Think and Move to Reduce Falls
We know that fall prevention programs that include balance exercises and resistance training are effective in reducing falls for older adults. For example, The Sunbeam Program, a fall prevention program using principles of Progressive Resistance Training, was recently tested for its effectiveness and the results were impressive.
221 participants were selected from 16 residential aged care facilities. Treatment was randomized, with 72 participants receiving progressive resistance and balance training (the exercise group) and 158 receiving usual care.For participants in the strength and balance training group, there was a 55% reduction in falls, greater than any previous intervention in a residential care setting.
So, the combination of balance plus strength training is effective for fall prevention. However, a third contributor to fall risk has been largely ignored – a breakdown in executive functioning.
In 2014, a study was published that demonstrated the importance of this missing link. The study involved 182 subjects who were randomly assigned to one of two fall prevention programs.
The first program included progressive strength training in combination with balance training. The second program was the same as the first except that it included the addition of cognitive training using a computerized virtual learning system. After participating in the training groups for 12 weeks, the participants were assessed for changes in their fall risk and the results were staggering.
Both groups showed a reduced risk of falling, but the participants in the training group that included cognitive training reduced their risk of falling by 80%!
Executive functioning has a serious impact on fall risk.
Falls happen for many different reasons and can be the result of a wide variety of intrinsic and extrinsic factors, including:
- Poor vision and other sensory impairments
- Decreased awareness of the position and movement of the body (proprioception)
- Dysfunction of the vestibular system which includes parts of the inner ear and brain that process sensory information involved with controlling balance and eye movements
- Decreased muscle strength, limited range of motion, and uneven weight bearing due to injury
- Environmental hazards – expected or otherwise
There's another major cause of falls: reduced executive functioning.
A considerable proportion of falls in seniors are associated with a decline in executive performance. Why? Throughout our lives, a constant feedback loop between the sensory system, the central nervous system, and the muscular system allows us to move through the world performing a variety of complicated tasks with ease.
Simply stepping off a curb and walking across the street requires an intake of quality sensory input that is transported quickly to the central nervous system where it is translated back out through the muscular system creating appropriate movements to successfully maneuver the street, curb, and any other objects that stand in our way.
This constant feedback loop occurs throughout each day, helping us perform daily tasks without even realizing that it’s happening. Problems arise when there are disruptions in this feedback loop.
As we age, most of us experience changes in the prefrontal cortex that are associated with executive functioning and attention. Compounding the problem, are age related declines in our ability to take in sensory information. This double whammy of executive function and sensory declines has a serious impact on our risk of falling.
When combined with a loss of muscle mass, limited range of motion, and environmental hazards, the cause of falls becomes multifactorial. So, the intervention should be too.
Keys to Effective Fall Prevention Programs:
- Risk assessment
- Balance training
- Strength training
- The missing link: Dual-task cognitive and motor training exercises
HUR Senso: Delivering the Missing Link in Fall Prevention.
The HUR Senso is a scientifically based dual-tasking fall reduction and cognitive training platform.
Most activities that we perform throughout a normal day involve the simultaneous performance of two or more cognitive and motor tasks. The HUR Senso was designed to train our ability to successfully manage multiple cognitive and motor tasks and thereby reduce the risk of falling.
The HUR Senso was created on the principle that learning is most effective when practice exercises closely resemble the actual environment in which that new skill will be performed. We know that in order to learn or improve a skill, it's vital to practice performing that exact skill. If many daily tasks involve simultaneous performance in both cognitive and motor areas, then we need to challenge both of those systems during practice sessions.
The Senso includes a wide assortment of games that challenge both the cognitive and motor systems. The games were designed to improve sustained attention, working memory, divided attention, reaction time, inhibition, cognitive flexibility, and visuo-spatial skills.
Two important benefits of HUR Senso training programs: They are personalized and progressive.
Every activity on the Senso can be customized to address each user’s unique needs and will automatically adapt to provide progressive challenges. Constant communication based on the user’s performance and automatic challenge adjustments prevents plateaus and keeps each user engaged.
- Interactive games and dual-tasking exercises challenge and improve cognitive-motor control, having a direct impact on fall risk.
- Fun, dual-tasking fall reduction and cognitive training game-style exercises
- Gamification provides fun and interactive challenges
- Improves physical health and cognitive functioning at the same time
Consistent Automatic Assessment
The Senso includes a variety of assessments that can predict fall risk. More than that, the Senso provides constant ongoing tracking of user performance while they train and over time.
As each individual user trains, the Senso assesses the user’s performance history and automatically adjusts to the appropriate challenge level for that individual. This prevents demotivating and ineffective plateaus so that the individual remains challenged and continues to improve.
For Further Study
Research that supports combining physical and cognitive training:
- Exercise interventions are the single most effective strategies to reduce the rate of falls. (Gillespie et al., 2012)
- Older adults, and especially those at risk of falling, have an impaired ability to initiate and execute quick, accurate voluntary steps, particularly in situations where attention is divided. (St. George et al, 2007)
- Cognitive-motor interventions based on strength and balance exercises with additional cognitive motor training are able to improve voluntary step execution under both single and dual task conditions in older adults. (Pichierri et al., 2012)
- Cognitive functions decline with age and if impaired fall risk increased. Combined cognitive and physical training leads to better performance in cognitive tasks than isolated cognitive or physical exercise. (Theill et al., 2013)
- Combined cognitive and motor training improves gait stability and reduced fall rate by 80%...and performance of executive functions can be optimized. A considerable proportion of falls in old age is associated with a decline in executive performance. (van het Reve & de Bruin, 2014)