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older adults falls > balance and fall > Flashcards

balance and fall Flashcards

1
Q

common risk factors for falls

A

impaired balance, gait, weakness
multiple medications (FRIDS)
vision
environemental hazards
postural/orthostatic hypotension
feet/footwear
(listed in order of importance)

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1
Q

highest risk meds

A

psycotropic meds
- sedatives.hypnotics
- anti-psychotics
- anti-depressants
- narcotics

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2
Q

how to balance needs of falls prevention for impatient environment

A

mitigation strategies include fall prevention plans, safe handling strategies, and early mobility

unintended consequence - increased zero fall environment, culture of mobility decreases

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3
Q

why over implemention of fall prevention strategies be an issue

A

multisystem organ involvement, susceptibility to infection/disease, immobility, deconditioning, functional decline

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4
Q

LOW RISK individualized fall interventions

A

educate patient
vitamin D +/- calcium
refer for strength and balance exercise (community exercise or fall prevention program)

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5
Q

LOW RISK for falls - STEADI

A

patient scores >/= 4 on the stay independent brochur

evaluate gait, strength, and balance
TUG - recommended

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6
Q

MODERATE RISK individualized fall interventions

A

educate patient
vitamin D +/- calcium
refer to PT to improve gait, strength, and balance
OR
refer to a community fall prevention program

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7
Q

HIGH RISK individualized fall interventions

A

educate patient
vitamin D +/- calcium
refer to PT to enhance functional mobility and improve strength and balance
manage and monitor hypotension
manage medications
address foot problems
optimize vision
optimize home safety
FOLLOW UP WITHIN 30 DAYS
- review care plan
- assess and encourage fall risk reduction behaviors
- discuss and address barriers to adherence

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8
Q

physical screening for fall risk
CDC STEADI Recommendations

A

30 seconds chair stand test
4 stage balance trst
TUG
Orthostatic hypotension test

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9
Q

30 second chair stand test

A

biomechanical constraints/ MSK determinants (strength)

anticipatory postural adjustments/postural movement strategies

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10
Q

4 stage balance test

A

biomechanical constraints/ MSK determinants (BOS)

anticipatory postural adjustments/postural movement strategies

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11
Q

timed up and go

A

anticipatory postural adjustments/postural movement strategies (STS)

stability in gait
observation of walk and turn

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12
Q

screening guidelines

A

ask every patient over 65 and older about history of falls

have you fallen in the lasy year
- if yes - ask about frequency and circumstances
- if no - ask any difficulties w walking or balance or unsteadiness
- if no to both - no fall risk assessment unless other red flags
- if yes to either - multifactorial fall risk assessment need to be done to screen for balance or mobility deficits

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13
Q

6 systems of postural control

A

biomechanical, stability limits/verticality, anticipatory postural adjustments, reactive postural adjustments, sensory orientation, stability in gait

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14
Q

test and measures for biomechanical system

A

goniometry, manual muscle test, 5x sit to stand, 30 second chair stand

example: ROM, strength, posture

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15
Q

test and measures for stability limits/verticality

A

seated/standing psoture and perceived vertical, functional reach tset; part of BERG

examples- reaching, contraversion or ipsiversion pushin

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16
Q

test and measure for anticipatory postural adjustments

A

parts of Tinetti, Berg (sit to stand, stand on one foot, alternating toe tap), 5c sit to stand, miniBEST

example: step initiation, going up/down curbs/staits

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17
Q

test and measures reactive postural adjustments

A

parts of Tinetti (sternal bridge), retropulsion test (pull test), miniBEST

example; unexpected pertubations

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18
Q

test and measures sensory orientation

A

sensation testing, vision testing, mCTSIB (part of miniBEST), Berg/Tinetti components with eyes closed

example’ instability on compliant surfaces or with eyes closed

19
Q

test and measures stability in gait

A

DGI, FGA, TUG and TUG-cog, miniBEST

example gait instability with head turns, pbstacle negotiation

20
Q

miniBEST and BESTTest

A

miniBEST examines 4 areas (not biomechanical or stability limits)
BESTTest examines all 6 areas

21
Q

PT balance interventions

A

individually tailored multifactoral exercise program
strengthening/resistance exercise (avoid under dosing, primary focus of intervention for those at high risk of falls)
targeted balance challenges
ROM and flexibility exercise
endurance
home modifications

22
Q

Treatment

A

exercise must provide a moderate or high challenge to balance
balance exercise must be of a sufficient dose to have an affect - 50 HOURS
ongoing exercise is necessary
programs without walking were MORE effectice (38% reduction in falls compared to 21% with)
strength training may be included

23
Q

balance exercise prescription

A

must provide moderate to high challenge to balance
- standing w little to no UE support
- reducing BOS
- altering COG
must be progressive and ongoing
2-3HRS/WK FOR A MIN OF 12 WEEKS
can be group or home based
other guiding principles (multidimensional stepping>walking)

