Specialist PSI Exercise Module

EXERCISE FOR THE PREVENTION OF FALLS

AND INJURIES IN FRAILER OLDER PEOPLE

‘PSI’ INSTRUCTOR COURSE

A SPECIALIST NATIONAL TRAINING INITIATIVE

Specialist PSI Exercise Module

WHY?• Need for training to:

– Support national accident prevention targets

– Ensure greater consistency of provision– Ensure best practice

• Need for training that is:– Specialist– Evidence-based– Practical– Interdisciplinary– Recognised

Specialist PSI Exercise Module

WHO?

• Department of Health

• Merton, Sutton & Wandsworth Health Authority

• Advisory Group of National Experts

• 1999 first pilot run

• To date over 1000 PSI instructors have qualified

Specialist PSI Exercise Module

Interested Co-workers

Specialist PSI Exercise Module

WHAT?

• First Recognised National Qualification

• Postural Stability Instructors (PSIs)

• Register of Exercise Professionals (REPS) at Level 4

– CPD at Level 3

• Chartered Society of Physiotherapy Endorsed

training

• Accredited by University of Derby

• Guidelines and Consensus Recommendations

Specialist PSI Exercise Module

HOW?

• Underpinning Knowledge• Application to Practice• Practical• Case Study• C.P.D.

Specialist PSI Exercise Module

AN INTERPROFESSIONAL NETWORK

District Nurse Family/Carers General Practitioner Health Visitor Chiropodist A & E

Hospital Doctors Hospital Therapists Ambulance Services Social Services Community therapy services Pharmacist Leisure Services

• Multifactorial Nature of Falls

• Multiprofessional Skills

• Professional Liaison• Respecting Boundaries/Building Trust• Patient Centred

Specialist PSI Exercise Module

ACCIDENT &EMERGENCY

AMBULANCESERVICES

PRIMARY CARE

GP

VERY SHELTERED/RESIDENTIAL HOME/

NURSING HOME

SECONDARYCARE

SELF REFERRAL

PRE-EXERCISE ASSESSMENT

‘PREHAB’ PREVENTATIVEEXERCISE

REHABILITATIONEXERCISE

CHAIR BASEDEXERCISE

SOCIAL SERVICES

ROUTES

INTO THE

FALLS

EXERCISE

PATHWAY

Specialist PSI Exercise Module

FALLS REHABILITATION GROUP

‘PREHAB’ PREVENTATIVE

EXERCISE

CHAIR BASED EXERCISE GROUP

REFERRAL

  

Exercise for the Older Person Sessions 

THE THREE EXERCISE GROUPS

Specialist PSI Exercise Module

Independently mobile older people

Independent with assistance/aids

Independent with assistance/aids/carer

Physically frail housebound/outpatient

Exercise Instructor NVQ2

OTAGO Exercise Leader Chair-based Exercise LeaderNVQ2/3

Dinan, 1999

Advanced Exercise InstructorExercise for the Older PersonNVQ3

Advanced Exercise InstructorExercise ReferralNVQ4

Specialist Exercise InstructorPostural StabilityNVQ4

Specialist Exercise InstructorClinical Exercise MSc

General PopulationsGeneral Populations

Special PopulationsSpecial Populations

Low RiskLow Risk

Patient Patient

PopulationsPopulations

Medium RiskMedium Risk

HighRisk

THE EXERCISE REGISTER UK

Specialist PSI Exercise Module

While I have been talking…..

• 4 older people will have been seriously injured...

• 6 older people will have had a minor injury..

…..as a result of a fall at home

Specialist PSI Exercise Module

While we are here today...

• 900 older people will have had a minor injury..

• 122 older people will have been seriously injured..

• 33 older people will never return home…

….as a result of a fall at home

Specialist PSI Exercise Module

A Four Point Plan to:

Improve Balance and co-ordination

Increase Functional Capacity

Increase Bone and Muscle Mass

Increase Confidence (reduce fear of falling)

Includes:

7 Evidence Based Activities

FaME into practice

Specialist PSI Exercise Module

1. Dynamic endurance training for balance

Specialist PSI Exercise Module

2. Dynamic balance training

Specialist PSI Exercise Module

Specialist PSI Exercise Module

3. Targeted resistance training (weights, bands and body weight) including targeted bone loading

-  for leg and ankle strength

-  for arm and back

-  open & closed chain

Specialist PSI Exercise Module

4. Backward chaining

Specialist PSI Exercise Module

5. Functional floor activities

Specialist PSI Exercise Module

6. Flexibility training for leg and ankle, chest, spine

Specialist PSI Exercise Module

7. Sustained, three dimensional adapted Tai Chi training