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Bourke R, Perez S, Mogollo AZ, Finucane C, Leenders M, Roberts F, Morren G, Maree A, De Melis M, Kenny RA, Foran T. 302 MONITORING FALLS RISK IN THE COMMUNITY USING AN IMPLANTABLE CARDIAC MONITOR WITH EMBEDDED ACCELEROMETER. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Falls are the most common cause of injury amongst older adults. Falls can lead to hospitalisation, functional decline and are associated with increased morbidity and mortality. The holy grail for clinicians would be to predict increased likelihood of falls occurring and intervene before the event. Understanding underlying dynamic biophysiological changes may therefore inform novel predictor models and falls prevention. This study examines activity and cardiac data acquired from an implanted Medtronic Reveal LINQ™ Insertable Cardiac Monitor (ICM) with an embedded tri-axial accelerometer.
Methods
Thirty participants with at least one unexplained fall in the previous two years were prospectively recruited. All met criteria for ICM insertion following comprehensive assessment. Participants were followed for one year and attended every three-months for cardiac and gait assessment. Information pertaining to activity levels, posture changes and cardiac parameters were collected daily from the device. Summary metrics and trends were collected for inclusion in a continual assessment of falls risk.
Results
Mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. There was seasonal variation in activity levels. Twelve participants had falls and cardiovascular, gait and activity variables were examined at the time of a fall to determine any trends in biophysiological changes.
Conclusion
Causes of falls are usually multifactorial. A holistic approach is necessary to manage and minimise risk factors. The use of an ICM with an embedded tri-axial accelerometer allows clinicians to formulate an algorithm to determine if a person is at an increased risk of falling based on biophysiological changes. This may create an opportunity for falls to be predicted and prevented.
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Affiliation(s)
- R Bourke
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - S Perez
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - AZ Mogollo
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
| | - C Finucane
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
| | - M Leenders
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - F Roberts
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - G Morren
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - A Maree
- St. James Hospital Department of Cardiology, , Dublin, Ireland
- Trinity College Dublin School of Medicine, , Dublin, Ireland
| | - M De Melis
- Medtronic Bakken Research Center , Maastricht, Netherlands
| | - RA Kenny
- Trinity College Dublin School of Medicine, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
| | - T Foran
- St. James's Hospital Department of Medical Physics and Bioengineering, , Dublin, Ireland
- St. James Hospital Mercer’s Institute for Successful Ageing, , Dublin, Ireland
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Fan C, Foran T, Cogan L, Kenny R. 023 ORTHOSTATIC HAEMODYNAMIC RESPONSES AND GAIT VELOCITY IN OLDER ADULTS. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al-Kalbani M, Collins N, Boyle G, Hegarty F, Foran T, Sheahan N, Coakley D. An automated ocular microtremor feature extraction using the Gabor thresholding technique. ACTA ACUST UNITED AC 2008; 2007:2851-4. [PMID: 18002589 DOI: 10.1109/iembs.2007.4352923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ocular Microtremor (OMT) is a very fine continuous eye movement which has potential in monitoring and identifying a number of clinical conditions. There is a need for improved analysis and processing techniques to extract useful, quantifiable parameters from the OMT signal. A number of papers have shown the clinical significance of looking at the 'bursts' and 'baseling' patterns of the OMT signal. Analysis to date relies on visual inspection alone. This paper introduces an automated approach to burst/baseline identification based on a time-varying filter using the Gabor transform.
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Abstract
The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. Bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.
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Affiliation(s)
- C J Teng
- Department of Psychiatry, St. Michael's Hospital, University of Toronto School of Medicine, Toronto, ON, Canada
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