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Industrial Academic Initial Training Network towards specific diagnosis and treatment of age-related gait and balance deficits

Periodic Reporting for period 2 - Keep Control (Industrial Academic Initial Training Network towards specific diagnosis and treatment of age-related gait and balance deficits)

Reporting period: 2019-03-01 to 2021-02-28

KEEP CONTROL was an EU-funded industrial academic initial training network between 2017 and 2021 towards specific diagnosis and treatment of age-related gait and balance deficits. It trained 13 PhD students in 12 three-year positions in the area of gait and balance deficits in older adults.

Balance and gait deficits are ubiquitous among the older population, and lead to an enormous personal, occupational and health care burden. Emerging pharmacological and non-pharmacological interventions to date have only had small to moderate effects on these deficits. This is likely due to remaining fundamental questions on underlying mechanisms and treatment. Together with their supervisors who are experts in the fields of clinical, biomechanical and neuroscience research as well as experts from industry, the PhD fellows in KEEP CONTROL investigated different aspects of age-related gait and balance deficits.

Overall, all scientific objectives not affected or limited by the COVID-19 pandemic were achieved or even outperformed. This is also reflected in the number of peer-reviewed publications already available at the end of the project, and in the number of publications that are a cooperation between KEEP CONTROL partners. Many of these papers were published in prestigious scientific journals. The close collaboration between the KEEP CONTROL partners, and in particular the fellows, is also reflected in the lively (virtual) social activity, e.g. the blog maintained independently by the fellows (https://keepcontrolhorizon2020.wordpress.com/).

Main scientific highlights of KEEP CONTROL are:
- the development and validation of multiple new algorithms for the detection of mobility in the usual environment with wearable sensors in the elderly and neurologically ill;
- the ML-based analyses of large datasets in walking and other mobility parameters in the elderly for a better understanding of balance disorders and falls;
- the investigation of gait parameters for the differential diagnosis of early Parkinson's disease versus controls;
- the confirmation and further development of the concept of "daily function" specifically for the elderly and neurologically ill;
- the recognition that specific dual-tasks can lead to an overload of brain capacity;
- showing that perturbation training improves reactive gait performance, which is relevant for keeping control after an external influence;
- detecting gait events during robot-assisted gait training, to trigger functional electrical stimulation in the future;
- the neurophysiological and behavioural evidence that an executive control deficit can trigger freezing of gait.

Taken together, KEEP CONTROL served as a facilitator and catalyst for a unique network of young and advanced researchers in the field of balance assessment in the elderly, which has developed very actively and successfully in the 4 years of funding, and will live on for a long time, not only through the currently presented results, but also through the collaborations and friendships that have developed.
The KEEP CONTROL partners formed a lively network and benefited from the exchange of both knowledge and resources, implemented by secondments. Fellows were integrated in the training program of KEEP CONTROL, which included a personal development plan, decision about a second mentor, enrolment in a Graduate School, and – if necessary – participation in a language course.

Three training weeks – including soft skill courses – took place, and were evaluated positively by both fellows and organizers. Moreover, additional courses on professional management, intellectual property rights, and career coaching took place during the final two years of KEEP CONTROL.

The KEEP CONTROL website was established to raise the public awareness of the project (www.keep-control.eu). All fellows published a brief description about their projects. The fellows also created their own website where they blogged about their experiences within KEEP CONTROL (https://keepcontrolhorizon2020.wordpress.com/).

All partners of the consortium met regularly to present results and to discuss open points.

The results of the project, as summarized above in the ‘Summary of the context and overall objectives of the project’, have been published in 31 peer-reviewed publications.
This ETN project included new features that are clearly beyond the state of the art.

From a content point of view, the project generated novel insights into diseases and pathologies that are important for the aging society, including, but not limited to:
- the development and validation of multiple new algorithms for the detection of mobility in the usual environment with wearable sensors in the elderly and neurologically ill;
- the confirmation and further development of the concept of "daily function" specifically for the same target group;
- the recognition that specific dual-tasks can lead to an overload of brain capacity;
- the detection of gait events during robot-assisted gait training.
These findings have direct implications for counselling and treatment of older adults with and without neurological diseases, such as Parkinson`s disease. The fellows also learned how to “holistically” assess study participants and patients, as the WHO-developed International Classification of Functioning, Disability and Health (ICF) was the main template and skeleton of all assessment protocols used in this network.

From a skills point of view, the experience of the fellows collected in this highly organised network helped them to grow to an outstanding level concerning network building capabilities and communication skills.

In sum, this ETN has provided outstanding results, both in the education of the fellows as well as the scientific progress, helping to better understand and treat gait and balance deficits in older adults with and without diseases.
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