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Dr. Mike Studer: Moving Through Fear Podcast Transcript Notes

Updated: Jun 28




Fear is a top predictor of falling. Neuro Physical Therapist, Dr. Mike Studer discussed the importance of addressing fear of falling and how to help people overcome their fear.


How to assess fear of falling:

If you don’t have time to administer a scale to assess their fear. Here is dialogue you can use:

“You know I’ve worked with other people who have moved similar to how I see you, and they’ve expressed to me that they have fear. I want to know, do you feel that you’re also fearful when you’re moving?”


Rather than accusing somebody, “you look like you’re fearful.” Which is a very good way to destroy a therapeutic relationship with somebody. You say, “I’ve had this experience. These people looked like this and told me this. You look like you’re similar. Tell me what you think because you know yourself best.”


How to help people overcome the fear of falling:

  1. Movement is associated with something that’s playful. Ex: kicking a balloon. They are doing something that could normally be fear evoking but because they’re just playing they will participate.

  2. Music: People may be willing to dance but not stand on one leg.

  3. Movement dedicated towards helping someone else: Volunteering, doing something productive, such as helping grandchildren, pushing a stroller, walking a dog

  4. Generalized exercise: Doing something with some intensity to release endorphins and give a ‘runners high’ can reduce fear.

  5. Exposure based therapy: Giving people successful experiences around their fear (ex: going down stairs)and habituating the exposure making sure they have control of an exit strategy

How to boost confidence:

  1. Giving people autonomy: Instead of dictating the session which some may appeal to some. You say” We could work on strength, balance, or endurance. What would you like to work on first? So number one, give them some responsibility in the session, autonomy.

  2. Gamify: Allow them to predict how they will do with gamification. Example: They predict it’s going to take 28 seconds to do a walk but you record it only takes them 17. Reflect back to them “I heard you predict 28 and you scored 17. How does that sound to you? Let them insert the value judgment rather than you just completely throw up all over them with all these, you know, congratulatory effects. Let them feel that they’ve earned it. That stays with people.

  3. End on a positive note: “We had a great session. Think of all the things we did today. Can you name two things that you want to make sure we do next session?” So they’re already looking forward to your next session because they started to build it.

  4. Give them autonomy in their homework: If you give them some things to work on at home and maybe you want them to do three things between now and when you see them again, give them five things and then you know what? Say, I want you to strike out two things on this list.

Tips: Give people the opportunity to express what has worked and hasn’t worked for them. This prevents you from forcing something on them they hate.

If someone is depressed, fearful or pessimistic allow them to predict how well they’re going to do but don’t give it a value

When I get the opportunity to pack my clothes, I’m looking forward to wearing them. If somebody else packed it for me, I don’t want to be surprised with what’s in here. It may feel like a mismatch when I have autonomy and I have the ability to build my sandwich, design the car that I’m going to buy, build the exercise program.I own it. It’s part of the endowment effect is what we call it.

5. Giving autonomy in a group setting: Leverage social cohesion where people will behave like the group. Have a participant come up and show his favorite exercise or help to lead the group. 

Tip: Instead of doing internal focus cues about body parts, make it external.

Example: “let’s walk like everybody in the crowd is your height and you need to be able to see over them to see how long the line is. So now see what you can do to actually see over the crowd. “ This will cause a person to stand/sit up straighter.

All motor control is organized around my perception of self, what the task is asking me to do, and what the environment is.

Fear is not the same thing as anxiety

Fear educates us, guides us and also can prevent us. So that’s true. But fear is not always altogether bad. Anxiety is not the same thing. Anxiety is I’m fearful about something and I’m ruminating on that thought and I’m ruminating even when it’s not even plausible that that could occur. You’re laying in bed at night. You’re safe. You’re going to be laid down for the next seven, eight hours, and you’re fearful of falling. That’s anxiety. So make sure we talk about those things in the same types of language where we separate them out.


How to assess for anxiety: Ask questions like “when you’re sitting down in a chair when you are having a meal in conversations or laying down in bed at night, are there times that you think about falling? When it could not rationally occur in the next few moments, so that you find yourself ruminating or thinking incessantly about falling?”


