Balance an Falls Flashcards
Fall – Operational Definition
Unintentional loss of balance that leads to failure of postural stability”
Unexpected change in position which usually results in landing on the floor
Fall WHO definition:
Event which results in a person coming to rest inadvertently on the ground or floor or other lower level surface
How many fall deaths annually?
27,000
Fall Risk Assessment Recommendations
Use of structured note template
Recommend home safety evaluations
Increase attention to high risk medications
Use STEADI materials
Increase public health messaging about falls and preventability
To prevent falls, providers should focus first on these modifiable risk factors;
lower body weakness difficulties with gait and balance use of psychoactive medications postural dizziness poor vision problems with feet/shoes home hazards
Wellness
Generally described as multifaceted, and as a process or outcome which maximizes potential and health
Domains of Wellness
Physical
Psychological
Social
Physical Wellness
Multiple factors involved (p 447)
PTs can most affect nutrition and exercise
Nutrition
Remember that low BMI correlated with increased mortality in elderly
APTA position on nutrition:
the role of the physical therapist to screen for and provide information on diet and nutritional issues to patients, clients, and the community within the scope of physical therapist practice
What is used clinically to assess nutrition?
Mini Nutritional Assessment
Benefits of exercise:
Reduce bone density loss (if WB)
Counteract loss of lean muscle mass/strength loss
Improve flexibility
Improve body composition
Health priorities for wellness:
Active living
Injury prevention
Secondary prevention in chronic disease and disability management
Psychological wellness includes:
emotional
spiritual
intellectual
Emotional wellness:
sense of well-being, ability to cope with ups and downs
Spiritual wellness:
provides meaning and connects oneself to something greater
Intellectual wellness:
ability to learn, self-efficacy
Social wellness:
meaningful relationships and presence of a social support structure
Occupational/Vocational wellness:
purpose in life, reason to get up in the morning
Types of Programs
Balance/fall prevention
Strength training
Aerobic training
Walking/mobility activities
Who are senior athletes?
Former competitive athletes
Lifelong athletes, “sports people”
Nonathletes that start exercising later in life (after 40)
Young-old
65-74 years
Old
75-84 years
Old-old
85-99
Body system changes
MSK
Cardiopulm
Bone/joint changes
Deterioration of joint surfaces
Breakdown of collagen fibers
Decrease in viscosity of synovial fluid
= loss of flexibility and increase in joint stiffness
Who demonstrate decreasing bone density?
master’s cyclists and swimmer
Who is normal bone loss not seen in?
those with vigorous WB activities
Muscular system changes:
Decrease in size, number and type of muscle fibers, especially type II
What is the change in percentage type I from?
to relative increase in endurance and decrease in force production/power, especially in women, especially in UE
How can sarcopenia be prevented?
Resistance training
PRT
General weight loss:
General strength loss 1-3% per year,
Macrotrauma
Fewer collision injuries
More likely to avulse muscle/bone than strain muscle or rupture ligament
Time needed for recovery can be devastating to senior athlete
Microtrauma
Elderly more susceptible due to:
Stiffer collagen
Arthritic changes in WB joints
Lower muscle mass/shock absorption
Tendinopathy
Elderly more at risk due to changes in collagen
Consider role of eccentric strengthening with tendinopathy
Cardiopulmonary
Predictable decline with increasing age, less in the physically active.
Modest declines until 60-70 years and then rapid decline in VO2 max.
Physical activity can slow the decline, cutting it in half.
Trained subjects perform better than sedentary at all ages (
Functional nonpainful (FN):
unlimited and unrestricted movement, painfree
Functional painful (FP):
unlimited and unrestricted movement that reproduces symptoms or brings on secondary symptoms
Dysfunctional nonpainful (DN):
restricted movement, lack of mobility or stability, painfree
Dysfunctional painful (DP
restricted movement, lack of mobility or stability, reproduces symptoms or brings on secondary symptoms
SFMA Lab
Toe touch
Overhead reach
Total body rotation
Single limb stance (eyes open and closed)
Overhead deep squat
Back scratch/back patting
Clearing tests(impingement and horizontal adduction)
Cervical (flexion/extension, combined flexion/SB/rotation)
Evidence for SFMA?
Poor inter-rater reliability
Fair to good intra-rater reliability with experience
Case study indicating use in treating patient with LBP
Robust evidence lacking whether use of movement screens superior to usual clinical exam
Opinion blog: abandon all movement screens?
Injury prevention
Laureson:
favorable outcomes for all prevention techniques except for stretching
Injury prevention Bizzini and Dvorak:
FIFA 11 plus warm-up confers 40-50% reduction in non-contact injuries among young soccer players when performed 2x/week
Injury prevention Caveat:
most evidence from NON-ELDERLY athletes
Fifa 11 plus
Evidence that it reduces risk of injury in young athletic population
Similar to evidence in favor of active warm-up and plyometric components
Unclear if results can be generalized to elderly population
