RESEARCH REVIEW
Prevention of Falls in Older Persons.
Motor Control and children with Autism
Treatable and preventable diseases are prevalent in society. The statistics in 1996 showed 78% of all deaths were attributed to eight killers: heart disease, cancer, stroke, hypertension, chronic obstructive pulmonary disease (COPD), diabetes and osteoporosis. Other diseases with strong association to these are obesity, arthritis, depression and dyslipidemia. ( Elrick, the physician and sports medicine Feb96' )
When we think of medicine we often think of a drug, something to be taken orally or injected that rid us of the ailment or disease. In many cases this is true, however diseases that develop over a long period of time such as heart disease or osteoporosis are deemed somewhat preventable. Drug treatment tends to be reactive in nature rather than proactive.
A large and growing body of clinical and epidemiologic evidence supports prescribed exercise as being highly effective as treatment and prevention for the above-cited diseases. Exercise is also proactive and health enhancing. Regular exercise reduces blood clotting, enhances self-image, modulates blood sugar, elevates mood, reduces stress (stimulates endorphins counteracting cortisol-stress hormone), improves appearance, increases energy and reduces body fat. In addition prescribed exercise restores abilities in muscles and joints after injury. It reinforces other positive life-style changes such as healthier eating habits and smoking cessation and stimulates creative thinking.
Ironically the decision to improve oneself after all other things are tried and considered; lifestyle changes that include prescribed exercise and moderate eating, are just the things we need to do !
Prevention of Falls in Older Persons
The incidence and severity of falls rise steadily after the age of 60. Frequently older people are not aware of the risks of falling and may not recognize nor report issues to their physician. Most fall-related injury in older persons stems from a high prevalence of comorbid diseases (e.g. osteoporosis) and age related physiological decline (e.g. slower reflexes). This can make even a mild fall potentially dangerous. The loss of independence due to a fall combines with a loss of confidence to move safely in depression and anxiety in the older person.
Risk factors for falling include: 1. Intrinsic factors: lower extremity weakness, poor grip strength, balance disorders, functional and cognitive impairment and visual problems 2. Extrinsic factors: multiple prescriptions 4 or more, 3. Environmental factors: poor lightning, loose carpets, bathroom safety, stair safety, and shoes/slippers. (JAGS 2001, Guidelines for the Prevention of Falls in Older Persons)
Treatment for prevention of the first fall or further falls is relatively the same. Improving the cardiovascular system (hypotension and hypertension may cause distorted centre of balance especially with standing from low positions), improve muscle strength, mobility of the joints and modification of walking (gait training). This is all possible at any age provided you are working with a professional who understands your health and medical concerns.
Motor Control and children with Autism
A baby's voluntary movements are the first means of its communication with relatives. Key elements such as anticipation, coordination and adaptation enable children in activity to exercise action towards a goal. This goal is meant to be integrated into their environment. This is essential for efficient and smooth motor development.
Various studies in children with autism reported a deficit in the organization of the action towards a goal. The main deficit in ASD children is the lack of mutual communication and usually interactions with their environment. Anticipatory postural adjustments (APA) occur before the onset of disturbance due to movement. The anticipation is for the next position which is a disturbance in posture. This posture may appear as a slumped position or over excited position or unbalanced stance. Their exists a feed-forward control in children without autism. The theory is that this feed forward mechanism is impaired. (Neuroscience Letters 2003, 17-20, Schmitz, Martineau, Barthelemy, Assaiante)
Current anatomical studies clearly suggest that the cerebellum is a damaged structure in autism. A dysfunction of this structure may also be the cause of deficient anticipated control. Retroactive postural control is substituted for proactive control by autistic children. This is shown during coordinative movements that require balance. However repetition of the movements invokes memory and a neurological pattern that overtakes the necessary proactive control. New movements and posture are difficult to achieve and require the behavioral intervention of a skilled practitioner.
The progression of knee osteoarthritis can be sped up by being overweight (BMI 25-29) or obese BMI 30+). People who are moderately bowlegged (legs curved outward) or knock kneed (legs curved inward toward each other) are the most at 23% effected. In a study of over 200 adults with knee osteoarthritis were followed for 30 months and higher body mass index (BMI) were associated with greater risk for worsening knees. This occurred however with individuals whose knees exhibited either "bowleggedness" or "knock-kneed positions". (A.Norton. Medline Plus c/o Reuters Health Dec. 2004)
Being overweight is already considered a risk factor for increased development of osteoarthritis where the cartilage of the joint breaks down which leads to pain, stiffness and reduced mobility.
Exercise with specific stretching and resistance training for the knees is imperative for those with chronic knee osteoarthritis. Those who are overweight specifically in the torso or hips, stress their knee joints. It is difficult to feel like exercise when your knees hurt. However the best thing to do is to move your body (safely) in ordered to minimize the pain in the longer term.
* More information will added ongoing. Please check back.