Falls Prevention 1 Annie Verghese PT DPT OCS Disclosure No Financial or NonFinancial Conflicts of Interests to Disclose Balance and Falls Are Related wwwhealthycellsmagazinecom wwwcontinuumcarecom ID: 674710
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Understanding Balance and Falls Prevention
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Annie Verghese, PT, DPT, OCSSlide2
DisclosureNo Financial or Non-Financial Conflicts of Interests to DiscloseSlide3
Balance and Falls Are Relatedwww.healthycellsmagazine.comwww.continuumcare.comSlide4
Fall Facts1 out of 3 over age of 65 fall, <50% tell doctor1 out of 5 has serious injury, 12.5 mil in ER >700,000 hospitalized 34 billion in direct medical costs www.cdc.gov
www.sciencealert.comSlide5
Falls PreventionIs Everyone’s ConcernSlide6
ObjectivesUnderstand factors that affect balance in the context of the individual, task, and environmentIdentify tests for clinical assessment of balanceIdentify fall risk factors and prevention strategies within the individual and environmentSlide7
Balancemedicalxpress.comSlide8
Posturewww.emergingwomen.comSlide9
Center of Gravitywww.travelingyogaman.com
mobilitymgmt.com
www.slideshare.netSlide10
Base of Support5koshasyoga.comfreshietosuperstar.wordpress.comSlide11
DYNAMIC SYSTEMS MODELBALANCE IS THE RESULT OFINTERACTIONS BETWEEN THE INDIVIDUAL, THE TASK, THE ENVIRONMENT www.psychologytoday.com
eldercompass.netSlide12
Dynamic Systems Overviewlookfordiagnosis.comSlide13
Peripheral Sensory ReceptionSomatosensory ReceptorsJoints, Muscles, Tendons, Ligaments, Connective Tissue, SkinVision FocalAmbientVestibularSemicircular canals Otoliths (utricle,saccule)
www.stlouisear.com
www.healthcentral.com
www.drwolgin.comSlide14
Central Sensory PerceptionInteraction between the Individual and the EnvironmentSensory Integration or OrganizationBrain StemCerebellumCerebrumVestibular SystemSensory ConflictsExtrinsicIntrinsicWhere am IInternal RepresentationExternal RepresentationSlide15
Central Motor Planning and ControlInteraction between the Individual and the TaskIntention, Attention, MotivationWhat do I want to do? How do I do it?Motor Plan TransmissionPeripheral Motor SystemCerebellumError Detection and Correction
www.nature.comSlide16
Motor Components of BalanceReflexesVestibuloocular Reflex (VOR)Vestibulospinal Reflex (VSR)Postural ResponsesAutomatic- Ankle, Hip, Suspensory, SteppingAnticipatoryVolitional Postural MovementsSlide17
Peripheral Motor ExecutionMusculoskeletalRange of MotionFlexibilityStrengthEnduranceNeural Cognitive
deafseniorsusa.blogspot.comSlide18
Dynamic Systems Overviewlookfordiagnosis.comSlide19
Other Factors Affecting BalanceSlide20
Medical Conditions Affecting BalanceHeart Disease, Heart FailureStrokeParkinson’s DiseaseHypotensionCOPDDiabetes, Peripheral NeuropathyPeripheral Vascular Disease, Foot Deformities ArthritisImpaired CognitionImpaired Visionlearnnottofall.comSlide21
Medications Affecting BalanceAce Inhibitors, beta blockers, Angiotensin II ReceptorAntagonists, Calcium Channel Blockers, Antiarrthymics, Diuretics, VasodilatorsAntipsychotics (neuroleptics), Anxiolytics, benzodiazepines, AntidepressantsOpioid Analgesics, Anticonvulsants, Skeletal Muscle RelaxantsAntihistaminesAntiparkinsonian AgentsDrugguide.comSlide22
coretrainingforsport.comSlide23
Balance TestingTest ObjectivesTest Selection
GTY_elderly_old_man_walking_sk_140127_16x9_608.jpg
2c2090f5fef0e14f0dcd4be0391175bb.jpgSlide24
Balance TestsStatic BalanceRomberg, Sharpened Romberg, 4-Stage BalanceDynamic BalanceFunctional Reach, 30s Sit-StandSensory ManipulationClinical Test of Sensory Interaction and Balance (CTSIB)Modified CTSIB/ Modified Romberg Functional MeasuresTinetti POMA, BergTimed Up and Go (TUG), Dynamic Gait Index (DGI)Slide25
Static Balancerehabmed.blogspot.com4-Stage Balance
Sharpened Romberg
www.acefitness.orgSlide26
Dynamic Balancefnagi-06-00286-g001.jpgFunctional ReachSlide27
Dynamic Chair Sit to StandAssess Lower Extremity Strength, Functional Mobility, Balance30 s to administerCommunity ElderlyScore below normative scores average indicates falls risk
87-yrsold-chair-exersie.jpgSlide28
Sensory ManipulationClinical Test of Sensory Interaction and Balance (CTSIB)Modified CTSIB Modified Rombergwww.oandp.orgSlide29
Tinetti Performance Oriented Mobility Assessment POMAAssesses Balance, Gait, and Fall RiskTested in elderly and neurologic populationsInvolves position changes, gait maneuversFree, no training required10-15 min to administer16 items- 9 balance 7 gaitItem Scale 0-2 Max score 28 Fall Risk Score <19=High 19-24=Med 25-28=LowSlide30
Berg Balance ScaleAssesses Balance and Fall Risk Tested in elderly and neurologic populations14 items - static and dynamic balance activitiesScale 0-4 Max score 56Fall risk 0-20=High 21-40=Med 41-56=Low<45/56 used as fall predictorMinimal Detectable Change 6.515-20 min to administerFree, no training requiredSlide31
Timed Up and Go (TUG)Assesses falls riskTested in elderly and neurologic populationsFree, no training required<5 min to administer>13.5 s is predictive of falls>30 s corresponds with functional dependencein persons with pathology Slide32
Dynamic Gait IndexAssesses Ambulatory Balance in the context of external demandsTested in elderly and neurologic populationsFree, no training required<10 min to administerScale 0-3 Max Score 24Fall Risk Score <19/24 >22/24= safe ambulatorsMinimal Detectable Change 2.9Slide33
FALLS ARE NOT INEVITABLESlide34
Falls PreventionExercise Medical ManagementRehabAdaptive Strategies and DevicesSupervision/AssistanceHome SafetySlide35
Home Safetywjla.comSlide36
www.nationwideeducation.co.ukSlide37
www.nationwideeducation.co.ukSlide38
www.sensoryworld.orgSlide39
www.nationwideeducation.co.ukSlide40
www.brookdale.comSlide41
Ken Taylor at 90http://cycleseven.orgSlide42
Banana Georgewww.legacy.comSlide43
www.musselfit.com