Monarch Balance for Life conducts interdisciplinary research examining how physical, cognitive, behavioral, and environmental factors shape mobility, participation, healthy aging, and fall risk. Our work combines clinical assessment, movement science, community-engaged research, and advanced analytical methods to better understand individual differences and support more personalized approaches to prevention and rehabilitation.
The research program has evolved from foundational studies of motor control and age-related movement to a current emphasis on multidimensional fall risk, cognition, gait, balance, measurement, technology, and clinical translation.
What Our Research Is Showing
- Fall Risk Is Multidimensional
Physical performance, cognition, confidence, gait, sensory function, and behavior contribute in different combinations. Data-driven approaches can reveal clinically meaningful patterns that are not visible from a single score.
- Cognition and Confidence Matter
Cognitive performance and fall-related confidence add information to physiological assessment and help distinguish older adults with different levels and types of risk.
- Gait Measurement Can Be Improved
Clinical gait protocols should account for acclimation, trial-to-trial change, dynamic stability, and the relationship between walking behavior and multidimensional fall risk.
- Movement Is Task-Specific Across the Lifespan
Foundational motor-control studies show that aging does not affect every movement in the same way and that concurrent rhythmic tasks can alter how people walk and respond.
Research Findings
1. Fall Risk Factors Occur in Meaningful Combinations
Our findings support a move away from treating fall risk as a single score or a single impairment.
An initial hierarchical cluster analysis examined how 66 measures from gait, cognition, physiological performance, and fear of falling changed together. Four groupings emerged: cognitive factors; fast-gait characteristics; physiological performance and fear of falling; and step width or base-of-support measures across walking speeds.
A subsequent machine-learning analysis shifted the focus from clustering measures to clustering people. Five clinically interpretable profiles were identified: Slow Walkers, Fearful but Fit, Strategy Shifters, Visually Dependent Balancers, and Resilient Agers. These profiles aligned with established clinical classifications while revealing important differences among people assigned to similar overall risk levels.
Together, this work suggests that data science can complement clinical judgment by helping clinicians recognize distinct patterns of need and select more targeted assessment and prevention strategies.
- Samulski B, Moghim N, Kulkarni A, et al. Archives of Physical Medicine and Rehabilitation. 2026;107(5):e4-e5.
- Samulski B, Kulkarni A, Gore R, et al. ISPGR World Congress Abstract Proceedings. 2025:91.
2. Cognition and Confidence Provide Clinically Relevant Information
Safe mobility depends on how people process information and how confident they feel, not only on physical capacity.
In more than 300 community-dwelling older adults, lower Montreal Cognitive Assessment scores were moderately associated with higher Physiological Profile Assessment falls risk scores. Cognitive performance was also related to simple reaction time, suggesting that global cognitive screening and processing-speed measures capture different but complementary aspects of risk.
When participants were grouped by cognitive status and fall-related confidence, those with intact cognition and high confidence had lower estimated fall risk. Participants with impaired cognition and low confidence reported more falls and had higher physiological risk than several other groups.
These findings support assessing cognition and confidence alongside balance, strength, sensation, and gait. They also caution against assuming that fear of falling is simply a negative factor, because confidence must be interpreted in relation to actual capacity.
- Moxey J, Langerhans K, Prupetkaew P, Samulski B. Journal of Sport and Exercise Psychology. 2024;46(S1):S1-S104.
- Samulski B, Langerhans K, Moxey J, Morrison S. Journal of Geriatric Physical Therapy. 2024;47(1):E19-E47.
Contact Us
Need additional information about Monarch Balance for Life? Contact us via email or call at 757-683-6757.