Post on 20-Aug-2015
transcript
• Falls among older adults are common and dangerous, with known significant morbidity and mortality.
• Approximately one-third of community-dwelling older adults will fall each year.
• 20-30% of falls result in moderate to severe injuries, including traumatic brain injury (TBI), cervical fractures, and spinal injury.
Fall Statistics
Fall Statistics
• Falls are the most common cause of hospital admissions for trauma among older adults and are the fifth leading cause of death in older adults.
– Older adults injured from falls and admitted to the hospital are significantly more likely to be discharged to long-term care than other age-matched patients admitted to the hospital from the emergency department (ED) for other reasons
Cost of Falls
– In 2000, $19 billion was spent on fall-related injuries for people aged 65 years and older.
– By 2030, nearly 1 in 5 Americans will be aged 65 years or older.
What is the Better Balance Program?
• Educational tool guided by evidence based practice to assist in identifying and addressing impairments that may lead to imbalance.
Mission of the Program
• Identify individuals who are at risk for falling
• Help at risk individuals take steps to reduce falls before they happen
• Encourage healthy aging by facilitating older adults to remain mobile and independent
• Reduce hospitalizations
Who Will Benefit?
• Individuals who:– Have fallen recently– Demonstrate difficulty getting up from a chair– Have difficulty walking or are unsteady– Are physically inactive– Are fearful of falling
Who Will Benefit?Individuals Who:
- Complain of dizziness or lightheadedness
–Have problems with the senses, such as impaired vision, numbness or neuropathy
–Demonstrate muscle weakness
–Have neurological or arthritic/orthopedic conditions that limit physical abilities
Balance or Postural Control
• The ability to locate and maintain one’s center of gravity within or over one’s base of support during static and dynamic tasks
• Controlled by interaction of sensory and motor systems– Disruption of these systems leads to imbalance and
increased risk for falls
Sensory Input
– Peripheral Sensory Systems•Visual: detects movement of head or environment,
reference for verticality•Vestibular: detects linear and angular head/eye
movement and position relative to gravity•Somatosensory: provides info about body’s
position relative to surface
Motor Output
• Maintenance of postural control– Static Postural Control
» Normal sway
» Reflexes
– Automatic or Reactive Postural Responses
» Response to stimuli
» Strategies
– Anticipatory Postural Responses
» Occur before actual stimulus
– Volitional Postural Movements
» Conscious control, trained responses
Reactive Postural Responses
• Occur in response to stimuli• Strategies– Ankle: response to small perturbation– Hip: response to larger or faster perturbation– Stepping: force strong enough to displace
COM outside of BOS, step to regain COM
Physical Therapy Evaluation
• Identify impairments– Outcome measures
•TUG, BERG
– Movement assessment•Range of motion, Strength
• Identify risk factors– Intrinsic versus extrinsic
Intrinsic Risk Factors
• >80• Arthritis• Balance Deficit• Cognitive Impairment• Depression• Dizziness• Fear of Falling
• Gait Deficit• History of Falls• Impaired ADLs• Medications• Muscle Weakness• Sensory disturbances• Use of assistive
devices
Extrinsic Risk Factors
• Inadequate lighting• Loose carpets• Unlevel floor
transitions• Clutter• Electrical Cords• Lack of Appropriate
adaptive equipment
• Inadequate stairs (railing, depth)
• Unstable furniture• Unsuitable footwear• Unlocked wheelchair• Weather conditions• Pets
Physical Therapy Treatment
• Individualized treatment plan for each patient
• Appropriate medical referral if needed– Medication management
•Four or more•Classifications linked to increased risk of falls
– Benzodiazepines, sleeping medications, neuroleptics, antidepressents, anticonvulsants and class 1A antiarrhythmics
– Blood Pressure
What Can Physical Therapy Do to Help?
• Address the following Impairments – ROM
– Strength
– Coordination
– Gait
– Endurance
– Safety
What Can Physical Therapy Do to Help
• Address vestibular dysfunction– Vestibular Treatment, Habituation Exercises
• Assess need for assistive devices