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Current Projects

Join our efforts to reduce the risk of falls and improve thinking, walking, balance, and overall independence in older adults. Transportation can be provided. Compensation is offered for participation.


Individualized Stimulation to Improve Mobility (ISTIM) Study
Principal Investigator: Brad Manor, Ph.D.

The goal of this study is to determine if non-invasive brain stimulation improves balance, walking and memory in older adults who have fallen in the past year. 

Eligibility Requirements: Age 65 or older with one or more falls in the past year and fearful of falling in future.

Participation: This study involves an eligibility screening visit, two optional MRI scans, a baseline assessment visit, 20 sessions of non-invasive brain stimulation, and 3 follow-up assessment visits. The entire study takes about 8 months to complete. Compensation is paid up to $510. 

For more information about the ISTIM study, please call the study team at 617-971-5310 or email us at BrainStim@hsl.harvard.edu 


Optimizing Brain Stimulation for Walking and Balance in Older Adults (OptiStim) Study
Principal Investigator: Brad Manor, Ph.D.

The goal of this study is to determine whether non-invasive brain stimulation improves walking and balance in older adults concerned about their walking or balance.

Eligibility Requirements:  Between 65 and 85 years old and concerned about walking or balance. 

Participation: This study includes an eligibility screening visit, one MRI scan, and 4 assessments visits with non-invasive brain stimulation. The entire study takes about 8 weeks to complete. Compensation is paid up to $150.

For more information about the study, please call Nicole LaGanke at 617-971-5358 or email nicolelaganke@hsl.harvard.edu 


Peripheral Neuropathy Walk2Wellness Study
Principal Investigator: Lewis A. Lipsitz, M.D.

This study investigates the long-term effects of Walkasins®, a lower limb sensory prosthesis, on balance and walking in individuals with sensory peripheral neuropathy. 

Eligibility Requirements:  Age 21 or older with a formal diagnosis of sensory peripheral neuropathy and balance problems.  

Participation: There are six visits over one year. In addition, there is an option to participate in two separate MRI visits, six months apart. Compensation is paid up to $225.

For more information about the Walk2Wellness study, please call Ike Iloputaife at 617-971-5305 or email him at Iloputaife@hsl.harvard.edu


The Individualized Stimulation to Improve Mobility in Alzheimer's Disease (ISTIM-AD) Study
Principal Investigator: Brad Manor, Ph.D.

The goal of the study is to see if brain stimulation improves memory, walking and balance in older adults with memory problems. 

Eligibility Requirements: Age 65 or older and concerned about your memory.

Participation: This study involves an eligibility screening visit, a baseline assessment visit, 2 optional MRIs, 10 sessions of non-invasive brain stimulation sessions, and 3 follow-up assessment visits. Most visits can be done at home. The entire study takes about two months to complete. Compensation is paid up to $250.

For more information, please call Kelly Black at 617-971-5307 or email KellyBlack@hsl.harvard.edu 


The Brain Stimulation Study for Steady Gait Study
Principal Investigator: Amy Lo, Ph.D.

The goal of this study is to determine whether a single session of non-invasive brain stimulation (tDCS) as compared to a placebo brain stimulation improves walking and thinking in older adults at risk of falling.

Eligibility Requirements:   Age 65 and older, a self-report of unsteadiness in walking, and a gait variability score > 3% demonstrated during the eligibility screening visit.

Participation: This study involves two visits at least one week apart with non-invasive brain stimulation. Compensation is paid up to $120.

For more information about the Steady Gait study, please call the study team at 617-971-5310 or email us at BrainStim@hsl.harvard.edu 


Modulating Brain Activity to Improve Goal-directed Physical Activity in Older Adults (Stim-Fit) Study
Principal Investigator: Amy Lo, Ph.D.

This project tests to see if non-invasive brain stimulation (tDCS) combined with one-on-one  counseling can improve physical activity, walking and, balance in older adults who report little to no physical activity.   

Eligibility Requirements: Age 65 and older who want to be more physically active and who report performing less than 150 minutes of at least moderate intensity exercise per week.

Participation: This involves 18 visits total with 10 tDCS sessions over 2 weeks and eight 15-30 minute personal goal-oriented counseling sessions over 10 weeks. A FitBit™ is provided for use during and after the study as well as compensation up to $160.

For more information about the study, please call the study team at 617-971-5310 or email us at BrainStim@hsl.harvard.edu 


Physical Therapy and tDCS (PT-Stim) Study
Principal Investigator: Amy Lo, Ph.D. 

This study is designed to understand the benefits of combining brain stimulation (tDCS) with physical therapy in older adults at risk of falling.

Eligibility Requirements: Participants must be 65 and older and scheduled to begin receiving physical therapy for balance and walking training. A referral is needed by a physical therapist at NewBridge on the Charles (NBOC) or Hebrew SeniorLife (HSL).  Compensation is paid up $160.

