Dr Alireza Ahmadvand is a very busy man. He is a General Practitioner at Our GP Complex in Spring Hill, Brisbane, Associate Professor and Senior Lecturer in Primary Care at Griffith University and Senior Medical Officer / GP at Princess Alexandra Hospital, Brisbane. He has a strong interest in healthcare technology and a professional commitment to empowering healthcare professionals in the digital health space.

He mostly does this through his role as Director of DreamMed, a small company specialising in generative AI webinars and workshops for medical and health professionals. He is also an aficionado of the Balance Mat, having used it with patients on and off for the past three years. Dr Reza found time in his busy schedule on Thursday 30 January 2025 to sit down with Balance Mat inventor Ian Bergman to talk about the Balance Mat as a precursor to a regular spot on The GP Show Podcast.

Dr Alireza Ahmadvand

Ian Bergman

Dr Reza: Ian, thank you for agreeing to this interview. If all goes well it will be the first in a series on health-tech that I’d like to do. Firstly, can you tell me how your Balance Mat invention quantifies postural sway, and what sets it apart from traditional fall risk assessments?

Ian: The Balance Mat quantifies postural sway electronically by measuring any movement a person makes while standing for 20 seconds on a computerised floor mat. There is a mesh of optical fibre embedded in the mat directly underneath the feet of the person standing (on some printed footprints – there are 14 cross-over points of optical fibre under each footprint printed on the mat). A sensor embedded in the mat uses signal processing to measure any movement. A combination of signal processing and algorithms deliver a score and graph of the person’s postural sway to a computer or laptop screen. The person’s postural sway is classified instantly into low, medium and high, which we know equates to low, medium and high falls risk.

To the second part of your question, what sets the Balance Mat apart from traditional fall risk assessments is that for the first time there is an objective measurement of postural sway (traditional assessments rely on questionnaires, observation based on the practitioner’s years of experience, their knowledge of the patient and the person’s history). The best predictor we have of falls likelihood is past falls at the moment. The Balance Mat is a technology solution that aims to help clinicians understand a person’s fall risk and do something to mitigate it.

Dr Reza: In regard to patient safety, how does Balance Mat help identify fall risks and what impact can it have on fall prevention?

Ian: The Balance Mat helps identify fall risks by providing an accurate measure of postural sway. I don’t know if you know the online publication MedicalNewsToday.com? Well, it clearly states that “Postural sway measurement is important because a high degree of postural sway can indicate reduced balance and an increased risk of falls.”

We know that postural sway can be invisible to the eye. As I mentioned previously, the Balance Mat records all of a patient’s movements on the mat, including those tiny gravity-defying ones they make to remain standing. The technology is vastly more sensitive than observation alone, or observation combined with a stop watch. The Balance Mat actually measures postural sway in a 20-second test for each of two stances, giving you a graph and score for each patient that together help you arrive at an aggregate falls risk analysis.

The beauty of the Balance Mat is that these postural sway tests are recordable, repeatable and reportable.

The Balance Mat is poised to have a major impact on fall prevention in three main ways.

• Firstly, the GP and the care homes and service providers can see if the patient or client has a balance problem and, if so, the extent of it.
• Secondly, they can use the data to help decide on the right practical or medical / allied health intervention or treatment.
• Thirdly, they can regularly repeat the test to see how well the intervention or treatment is working.

For those people with low postural sway on the Balance Mat (or low falls risk), doctors and nurses can simply repeat the test annually as part of a regular health checkup routine.

For people with medium postural sway on the Balance Mat (or what we believe is medium falls risk) we can stop them slipping into the high fall risk category with exercise therapy delivered by an exercise physiologist or physiotherapist.

For those people with high postural sway (and potentially high falls risk) they can be referred to a specialist or allied health practitioner if it’s a neurological condition. If it’s a sarcopenia-related condition (that is weakened muscles due to ageing) the patient can be referred to an exercise physiologist or physiotherapist for an appropriate intervention.

Generally I would say that physiotherapists are often a good first point of call and exercise physiologists are good for chronic conditions but there is some overlap when you’re talking about exercise. The main thing is that balance is a trainable skill and allied health practitioners have the qualifications and experience to help people become stronger and steadier on their feet. That’s why Balance Mat Pty Ltd’s company motto is to help people to Live Well Longer. The motto of Balance Metrix, incidentally, is to “Enable nuanced healthcare.” That’s intended to reflect the multi-disciplinary nature of falls risk mitigation.

Dr Reza: Regarding clinical use, what challenges have you faced in integrating Balance Mat into clinical practice, and how have healthcare professionals responded?

Ian: I’m very fortunate to have had the support of Dr Phil Ewart for the past five years. He reached out to me on LinkedIn for help in assessing falls risk. Dr Phil is the practice principal in a regional New South Wales town called Wauchope, on the mid north coast of New South Wales, just down the road from Port Macquarie where my Balance Metrix supplier business is based.

Dr Phil has had his practice nurses measuring patients’ balance for almost 5 years now. He also hosted the launch of the Balance Mat by Dr David Gillespie MP, who was then the federal Minister for Regional Health. The challenges have mainly been around how to apply the results from the Balance Mat to patients. Diabetes is the big one for his practice – Hastings Medical Centre there at Wauchope. Eight out of ten diabetes patients have high postural sway on the Balance Mat. There are a couple of different ways of treating diabetes – medication and exercise. The Balance Mat allows the doctors to see which type of treatment is working best in terms of balance. The nurses test everybody to get at a baseline measurement and then repeat the test as the treatment progresses.

