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	<title>Comments on: Fall prevention in older people &#8212; Stephen Lord at HCSNet</title>
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	<description>For a greater understanding of the encultured brain and body...</description>
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		<title>By: Dr. Michael Flanagan</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-13375</link>
		<dc:creator><![CDATA[Dr. Michael Flanagan]]></dc:creator>
		<pubDate>Fri, 06 Aug 2010 09:15:43 +0000</pubDate>
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		<description><![CDATA[There is another cause to consider for falls in seniors called drop attacks. The bent base of the cranium and migration of the foramen magnum beneath the center of the skull predisposes humans to pressure conus type conditons in which the brainstem sinks into the foramen magnum. Pressure conus conditions were first noted as a result of spinal taps in which too much CSF was removed. A pressure conus compresses the brainstem and can result in loss of all vital funcitons and consciousness. The problem is that the brain floats in cerebrospinal fluid/CSF inside the cranial vault. Dilations in the subarachnoid space called cisterns are also stratigically located around the brainstem to provide additional support to keep it from sinking into the FM. Likewise in a similar condition called cerebellum tonsilar ectopia (CTE), which is also called a Chiaria condition, the tonsils of the cerebellum herniate into the foramen magnum. In any case, Chiari/CTE/pressure conus type conditons block the lowest and most important accessory venous outlets used by humans to drain the posterior fossa in the upright position. Chiari conditions consequently can cause hydrocephalus in the brian above the point of constriction and syrnixes in the central canal of the cord below. Blockage of these outlets also causes venous shifts and sluggish venous blood and cerebrospinal fluid flow out of the posterior fossa. This would affect CSF volume in the cisterns surrounding the brainstem. Except for the nose and eyes all of the other cranial nerves are located in the posterior fossa, including the eigth. Most of the CNs are located more ventrally on the underside of the brainstem toward the clivus. Either an increases or a decreases in CSF volume in the cisterns can compress these CNs. Additionally, an increase in CSF volume in the fourth ventricle would affect the flocculonodular lobe, which controls posture, coordination and balance and has close connections to the eigth CN. It also lies next to the tonsils of the cerebellum which are involved in CTE conditions. Recent studies show a significant correlation between cervical truama and Chiari conditions and Chirari conditons are known to cause drop attacks.]]></description>
		<content:encoded><![CDATA[<p>There is another cause to consider for falls in seniors called drop attacks. The bent base of the cranium and migration of the foramen magnum beneath the center of the skull predisposes humans to pressure conus type conditons in which the brainstem sinks into the foramen magnum. Pressure conus conditions were first noted as a result of spinal taps in which too much CSF was removed. A pressure conus compresses the brainstem and can result in loss of all vital funcitons and consciousness. The problem is that the brain floats in cerebrospinal fluid/CSF inside the cranial vault. Dilations in the subarachnoid space called cisterns are also stratigically located around the brainstem to provide additional support to keep it from sinking into the FM. Likewise in a similar condition called cerebellum tonsilar ectopia (CTE), which is also called a Chiaria condition, the tonsils of the cerebellum herniate into the foramen magnum. In any case, Chiari/CTE/pressure conus type conditons block the lowest and most important accessory venous outlets used by humans to drain the posterior fossa in the upright position. Chiari conditions consequently can cause hydrocephalus in the brian above the point of constriction and syrnixes in the central canal of the cord below. Blockage of these outlets also causes venous shifts and sluggish venous blood and cerebrospinal fluid flow out of the posterior fossa. This would affect CSF volume in the cisterns surrounding the brainstem. Except for the nose and eyes all of the other cranial nerves are located in the posterior fossa, including the eigth. Most of the CNs are located more ventrally on the underside of the brainstem toward the clivus. Either an increases or a decreases in CSF volume in the cisterns can compress these CNs. Additionally, an increase in CSF volume in the fourth ventricle would affect the flocculonodular lobe, which controls posture, coordination and balance and has close connections to the eigth CN. It also lies next to the tonsils of the cerebellum which are involved in CTE conditions. Recent studies show a significant correlation between cervical truama and Chiari conditions and Chirari conditons are known to cause drop attacks.</p>
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		<title>By: Susan Stringfellow</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-11050</link>
		<dc:creator><![CDATA[Susan Stringfellow]]></dc:creator>
		<pubDate>Mon, 01 Mar 2010 02:59:26 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-11050</guid>
		<description><![CDATA[The loss of peripheral vision is mentioned as a cause of falls in older people, but not the loss of central vision. Macular degeneration is increasingly a problem as we age and loss of central vision can also lead to falls in the elderly. &quot;Walking&quot; glasses are an excellent idea (though probably not so helpful for macular degeneration), as many optometrists only correct for reading and/or driving and cannot seem to comprehend that these visual corrections might create problems in depth perception which could lead to falls. Are there any optometrists out there with an interest in this area??]]></description>