Participation: Eligible patients will receive non-invasive brain stimulation prior to ten PT sessions and will complete three assessments conducted at the outpatient clinic of NBOC or HSL. 

For more information about the PT-Stim study, please call the study team at 617-971-5310 or email us at BrainStim@hsl.harvard.edu 


The HomeBase Study  
Principal Investigator: Brad Manor, Ph.D.

The goal of this study is to find out if older adults can successfully complete non-invasive brain stimulation (tDCS) sessions at home with the help of a trained partner. We aim to make this technology a new, accessible tool to improve stability in walking. 

Eligibility Requirements:   An individual who is 60 years or older who has had one or more falls in the past year with a partner (spouse, family member, or caregiver) who is computer-proficient and aged 21 years or older.   

Participation: This study involves 3 assessments visits in the lab at Hebrew SeniorLife (HSL) and 22 non-invasive brain stimulation visits at home. The partner administrating the brain stimulation will receive ongoing training and support throughout the study. Participant is paid up to $295 each.

For more information about the study, please call Nicole LaGanke at 617-971-5358 or email nicolelaganke@hsl.harvard.edu 


Vascular Mechanisms of Gait and Posture in Aging and Age-related Disease
Principal investigator: Azizah J. Jor’dan, PhD

This study seeks to better understand how aging, Type 2 diabetes, and Alzheimer’s disease influence the blood flow and oxygen levels in the brain, and how these changes influence one’s balance when standing and walking. 

Eligibility Requirements: Age 70 and older, with either Type 2 diabetes or Alzheimer’s disease. 

Participation: There is one study visit that includes movement and cognitive tests. Compensation is paid up to $75.

For more information, please call Azizah Jor’dan at (857) 364-6339 or email AzizahJordan@hsl.harvard.edu 


Cerebrovascular Mechanisms of Slow Gait and Falls
Principal Investigator: Lewis A. Lipsitz, M.D.

Falls and mobility problems are common causes of disability and death in elderly people, yet their causes are poorly understood. Slowing of gait is a prominent feature of human aging, even in the absence of specific diseases, and it is strongly associated with falls (1), dementia (2), and mortality (3). Recent studies by our group, supported by an NIA-funded program project grant called the MOBILIZE Boston Study (an acronym for the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston) have demonstrated significant relationships between abnormal blood flow to the brain, slow gait speed, and falls in elderly subjects.  By measuring cerebral blood flow velocity (CBF) with transcranial Doppler ultrasonography (TCD) in a representative population-based cohort of 419 seniors living in the Boston metropolitan area, we have shown that:

  • Low cerebral vasoreactivity (i.e., changes in brain blood flow in response to changes in carbon dioxide (CO2) in the air we breathe) is associated with slow gait speed and falls (4). 

  • Impairment in the ability to increase brain blood flow during cognitive tasks is associated with slow gait speed (5).

  • Damage to white matter on Magnetic Resonance Images of the brain (MRI) is associated with slow gait speed (5).

These observations have led us to the overall hypothesis that alterations in the control of brain blood flow associated with aging and cardiovascular risk factors are associated with white matter damage to the brain, which ultimately results in slowing of gait, cognitive impairment, and their functional consequences such as falls. 
This study will explore this hypothesis by performing TCD measurements of brain blood flow and MRI measurements of brain structures and functions in 100 elderly participants in the MOBILIZE Boston study (MBS). Our specific aims are:

  1. To determine whether abnormalities in blood flow to the brain are associated with slowing of gait speed, cognitive dysfunction, functional decline, and recurrent falls in the MBS cohort, and

  2. To determine whether abnormalities in blood flow to the brain are associated with damage to white matter on brain MRIs that can explain the onset of slow gait and falls in older age.

These aims will be accomplished by recruiting 50 subjects with the lowest brain blood flow and 50 subjects with the highest brain blood flow when it was measured at the beginning of the MBS 6-8 years ago. We will invite these subjects to come to the Hinda and Arthur Marcus Institute for Aging Research Clinical Research Laboratory for repeat blood flow measurements, then obtain brain MRI studies at the Boston VA hospital.  All of the proposed tests have been performed safely without complications in very elderly subjects previously participating in the MOBILIZE Boston Study and have been approved in the past by the IRB.  MRIs for MOBILIZE Boston participants are already approved by the VA IRB and are being performed as part of Dr. Leveille's MOBILIZE Boston project that examines the effect of pain on falls. The current project will increase the number of MRI studies in the MOBILIZE Boston database, making it more valuable for these two projects, as well as future ancillary studies.

This study will provide novel information necessary for the early detection and ultimate prevention of cerebrovascular causes of falls and mobility impairments in elderly people. If abnormal brain blood flow is discovered to be a cause of falls, currently available interventions to increase brain blood flow, prevent cerebrovascular damage, grow new blood vessels, or build new neural pathways may be tested to prevent future falls.


Nonlinear Dynamics of Frailty
PI: Lewis A. Lipsitz, M.D.