Dual-tasking

Dual tasking can be beneficial because it can serve as a healthy distractor away from my fear. It can also serve as a nice environment that can help someone see, oh my gosh, I can walk and do this. Now I feel more empowered, more capable

Example 1: Walking with a backpack then opening the backpack to take something out.

Example 2: Moving around the house thinking about what you need from the grocery store.


4 Types of Dual-tasking:

  1. Cognitive: I give you something to think about. You hold onto it. You give it back to me.

  2. Auditory: While you are doing it, I give you something that’s meaningful to you and they state it back to you. Giving directions: Turn right at  the McDonald’s and left at the first stop sign.

  3. Visual: Name this animal, name a color that someone is wearing in the front row.

  4. Manual: Pulling a tissue out of a pocket, or credit card out of a wallet.

Tips: Give meaningful information they hold rather than novel information.Create tasks that are relevant.

In a group setting:

Standing in a balanced challenged position (tandem, feet together, semi-tandem, 1-foot) then list 6 varieties of trees. Ask someone in the room their interest/expertise and have them create list of things for the group to remember. Other examples: Spell words backwards, do math


Myths on Aging:

If you read some of the literature, it says your ventilation perfusion, your vo2 max or your Exercise capacity, if you will, is lost by 15 percent per decade starting at age 40. Well, what we’re realizing now is that part of the losses are age specific losses. Your lungs get a little bit stiff, you lose some hydration, you denervate some muscles, your type 2 fibers turn into type 1, and I could bore you guys with all the science. But I’ll tell you this, assign all of the blame for these losses to aging. But in fact, part of them are because of life choices. Well, I decided to live in a one story home. I got a recliner lift chair. I don’t have stairs anymore. And so therefore, I lost how many repetitions of a strength stimulus? Well, I’ll tell you why you lost strength. Because you no longer do anything that requires strength.

So life choices are the one part that we neglect. And then here’s the third part. Because aging can only be blamed for a portion of it. Choice is part of it. And society, the third part, he’s too old to be riding a bicycle outside. He’s actually, he shouldn’t be jogging anymore. You know, he shouldn’t be lifting weights.

That’s dangerous for him. And when society, family members, friend groups and etc tell us that we shouldn’t do something. We begin to believe it. So we stopped doing it and therefore we lose that stimulus. And I can tell you the one thing that you will always lose, and that’s something that you haven’t done for a while.

Inactivity, illness, and injury. Those are the three main killers and because they influence our immune system. It influences eight different cancers are influenced by exercise. It influences our cognition and etc. It doesn’t have to be this way.

You’ve got to make certain that you experience a variety of life, you keep up only those skills that you might need in an emergency

It’s going to be a lot easier for you, Gertrude, to actually put some strength in your body here at 71 than it is for you to try to put some strength into your body at 81. So you decide. It’s, your aging will make it go down a little bit, but how big would you like the bank to be? Before it starts to draw some interest because the bank’s finance charges. So you decide how big you want that to be before it starts to go down.

Exercise Snacks: This approach encourages habitual physical activity without requiring large time commitments.


Neuroplasticity

Neuroplasticity is not age dependent. Neurogenesis, (creating new nerve cells) is age dependent. So only if you demand it, will I [the brain] supply it.

“It’s demand and supply model, If you ask the brain to do it, that is a stimulus that will help the brain figure out a way to make new connections. All neuroplasticity is learning. So I can learn how to tolerate another thought while I’m walking. That’s dual tasking. So people recover from stroke. They keep Parkinson’s disease at bay. They recover from concussion through neuroplasticity. The brain responds to a problem over here and says, Oh my gosh, those cells are gone. They’re never coming back. But the brain, if it’s demanded, says, let me see if I, how I can represent the function that those cells used to do using other neurons. We have 83 billion neurons in our brain. Each one of those neurons, Connections can make anywhere from 5, 000 to 100, 000 connections. So that means if we ask the brain to be able to do it, there’s a lot of room that will give it an opportunity to make new connections at any age.”

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