		<content:encoded><![CDATA[<p>The loss of peripheral vision is mentioned as a cause of falls in older people, but not the loss of central vision. Macular degeneration is increasingly a problem as we age and loss of central vision can also lead to falls in the elderly. &#8220;Walking&#8221; glasses are an excellent idea (though probably not so helpful for macular degeneration), as many optometrists only correct for reading and/or driving and cannot seem to comprehend that these visual corrections might create problems in depth perception which could lead to falls. Are there any optometrists out there with an interest in this area??</p>
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		<title>By: Lose your shoes: Is barefoot better? &#171; Neuroanthropology</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-6311</link>
		<dc:creator><![CDATA[Lose your shoes: Is barefoot better? &#171; Neuroanthropology]]></dc:creator>
		<pubDate>Sun, 26 Jul 2009 13:18:04 +0000</pubDate>
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		<description><![CDATA[[...] dynamic reactions in the foot muscles (see Abbound 2002: 171, and for a review). As we’ve already discussed here on Neuroanthropology.net, some researchers who study loss of stability in older people point to diminished sensitivity in [...]]]></description>
		<content:encoded><![CDATA[<p>[...] dynamic reactions in the foot muscles (see Abbound 2002: 171, and for a review). As we’ve already discussed here on Neuroanthropology.net, some researchers who study loss of stability in older people point to diminished sensitivity in [...]</p>
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		<title>By: Months of the Year: Neuroanthropology 2008 &#171; Neuroanthropology</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-4278</link>
		<dc:creator><![CDATA[Months of the Year: Neuroanthropology 2008 &#171; Neuroanthropology]]></dc:creator>
		<pubDate>Fri, 09 Jan 2009 14:19:40 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-4278</guid>
		<description><![CDATA[[...] Fall prevention in older people – Stephen Lord at HCSNet Bench and couch: genetics and psychiatry Habits to Help When Pink Ribbons Are No Comfort: On Humor and Breast Cancer by guest blogger Casey Bouskill [...]]]></description>
		<content:encoded><![CDATA[<p>[...] Fall prevention in older people – Stephen Lord at HCSNet Bench and couch: genetics and psychiatry Habits to Help When Pink Ribbons Are No Comfort: On Humor and Breast Cancer by guest blogger Casey Bouskill [...]</p>
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		<title>By: Habits to Help &#171; Neuroanthropology</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-2774</link>
		<dc:creator><![CDATA[Habits to Help &#171; Neuroanthropology]]></dc:creator>
		<pubDate>Tue, 29 Jul 2008 15:31:54 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-2774</guid>
		<description><![CDATA[[...] to Help &#8230; on Mirror neurons: shameless plug&#8230;MedBlogs Grand Round&#8230; on Fall prevention in older peopl&#8230;Go forth and read…&#8230; on Girls gone guilty: Evolutionar&#8230;Ryan on Girls gone guilty: [...]]]></description>
		<content:encoded><![CDATA[<p>[...] to Help &hellip; on Mirror neurons: shameless plug&hellip;MedBlogs Grand Round&hellip; on Fall prevention in older peopl&hellip;Go forth and read…&hellip; on Girls gone guilty: Evolutionar&hellip;Ryan on Girls gone guilty: [...]</p>
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		<title>By: MedBlogs Grand Rounds 29 July, 2008. &#8216;Why do we do it?&#8217; at edwinleap.com</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-2770</link>
		<dc:creator><![CDATA[MedBlogs Grand Rounds 29 July, 2008. &#8216;Why do we do it?&#8217; at edwinleap.com]]></dc:creator>
		<pubDate>Tue, 29 Jul 2008 06:18:23 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-2770</guid>
		<description><![CDATA[[...] http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/ [...]]]></description>
		<content:encoded><![CDATA[<p>[...] <a href="http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/" rel="nofollow">http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/</a> [...]</p>
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		<title>By: Noli Irritare Leones &#187; Blog Archive &#187; Preventing falls in older people</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-2710</link>
		<dc:creator><![CDATA[Noli Irritare Leones &#187; Blog Archive &#187; Preventing falls in older people]]></dc:creator>
		<pubDate>Wed, 23 Jul 2008 15:10:12 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-2710</guid>
		<description><![CDATA[[...] Downey at Neuroanthropology has a detailed post on Fall prevention in older people — Stephen Lord at HCSNet, describing new research in predicting the likelihood of falls, determining fall risk factors and [...]]]></description>
		<content:encoded><![CDATA[<p>[...] Downey at Neuroanthropology has a detailed post on Fall prevention in older people — Stephen Lord at HCSNet, describing new research in predicting the likelihood of falls, determining fall risk factors and [...]</p>
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		<title>By: gregdowney</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-2693</link>
		<dc:creator><![CDATA[gregdowney]]></dc:creator>
		<pubDate>Mon, 21 Jul 2008 12:01:21 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-2693</guid>
		<description><![CDATA[Daniel --

So i think it&#039;s official: everyone at Neuroanthropology has a copy of Doidge&#039;s book.  Paul and I were discussing it, too.  And, yes, that whole discussion is why I asked Lord about deafferentiation of the feet.  Thanks for reminding me of the &#039;cobblestone mat&#039; example -- I&#039;ll have to include it in my eventual equilibrium chapter/paper (the one I&#039;ll give at the AAAs if our panel gets accepted).

