Dr. Dalton Wolfe, at Parkwood Institute, a part of St. Joseph’s Health Care London. Her doctoral research focuses on practice patterns of physiotherapists to determine which practices are associated with the best possible outcomes in persons with spinal cord (SCI) and acquired brain injury (ABI). Her work involves mobilizing physiotherapists, hospital leadership, and researchers towards greater collaboration.
Marrocco is an invaluable part of her lab, helping to develop and implement experiential learning opportunities for Health Studies and Kinesiology students as well as mentoring students one on one. “She is an exceptional leader in all that she does, and is very deserving of this award,” says Dr. Cheryl Forchuk, Lawson Scientist and Marrocco’s nominator.
The Research 2 Practice (R2P) team at Parkwood Institute is endeavoring to establish a new model for the way research teams operate within a clinical environment. This involves embedding the team within the hospital and integrating research with clinical and teaching activities using implementation science and practice-based research methods. “Marrocco has been a true innovator in working alongside myself in developing this approach and has been integral in implementing this model. I was honoured to support her nomination,” says Dr. Wolfe, Lawson Scientist.
Marrocco is an exceptional leader and strong advocate of the “exercise as medicine” perspective. She co-led two program retreats for the Parkwood SCI Rehabilitation Program and has helped develop a national strategy for physical activity programming for persons with SCI. She is formerly a representative for the Lawson Association of Students and Fellows, the first representative of this committee placed at Parkwood Institute Research. Marrocco offers a student perspective and advocates for trainees at Parkwood Institute Research and maintains a leadership role on the R2P team.
“I am extremely grateful for this award. It is a good feeling to know that my peers and those I look up to are so supportive,” says Marrocco.
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.