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Brain Training for Fall Prevention (Weird, But Critical Tests!)

Video Highlights

- The Role of Cognitive Impairment in Fall Risk
- Examples of Inhibition and Executive Function Tests
- Training Inhibition and Executive Function
- Additional Recommendations for Fall Prevention

Today, we’re going to be talking about your ability to inhibit your behavior and how that can play an enormous role in fall risk. If you are new to the channel, I’m Dr. Eric Cobb of Z-Health performance. We are a brain-based education company focused on working with elite doctors, coaches, and therapists around the world. So if you’re interested in brain-based training, make sure to check out our channel.

Now, what are we really about today? We’re continuing our series on fall prevention. Next week, we have our first live class coming up on this particular topic called Defying Gravity. Fall prevention and Fall Preparation. It’s happening here in Las Vegas. It’s also live streamed.

We have, for the last eight weeks or so, been talking about falls. They are an enormous health concern around the world, particularly as people get older.

And today, what I want to talk about is a kind of unique topic, which is cognitive impairment and its relationship to falls. Now, cognitive impairment, most of the time when people hear that, they think, oh, well, that means that, you know, someone’s having a lot of memory loss, or they’re having difficulty remembering where they put their keys, or they are forgetting what people’s names are, things like that.

And yes, as we see mild cognitive impairment increasing, those are things we might be concerned with. However, whenever we look at people that are at risk of falling, one of the things that we regularly see is a loss of the ability to what is called inhibit. A part of our brain, particularly the frontal lobe areas, are in charge of preventing us from maintaining habitual behavior or doing something reflexive.

And instead of doing something a little bit more conscious. In some cases, we will refer to that as one portion of what is known as executive function. So your ability to prevent a reflex from happening is a key part of actually being able to move around in the world. So, for instance, if I’m walking and I see, you know, a puddle in front of me, my ability to stop my next step from landing in that puddle, which might be slippery, is an example of inhibition.

Now, in a kind of laboratory or gym setting, we have to be able to test this. And one of the easiest ways to kind of test this is to use something called the stroop test. Now, you might not be able to see it clearly, but we’ll put a little picture of it up for you. This is a little test that a lot of people have seen. And what you see is a bunch of words on a screen, and those words are all colors.

So it’ll say, like, green, yellow, blue, red. But in some versions of this test, the word green may actually be written or typed in, in red ink. So your job is to read across the page. But instead of reading the word green, you have to say the color that you see in front of you. And while that may sound really, really simple in most tests, what you’ll see is that when people are required to inhibit, it will take them two to even, two and a half times as long to read through a list of words when we compare it to just reading what they see.

So this is an example of inhibition. Another example is a test that we do regularly called anti-saccades. Our brain is wired to whenever something startles us or something rapidly comes into our field of view, our eyes will typically flick to it to evaluate it and then come back to whatever we were doing. That’s a saccadic movement. An antisecode means that something moves over here, and I move my eyes in the opposite direction.

In other words, I inhibit my reflexive need to look at that moving object so that I can look somewhere else. So these are a couple different ideas that we talk about whenever we do assessments of executive function. Whenever you look into the literature, what you will see is that people that are at higher fall risk score poorly on things like inhibition test or tests of executive functioning. And the beautiful thing is that this is something that you can train.

As I said, we have a lot of different drills in our system that are based off receiving a command and then ignoring that command and doing something different. Why this becomes very, very important as you get older is that as we’re moving around, we know we’re walking and talking. And as I said, there’s going to be obstacles in front of us. And if there is even a momentary delay in our ability to inhibit, kind of a reflexive next step, a reflexive movement of our eyes that can spell the difference between a fall and not falling, which can, in some cases, be the difference between living and dying. That’s how important this is.

So if you are a movement professional, please include these types of exercises in all of your work with all of your clients, because it stimulates the frontal lobe, and it, again, is a training process. We can build on and increase the plastic ability of the brain to become better at inhibition. It’s just something that we have to remember to train regularly. Another piece of this is also aerobic exercise, because we want to make sure that we’re getting good blood flow to those areas of the brain.

So whenever we combine aerobic exercise with some strength training, and then we add in some additional executive function inhibition type work. We’re really setting the stage to give our clients and ourselves kind of the best opportunity to make sure that we don’t make mistakes when we’re out in the real world, that we’ll cause a fall.

Final one I’m going to talk about here, and I know this is a little bit weird, but it is something that I do a lot with my own clients and my athletes, actually, is being able to, to, in the heat of the moment, let go of something in your hand.

One of the things that is fascinating to see and sad to see is that a lot of people that are struggling with inhibition or executive function will hold on to things as they are falling, rather than releasing them and reaching out to grab onto a chair for support, to touch a wall, or to use their hands as a part of their process of getting down on the floor more safely.

This is something, again, that needs to be trained, because your ability to let go of something is a form of inhibition. In other words, it’s a requirement for us to release something reflexively that’s already held here. You’ll see this a lot in older people who are using some kind of assistive device like a cane. They’re walking, they begin to fall, and rather than letting go of the cane and using their hands, they will continue to hold onto it. That’s, again, another example of poor inhibitory capacity, and it’s something we need to be concerned about and working on.

As I said, if you’re a movement professional, this is very simple to include in basically everything that you do with your clients. You can include 5-10 minutes blocks where you’re asking them to not do something and instead do something else whenever they are reflexively triggered to do something. So there’s a lot of different ways to play with it.

We’ll cover that in a lot more detail in the course that’s coming up. You can also look at some of our other blogs, so I hope you found this interesting and helpful. It is, again, a critical concept, and if you want some more information about it, let me know, and we can put some more drills out here on YouTube. All right, so have a great week, and we will talk to you soon.

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