But overall, I think that balance is a great example -- glad I&#039;m not the only one.  Since I&#039;m also interested in the high-performance end of balance abilities, such as capoeiristas who achieve almost uncanny unbalance while walking on their hands and on Uighur kids who are taught to tightrope walk at a very early age, I&#039;m intrigued by what other sorts of sensory input might also be brought into the &#039;equilibrium synthesis,&#039; especially when some of the normal inputs are taken out of the equation.  In other words, equilibrium is a great ability to deal with because, both in degenerate and exceptional forms, the &#039;sense&#039; is making use of different sorts of sensory inputs, forms of self-monitoring, strengths, and behaviour patterns to keep the body balanced (which is itself a situatlonally defined standard, as different activities allow us to compensate in diverse ways -- a tightrope walker has fewer action options to compensate for instability, for example).

But overall, it&#039;s fun stuff.  That&#039;s why I&#039;ve had such a great time getting stuck into it.  Thanks, though, for the great reference.  Lord&#039;s research and work has been a great boost to my thinking, and I&#039;ve barely scratched the surface on it.  GD]]></description>
		<content:encoded><![CDATA[<p>Daniel &#8211;</p>
<p>So i think it&#8217;s official: everyone at Neuroanthropology has a copy of Doidge&#8217;s book.  Paul and I were discussing it, too.  And, yes, that whole discussion is why I asked Lord about deafferentiation of the feet.  Thanks for reminding me of the &#8216;cobblestone mat&#8217; example &#8212; I&#8217;ll have to include it in my eventual equilibrium chapter/paper (the one I&#8217;ll give at the AAAs if our panel gets accepted).</p>
<p>But overall, I think that balance is a great example &#8212; glad I&#8217;m not the only one.  Since I&#8217;m also interested in the high-performance end of balance abilities, such as capoeiristas who achieve almost uncanny unbalance while walking on their hands and on Uighur kids who are taught to tightrope walk at a very early age, I&#8217;m intrigued by what other sorts of sensory input might also be brought into the &#8216;equilibrium synthesis,&#8217; especially when some of the normal inputs are taken out of the equation.  In other words, equilibrium is a great ability to deal with because, both in degenerate and exceptional forms, the &#8216;sense&#8217; is making use of different sorts of sensory inputs, forms of self-monitoring, strengths, and behaviour patterns to keep the body balanced (which is itself a situatlonally defined standard, as different activities allow us to compensate in diverse ways &#8212; a tightrope walker has fewer action options to compensate for instability, for example).</p>
<p>But overall, it&#8217;s fun stuff.  That&#8217;s why I&#8217;ve had such a great time getting stuck into it.  Thanks, though, for the great reference.  Lord&#8217;s research and work has been a great boost to my thinking, and I&#8217;ve barely scratched the surface on it.  GD</p>
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		<title>By: dlende</title>
		<link>http://neuroanthropology.net/2008/07/21/fall-prevention-in-older-people-stephen-lord-at-hcsnet/#comment-2692</link>
		<dc:creator><![CDATA[dlende]]></dc:creator>
		<pubDate>Mon, 21 Jul 2008 11:42:54 +0000</pubDate>
		<guid isPermaLink="false">http://neuroanthropology.wordpress.com/?p=644#comment-2692</guid>
		<description><![CDATA[Greg, what a great example.  I was particularly impressed by the consideration of leg strength, the individual variability in sway, and on-going awareness of where your body is in space.  Adds a lot to what we mean by &quot;balance&quot;, but also shows that we can focus on the specific processes involved in a research problem for great benefit, both for understanding and for intervention.

