New collaboration advances the science of fall prevention

Walking is just one foot in front of the other for almost everyone. But even that simple process can prove precarious for people suffering from conditions ranging from joint damage to dementia.

“Most people don’t really think about walking,” said Thurmon Lockhart, a professor of biomechanics in the Ira A. Fulton Schools of Engineering at Arizona State University. “They don’t consider the fact that each step is actually the beginning of a fall, and that they catch themselves from falling only by taking another step.

“This is particularly the case for older adults, who represent an expanding share of our population. And as their numbers increase, so does the societal incidence of falls and injuries from falling,” said Lockhart, a faculty member in the School of Biological and Health Systems Engineering, one of the six Fulton Schools. “This growing issue inspired me to develop technology that can predict falls and help prevent them from happening.”

Confirming the value of Lockhart’s innovative work, the Musculoskeletal Orthopedic Research and Education, or MORE, Foundation has designated Lockhart as the first MORE Foundation Professor of Life in Motion. The professorship includes five years of financial support, as well as testing access to patients at The Core Institute, one of the nation’s largest orthopedic and neurological clinical care providers.

“Applying Professor Lockhart’s technology to our patient population can save a lot of pain, suffering and cost by reducing falls,” said Marc Jacofsky, the chief scientific officer for The Core Institute and executive director of the affiliated nonprofit MORE Foundation. “As orthopedic surgeons, we treat the fractured shoulders, hips and spines that people experience when they fall. So, in a way, we want to apply this technology to keep people out of our clinics in the first place.”

Lockhart’s focus on falling began more than 20 years ago as a graduate student of industrial and systems engineering, and specifically the area of human factors and ergonomics, at Texas Tech University. His biomechanics research continued as a professor at Virginia Tech, and the impact of his work accelerated after he joined ASU in 2014.

That was when the Fulton Schools facilitated Lockhart’s entrepreneurial training through the National Science Foundation’s Innovation Corps program. Equipped with new insights on how to move his discoveries from the lab to the marketplace, Lockhart shifted his focus from a wristwatch design to a smartphone application now called the Lockhart Monitor.

The system works with a phone’s internal accelerometer and gyroscope to gather parameters like walking speed and step length. It also applies a branch of physics called nonlinear dynamics in relation to muscle motor control.

“That lattermost element is where we excel,” Lockhart said. “Nonlinear dynamics and chaos theory permit our system to predict how a person will react to a perturbation, which is an unexpected event that creates instability. This prediction enables an accurate assessment of their fall risk.”

It happens by first creating a baseline set of data for each person’s measures of gait, posture and stability. Then, in the future, if these personal motion parameters suddenly drop below their baseline, the technology can warn the individual that they are at greater risk of falling.

As Lockhart has refined this technology in recent years, he began working with ASU’s Building Reliable Advances and Innovation in Neurotechnology, or BRAIN, Center, which is part of the National Science Foundation’s Industry-University Cooperative Research Centers Program to cultivate commercial partnerships. It was through BRAIN that Lockhart connected with Jacofsky and the MORE Foundation.

Jacofsky noted that Lockhart had done impressive work to develop his Lockhart Monitor software and to validate its use among older adults. But he immediately thought of the value it could represent to clinicians caring for people of any demographic who need joint replacements.

“Having that information would enable us to assign them to the right nursing and physical therapy staff in the hospital,” Jacofsky said. “It would also tell us how a patient is progressing in their recovery after surgery. Ultimately, it could guide us in restoring their walking ability to the point where they are no longer a fall risk or their risk is reduced to the level of someone who never needed surgery.”

With that goal in mind, Lockhart and Jacofsky are in the process of validating the technology with 100 patients who are undergoing hip or knee replacements at The Core Institute. But they are also considering how to apply the system to patients experiencing back pain and other conditions.

“There are many different patient populations to consider. For example, we may be able validate this work for patients with Parkinson’s or Alzheimer’s disease,” Jacofsky said. “And what about patients who’ve had amputations from diabetes and walk with a prosthetic? I think we’re going to continue research that gives us the level of confidence we need to roll this out on a much larger clinical basis.”

The enormous potential of this work inspired creation of the MORE Foundation Professor of Life in Motion as a means to make the most of the collaboration.

According to Kati Martinez, a director of development for the Fulton Schools and the originator of the idea for the professorship, “It’s a powerful affirmation of the fact that we can accomplish much more together than we can by working in our own silos. It’s particularly inspiring to think about the engineering students who will be trained through this collaboration to go out and make a difference in our communities.”

Lockhart agrees that the student impact represented by the professorship is especially motivating.

“Their access to MORE Foundation facilities will enable them to see how our research connects with the real world and how it really matters to people who are suffering,” he said. “Direct student communication with both clinicians and patients will make learning so much more meaningful.”

Jacofsky adds that the educational impact is reciprocal.

“We’ll certainly benefit from having students come to our facility and work with our researchers,” he said, “because we will learn about new techniques and technologies. We’ll get to access tremendous innovation.”

Lockhart says the combination of factors extending from the new professorship offers multifaceted benefits as well as tremendous reason for hope.

“One of the most important messages here is that people who are prone to falling don’t need to despair,” he said. “We have solutions and these solutions are not just technology. They are technology-enabled capabilities that can help patients and their caregivers to more effectively restore mobility and real quality of life.”