The Aims of this NIA-funded project are 1) To determine cross-sectionally in a representative population of elderly people aged 70 years and over, whether there is a relationship between “frailty” and loss of complexity in the dynamics of multiple physiologic systems. 2) To determine whether a loss of complexity in cardiovascular, cerebrovascular, and/or balance dynamics, is associated with an impaired ability to adapt to common physiologic stresses imposed on these systems. 3) To determine longitudinally over a two-year follow-up period in the same population, whether reduced complexity in the dynamics of these physiologic systems at baseline, or loss of complexity in these systems over time, is predictive of the subsequent development of frailty, its component symptoms, and/or other measures of physical and cognitive functional decline


Evaluation of stochastic resonance insoles to Improve Mobility in Healthy Older Adults
PI: Lewis A. Lipsitz, M.D.

Age-related loss of somatosensory function (tactile and proprioceptive senses) has been shown to be strongly predictive of a propensity to fall.  It has been demonstrated in several biological systems, ranging from ion channels to sensory neurons to human psychophysics, that the presence of a particular sub-threshold level of noise can be used to enhance signal recognition and detection. This phenomenon is known as stochastic resonance (SR).  Previous studies indicate that SR is potentially a viable technology to improve balance and gait if used in a therapeutic medical device. Noise-based devices, such as shoe insoles, may therefore enhance the control of dynamic balance activities and thus, enable those with reduced function to overcome mobility impairments caused by aging. 

The purpose of this research study is to evaluate how applying small, sub-threshold vibrations to the bottom of the feet via shoe insoles affects balance and gait.  The study also aims to determine if different levels of vibrations have different effects on functional outcomes, and if the level at which an individual can feel the vibrations changes throughout the day.  The information collected from this study will be used to develop shoe insoles which may enhance balance and walking in older adults.


Identification of locomotor brain networks using fMRI
PI: Brad Manor, Ph.D.

Foot sole somatosensation is an important source of feedback for the control of gait and balance.  The goal of this project is to enable investigation into the brain networks involved in processing and utilizing this source of afferent feedback, and how they are affected with aging and disease. To do so, we have developed an MRI-compatible stimulation system capable of applying controlled pressures to the entire foot sole that closely mimic those experienced when walking. Our effects to date have demonstrated that the application of walking-related foot sole pressure elicits a characteristic pattern of brain activation in healthy adults. Through several ongoing studies in collaboration with Peking University in Beijing, China, we are now examining 1) the effects of performing a simultaneous cognitive distraction task on the brain’s response to walking-related foot sole pressures, 2) the effects of age- and disease-related somatosensory impairments on the brain’s response to applied foot sole pressure, and 3) the capacity of noninvasive brain stimulation to augment the brain’s response to applied foot sole pressures.


Monitoring falls within the nursing home setting
PI: Lewis A. Lipsitz, M.D.

Falls comprise the leading cause of injury-related morbidity and mortality among adults over the age of 65. Currently, an automated method for accurately recording falls is not available. However, there are some new fall detection technologies available for older adults living alone for use in case of a fall where the patient cannot reach a phone to request outside assistance. One in particular is worn as a pendant and uses both a traditional patient-activated button as well as technology capable of detecting falls and automatically reporting them to the response center. In this way, it allows patients to prolong autonomy in their own home without the need for supervision.

From a scientific perspective, this technology may dramatically improve the quality of data recorded in an objective manner in a community or institutional setting where trained health care professionals are not available for documenting falls. In addition, data collection is not dependent upon patient reporting, recall or response rate, a significant limitation to previous methods of measurement. The primary objective of this exploratory study is to assess the validity of a modified system for detecting falls, as compared to falls reported by nursing staff, in a nursing home setting.


Prediction of Activity of Daily Living Disability in Older Adults
PI: Dae Kim, M.D.

This research is to develop and validate a practical clinical prediction model for activity of daily living disability in community-dwelling older adults, using data from the Cardiovascular Health Study and Established Populations for Epidemiologic Studies of the Elderly.  The prediction model will compare self-reported health information, objective tests of cognitive and physical performance, and laboratory and non-invasive test results in their ability to predict activity of daily living disability.  It is funded by the Charles A. King Trust Foundation Postdoctoral Fellowship Award.


Functional outcomes of older patients with severe aortic stenosis
PI: Dae Kim, M.D.

This prospective cohort study is a collaborative project between gerontology and interventional cardiology at Beth Israel Deaconess Medical Center.  The objective is to examine the change in cognitive and physical function and activity of daily living disability in older patients with symptomatic severe aortic stenosis.  Functional status and disability are assessed via repeated telephone interviews for 12 months.  These outcomes will be compared between patients who are treated with transcatheter or surgical aortic valve replacement and patients who are treated conservatively.  This research will also test a novel approach to combine functional outcomes with traditional outcomes of hospitalizations and mortality in testing the effectiveness of aortic valve replacement.