Основные принципы предупреждения падений (тренировка глаз и внутреннего уха!)

Hi, I am Dr. Eric Cobb of Z-Health performance. Today, we’re going to talk about the eyes and the inner ear in relationship to fall prevention and improving balance. If you are new to Z-Health, we are brain-based education company. Our primary focus is on working with doctors coaches and therapists who are interested in bringing modern Neuroscience into their work with movement and pain. So if that’s you make sure to subscribe to the channel. 
Last week I gave a little bit of a lecture with regards to fall prevention. When we start to look at risk factors we talked a lot about the idea that we need programs that involve all the systems involved in balance. Whenever we’re moving through the world we have to see well we have to balance well we have to move well and then put all that stuff together to function in the real world. So today we’re going to talk a little bit about both vision and vestibular systems.  I have done probably 100 videos on YouTube about vision training and vestibular training so you can go back through our logs but really what I want you to just understand today is that when we talk about the visual system specifically we need to make sure that we’re improving acuity. Now acuity is my ability to see clearly. And that acuity is in bright sun that acuity is also in a dim lighting condition because those are not exactly the same thing. So if you have clients you want to improve their balance you need to make sure that you’re testing and referring out if necessary to improve their acuity in the different environmental conditions they’re going to encounter in life.
From there, we then need to start talking about eye movements. Whenever we talk about eye movements there are a couple of critical ones with regards to balance the first one is called a smooth pursuit. If you can imagine that there’s a very slow fly moving across in front of my eyes and I am following that, that is called a smooth pursuit. And then we have what are called saccades. Saccades are very rapid changes shifts in my visual fixation points. What we see in people with compromised balance is they often have problems with both of those issues both smooth pursuits and saccades.
So what we’d like to have people to do just as a basic training program is to consider the eight points of the compass right we have north south east west and then our ordinal directions. We want to have clients practicing smooth pursuits in each of those directions. We want to have them practicing saccades in each of those directions. This is very easy to set up you can go in your gym wall go in your garage wall and put some tape up just making sure that you cover the kind of eight positions from a compass and then you just have your clients spend about 30 seconds per line doing smooth pursuits smooth pursuits and then you switch to saccades.
Now that doesn’t sound like a lot but I guarantee you that five to eight minutes of work with the visual system is going to be very fatiguing for a lot of people.
So that’s a great place to start. Now how we transfer that in kind of more dynamically into balance is we want to make sure that we’re making the stance more challenging. So in the beginning if someone’s really compromised they’re going to hold on to the wall hold on to a chair have a nice wide base their knees are going to be bent and they’re just going to be doing their eye work. We then progressively start to take away all that stability we move the chair away so they’re only using a fingertip we bring their stance closer together we have them straightened up we have them stand on one foot or with the feet directly in front in line as if they’re on a balance beam and we just make it slightly harder over time. 
At that point we I like to have people then transition into adding a little bit of strength work to this so now we would imagine taking those Post-it notes and bringing them down the wall maybe foot and then we’re going to have our clients repeat the same exercises but in an isometric squat and an isometric lunge and in a different isometric lunge and maybe we’re doing multiple angles. Remember I said 30 seconds. So if they’re doing 30-second smooth pursuits while holding an isometric position they’re going to be getting a little bit of strengthening work it’s going to be more of a dual-tasking problem which means they have to think about staying in that squat because what will happen is as they’re doing more eye work and it’s getting harder they’ll stand up. 
So this is actually a progression that you can work on for eight to ten weeks with a lot of people and make tremendous progress in building their strength building their resilience and also being to improve their balance. That’s just from the eye work. 
Then if we move to the balance idea using the vestibular system we would repeat that exact process but now we would be focusing on what’s called the vestibular ocular reflex which now means that I’m going to put and dot or another Post-It note directly in the center of the compass like where the needle would be on an actual compass.
Now instead of having my clients keep their heads still and move their eyes they’re now going to keep their eyes still and they’re going to move their head on all of those compass lines and we would again go through that same process using the wall or chair wide stance nice and comfortable and safe and then progressively making it more challenging. If you take the time to have people work through this again it’s going to take weeks even months depending on how compromised they are you always have to do it to a client’s comfort and make sure that you’re not creating pain or nausea but it is critical that you start to get people using the eyes using the head and neck challenging the vestibular system and building that together into more challenging stance positions as well as beginning to do some basic strength work. 
This is a great starting point for a lot of people who are compromised already maybe they’re elderly maybe they haven’t exercised in a long time and we also use this program often for athletes recovering from a concussion because the visual system and vestibular system are often compromised after head injury so you need to learn this and make sure that you start implementing it.  I hope you find this one really useful and good luck.