24
Q

assistive devices

A

as a SINGLE intervention, does not reduce the number of falls or fallers
- no adverse effects tho
- used as part of multifaceted intervention proves effect for fall reduction
increase base of support
provide tactile cues about ground
can provide support

25
Q

intervention recommendations from AGPT CPG

A

strength and balance (tai chi)
walking program (no sufficient evidence of reducing falls)
gait
ADL
Environmental and Home Hazards (after being hospitalized)
Footwear (low heel hight and high backs)

26
Q

summary

A

fall risk is a chronic condition and should be monitored on an ongoing basis

can be exaccerbated during a hospitalization

can be reduced by as much as 30% by applying a simple, evidence-based intervention

fall risk assessment is a multifactoral problem

no simple solution

all PTs should be screening older adults

a combo of medical, physical, and enviromental strategies is more effective than one

participating in various programs will help improve physical function, reduce fall risks, prevent falls

27
Q

In Horak’s Systems Framework for Postural Control, she discusses 6 systems that control
balance. Which of the following is an example of a Biomechanical Constraint?

A

limited ankle ROM

28
Q

In Horak’s Systems Framework for Postural Control, she discusses 6 systems that control
balance. Which of the following is an example of a problem in Sensory Orientation?

A

visual deficits

29
Q

Bending the knees during standing or ambulation for the purpose of maintaining a stable
position during a perturbation is an example of a(n)

A

suspensory strategy

30
Q

Which 2 core tasks provide insight into a patient’s steady state postural control?

A

sitting and standing

31
Q

The ability to generate postural adjustments prior to the onset of and during voluntary
movement” describes which control strategy for balance?

A

anticipatory postural control

32
Q

The appropriate use of an ankle, hip, or stepping strategy indicates adequate

A

postural responses/reactive control

33
Q

You ask a patient to stand on one leg and observe for appropriate weight shift prior to raising
the contralateral limb. This evaluate

A

anticipatory postural adjustments/control

34
Q

The purpose of the CDC’s STEADI program is to

A

screen older adults for fall risk

35
Q

outcome measures

A

BEST
Berg
Dual task - cognitive
Four square step test (FSST)
functional gait assessment
gait speed
sensory organization test (SOT)
TUG
TUG-COG

36
Q

Berg Balance Scale BBS interpretation

A

for non vestibular balance assessment. measures functional balance and fall risk in adults

0-20 = wheelchair user
21-40 walking w assistance
41-56 = independent

lower the score = greater fall risk

56=functional balance
<45 greater risk
<40 100% risk of fallinf

<51 and history of falls
<42 and no h/o falls

<47 and in nursing home = indicates patient is at risk of falls

37
Q

BBS

A

used to assess functional balance - static and dynamic

highly reliable and valid

used for lower performing community dwellers and lower functioning older adults

approx. 20 mins

38
Q

balance interventions - reactive postural control

A

ankle, hip, knee, stepping strategy
weight shifts
pertubations

39
Q

balance interventions - stability limits

A

reaching activities
functional activities

40
Q

balance interventions - anticipatory postural control

A

expected changes and learned experience
- functional activities
- dynamic activities

41
Q

balance interventions - sensory orientation

A

surface changes
functional activities
eyes open/closed

42
Q

falls efficacy scale - international

A

individuals are instructed to rate each activity on a four point scale depending on how concerned they are that they might fall or if they can actually perform the activity

1 = not at all concerned
2 = somewhat concered
3 - fairly concerned
4 - very concered

scores range 16-64

higher the score greater fear of falling

43
Q

activities - specific balance confidence scale

A

self reported measure in which patients rate their balance confidence for perfoming activities

rated on scale 0-100

score of 0 represents no confidence and 100 represents complete confidence

44
Q

minimental status exam

A

Mini-Mental Status Exam MMSE: * One of the most frequently used cognitive screenings
in older adults * < 5 minutes to administer * Quick screen to determine if there is
cognitive impairments * Does NOT provide information to cause of cognitive impairment
Scores: 0-30 with lower scores indicating poorer cognitive status, Folstein et al 1975:
overall scores of 23 and lower are indicative of cognitive impairment * 24-30 identify
individuals cognitively intact * 18-23 mild cognitive impairment * 0-17 severe cognitive
impairment

45
Q

montreal cognitive assessment - MoCA

A
  • 10 minute screen exam to assist in detection of MCI in
    multiple different conditions * Some stronger properties than MMSE in detecting MCI * Multiple
    languages Components * Attention and concentration * Executive function * Language *
    Conceptual thinking * Calculations * Orientation * Alternative trial making visuoconstructional
    skills: rectangle * Visuoconstructional skills clock * Naming memory attention * Sentence
    repetition * Verbal fluency * Abstraction * Delayed recall * Scoring: sum subscores listed on right
    hand side, add 1 point for fewer than 12 years education, 26/30 Norm Psychometrics:
    Nasserddina et al 2005: detects 90% subjects w/MCI, 100% sensitivity in Alzheimers, Smith et al
    2007: in pts already dx w/ MCI helps identify those at risk of developing dementia at 6 mos
46
Q
A

older adults falls (2 decks)

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