Vestibular control of balance in older adults at high risk of falling

This is a 3 year project funded by the MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research (www.birmingham.ac.uk/musculoskeletal-ageing) - A cross-institutional collaboration between the University of Birmingham and the University of Nottingham. The position will be situated at the University of Birmingham in the School of Sport Exercise & Rehabilitation Sciences.

Approximately 30% of older adults over 65 yrs of age will have experienced a fall within the last year, rising to 50% after 85 yrs. The resulting injuries lead to increased mortality and morbidity, costing the NHS and associated social services ~£1 billion in 1999 (Scuffham et al, 2003). The cause of falls is multi-factorial, and numerous age-related deficits have been shown to correlate with fall risk, including reduced strength and vision. However, beyond such correlation analysis, the precise aetiology of falls in older adults remains very unclear.

Here we propose to use a recently developed test of sensorimotor function to assess the efficacy of postural control in older adults (Reynolds, J Physiol, 2011; Osler & Reynolds, Proc Phys Soc, 2013). This involves the use of Galvanic Vestibular Stimulation (GVS) to evoke a sway response in standing subjects. The novelty of this test, beyond traditional measures of sensory function in older adults, is that the integrity of the whole balance system is investigated within a single simple test. Unlike tests which assess peripheral vestibular loss or visual acuity for example, the GVS balance test actually measures the efficacy of the whole sensorimotor pathway for balance. It therefore offers a highly sensitive technique for detecting deficits in postural control. The GVS-evoked sway response will be measured in patients recruited from the falls clinics of Drs Tandon & Irving (QEHB), and compared with aged-matched controls without elevated fall risk. The sway response will be quantified using ground reaction forces. Response magnitude and direction will be measured separately to determine sensorimotor gain and accuracy, respectively. Deficits in the GVS response will be correlated with fall risk. This will be assessed by a combination of prior falls history, along with questionnaire assessments of known risk factors such as medication and fear of falling. The degree to which the GVS response can provide an accurate diagnostic predictor of fall risk will be assessed prospectively by a 1 year follow-up to determine fall occurrences.

The ultimate purpose of this research is to better understand the mechanisms linking postural instability to falls, and to provide a highly sensitive diagnostic test for assessing postural insufficiency and fall risk. This will not only be of use for identifying specific individuals at risk, but also for assessing the efficacy of exercise programmes aimed at reducing risk.

Person Specification
Prospective candidates are expected to have or obtain at least an Upper Second Class Honours Degree in a relevant subject.

How to apply
Applications including a CV, names and addresses of two referees and a covering letter should be sent to Alison Fletcher, C/o Research and Knowledge Transfer Office, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT or email [Email Address Removed]

Enquiries can be directed to Dr Raymond Reynolds: Email: [Email Address Removed]

The closing date is Monday 3rd March 2014 and Interviews will be held on Friday 14th March 2014