The practice also has a lot of fallers. In fact that’s the reason Dr Phil became interested in the Balance Mat in the first place – because he had a lot of elderly patients referred to him for falls risk assessment. He used the Berg Balance Scale and the Timed Up and Go systems which are rather time-consuming. The Balance Mat is never going to replace a doctor’s professional assessment or assessments using these questionnaires, but it is going to save them time and therefore money by being so quick.

Because this is new technology it’s been a test, record, repeat and study kind of process. It’s only recently that I’ve based myself at the practice. I moved in to my new workspace there in October last year and since then I’ve been working with the doctors, nurses and reception staff to come up with a kind of triaging system for them based on balance data. The people with high postural sway need to immediately see the doctor. The medium results people have a report sent to the doctor to deal with appropriately and the low results people walk away with a smile on their faces and a huge dose of relief.

I even had one 90-year-old lady grab my arm and say, “Thank you so much. You’ve changed my life. I’m not worried any more. My balance is fine. I can see it on the screen. It’s the same as everyone else’s.”

Now you might be thinking sceptically, ‘But they all might have bad balance.’ My answer to that is that they don’t. For example, one 77-year-old woman had zero and zero postural sway in the normal and semi tandem stances (they’re the two stances that we’ve found give you enough information about the person’s balance ability to make a falls risk assessment).

Given that it only takes 20 seconds to enter the person’s biodata on the Balance Mat database, and 20 seconds for the normal test, 20 seconds for the semi-tandem, it really is true that “It only takes a minute” using this system to make an assessment.

So, just to summarise, what I’ve found is that everybody past a certain age thinks they’ve got a balance problem, and that’s not necessarily true. I’ve met many fit and healthy 80- and 90-year olds out of the 110+ people whose balance I’ve tested at Wauchope over the past three months. That never ceases to amaze me.

Dr Reza: On the topic of real-world impact, can you share examples where Balance Mat has improved outcomes or helped prevent falls?

Ian: A little while ago, Dr Phil Ewart took me with him to a local aged care provider in Wauchope and he introduced me to the manager there so that I could demonstrate how the Balance Mat works. It seems to happen that whenever elderly people hear about the Balance Mat they’re suddenly queuing up to have their balance tested. So that’s what happened there – I was suddenly doing impromptu testing of 12 residents’ balance.

I had a similar experience at Garden Village in Port Macquarie. It’s early days yet but they’ve told us they’re keen to buy a Balance Mat to help prevent falls. I tested the balance of 29 residents there (six from Independent Living and 23 from Residential Aged Care) and the nurses and residents all believe the Balance Mat is really going to help them tackle the problem of preventable falls. Anything to stop those weekly ambulance calls!

Dr Reza: Regarding accuracy and reliability, how accurate is Balance Mat in assessing postural sway, especially for patients with neurological conditions or older adults?

Ian: I would say the Balance Mat is very accurate in assessing postural sway. Its test – re-test – repeatability has been validated by Associate Professor in Exercise Physiology Dr Isaac Selva Raj from Edith Cowan University, and so has its reliability against a force plate – a commonly used big clunky piece of technology that assesses sportspeople’s balance after they jump up and down on it. Of course the Balance Mat is very lightweight and portable, unlike a force plate, and it’s very user friendly and comfortable and non-threatening for older people to stand on.

It’s also been validated by Dr Maryam Ghahramani, a human movement researcher and senior lecturer in electronics at University of Canberra. She’s tested the Balance Mat against inertial sensors (and its test-retest repeatability has been studied there by Maryam and robotics professor Damith Herath. They actually built a robot to do that sort of testing.

But you asked me about neurological conditions – we have an Innovation Partner on the Sunshine Coast – physiotherapist Barbara Cullinan from The Park – Parkinson’s Wellness Centre – who’s been using the Balance Mat for people living with Parkinson’s disease. They like it because they can see their movements on the mat. Barbs is innovative because she’s using the Balance Mat to train balance rather than simply measure it.

Another person using the Balance Mat with Parkinson’s clients is Danny Miller from Rehab on the Road in Sydney. She’s a clinical exercise physiologist who specialises in helping older clients. In fact some of Danny’s clients had their balance tested at Dee Why Beach on World Clinical Exercise Physiology Day that we supported. They were the 3 people with high readings on the Balance Mat out of the 43 people tested. Danny has given us a glowing testimonial which you can see on the home page of our website (Balancemetrix.com.au). Here’s a snippet from it: She says, and I quote:

“What sets the Balance Mat apart is its utility in multidisciplinary care. The detailed reports I generate from the balance assessments are highly regarded by GPs and specialists, who appreciate the objective metrics reflecting their patients’ functional improvements. These reports strengthen collaborative relationships by ensuring transparency and demonstrating the clinical effectiveness of exercise-based interventions.”

I want to end by saying that falls risk mitigation is a multi-stakeholder ecosystem and Danny Miller’s testimonial highlights exactly how true that is. It’s why we’ve become kind of evangelists for the exercise physiology profession and vice versa. To us it’s a no-brainer that exercise – especially for that middle group of swayers – is going to stop people becoming fallers. And for the fallers, it’s going to help the stakeholders in the ecosystem, including the fallers themselves, take a patient-centric stance and do something to improve their balance.