I&#039;ve been reading Doidge&#039;s The Brain That Changes Itself, and he relates an idea from Michael Merzenich about the decline in &quot;gross motor control&quot; as we age.  To quote: &quot;Aside from a failure of vestibular processing, this decline is caused by the decrease in sensory feedback from our feet.  According to Merzenich, shoes, worn for decades, limit the sensory feedback from our feet to our brain.  If we went barefoot, our brains would receive many different kinds of input as we went over uneven surfaces.  Shoes are a relatively flat platform that spreads out the stimuli, and the surfaces we walk on are increasingly artificial and perfectly flat.  This leads us to dedifferentiate the maps for the soles of our feet and limit how touch guids our foot control.  Then we may start to use canes, walkers or crutches or rely on other senses to steady ourselves.  By resorting to these compensations instead of exercising our failing brain systems, we hasten their decline.&quot;

In other words, the argument is that the lack of diverse sensory input from our feet leads to the &quot;use-it-or-lose-it&quot; phenomenon in neuronal processing.  This can create its own sort of &quot;sensory weakness,&quot; similar to the muscular strength weakness in the legs.  And Doidge&#039;s point about the emphasis on compensation, rather than re-training the under-used parts of the brain, is one he repeats throughout the book, as it works well with the break-it-down-into-pieces research approach (provided individual variation is also considered).

Not surprisingly, Chinese medicine, with its emphasis on accupuncture and accupressure, seems to have realized this sort of thing long ago.  One particular &quot;intervention&quot; was to walk along a path of rounded but uneven stones, thus stimulating the feet (and thus the overall body).  In the US, this has been adapted to a &quot;cobblestone mat&quot; that has been clinically shown to be an effective intervention for balance and for blood pressure in people over 60.  For more info, see here: http://massagetherapy.suite101.com/article.cfm/reflexology_and_cobblestone_mats]]></description>
		<content:encoded><![CDATA[<p>Greg, what a great example.  I was particularly impressed by the consideration of leg strength, the individual variability in sway, and on-going awareness of where your body is in space.  Adds a lot to what we mean by &#8220;balance&#8221;, but also shows that we can focus on the specific processes involved in a research problem for great benefit, both for understanding and for intervention.</p>
<p>I&#8217;ve been reading Doidge&#8217;s The Brain That Changes Itself, and he relates an idea from Michael Merzenich about the decline in &#8220;gross motor control&#8221; as we age.  To quote: &#8220;Aside from a failure of vestibular processing, this decline is caused by the decrease in sensory feedback from our feet.  According to Merzenich, shoes, worn for decades, limit the sensory feedback from our feet to our brain.  If we went barefoot, our brains would receive many different kinds of input as we went over uneven surfaces.  Shoes are a relatively flat platform that spreads out the stimuli, and the surfaces we walk on are increasingly artificial and perfectly flat.  This leads us to dedifferentiate the maps for the soles of our feet and limit how touch guids our foot control.  Then we may start to use canes, walkers or crutches or rely on other senses to steady ourselves.  By resorting to these compensations instead of exercising our failing brain systems, we hasten their decline.&#8221;</p>
<p>In other words, the argument is that the lack of diverse sensory input from our feet leads to the &#8220;use-it-or-lose-it&#8221; phenomenon in neuronal processing.  This can create its own sort of &#8220;sensory weakness,&#8221; similar to the muscular strength weakness in the legs.  And Doidge&#8217;s point about the emphasis on compensation, rather than re-training the under-used parts of the brain, is one he repeats throughout the book, as it works well with the break-it-down-into-pieces research approach (provided individual variation is also considered).</p>
<p>Not surprisingly, Chinese medicine, with its emphasis on accupuncture and accupressure, seems to have realized this sort of thing long ago.  One particular &#8220;intervention&#8221; was to walk along a path of rounded but uneven stones, thus stimulating the feet (and thus the overall body).  In the US, this has been adapted to a &#8220;cobblestone mat&#8221; that has been clinically shown to be an effective intervention for balance and for blood pressure in people over 60.  For more info, see here: <a href="http://massagetherapy.suite101.com/article.cfm/reflexology_and_cobblestone_mats" rel="nofollow">http://massagetherapy.suite101.com/article.cfm/reflexology_and_cobblestone_mats</a></p>
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