Balance and Fall Prevention in Older Adults

Question 1

Balance Feedback Control

Answer 1

Sensory input to central processing to Motor Output

Question 2

Feedforward Control of balance is:

Answer 2

Central processing to
APA motor output to
Motor output with ongoing sensory feedback

Question 3

APA motor ouput aka

Answer 3

anticipatory postural adjusments via stabilizer muscles

Question 4

central processing is the

Answer 4

thinking about doing a task

Question 5

3 main ways we get sensory info about positioning

Answer 5

1. Vestibular
2. Vision
3. Somatosenosry

Question 6

info about position from mvmt of head with respect to gravity and inertial forces

Answer 6

vestibular input

Question 7

what changes about vestibular input with age?

Answer 7

decrease in DVA (dynamic visual acuity)

Question 8

info about position and motion of head with respect to surrounding objects

Answer 8

vision input

Question 9

info about position and motion of body with reference to supporting surface, relationship of body seg to each other

Answer 9

somatosensory

Question 10

cerebellums role in central processing

Answer 10

integrates and compares sensory input and motor ouput and adapting response as needed

Question 11

4 key factors CNS does for balance

Answer 11

1. scan for cues
2. anticipate
3. focus +/- switch attention (dual task)

Question 12

motor output components

Answer 12

1. Joint ROM
2. Muscle strength/for of muscle force
3. latency of muscle firing
4. timing of antag/agonist muscle
5. grading of muscle response
6. power

Question 13

who might have problems with motor output

Answer 13

arthritis, parkinsons, MS, neuromuscular issue, frail

Question 14

what is a task?

Answer 14

CNS organiszes around the mvmt goal

Question 15

3 task requirements

Answer 15

speed
accuracy
force

Question 16

crosswalks are ex of..

Answer 16

external pacing

Question 17

dependence, loss of autonomy, depression, decreased confidence in ambulation, fam anxiety about injury, limits moblitiy

all s/s of..

Answer 17

post fall syndrome

Question 18

Fear of falling predictors (3)

Answer 18

1. cognitive impairment
2. decreased social activity
3. poorer physical function

Question 19

ex of intrinsic fall risk factors

Answer 19

1. hx fall
2. sensory loss
3. decreased ROM/Strength/rxn time
4. mobility prob
5. depression
6. incontinence
7. decreased cognition
8. chronic health conditions
9. meds

Question 20

decreased cognition defined as

Answer 20

score of MMSE under 26 = moderate to sever high risk of serious fall related injuries

Question 21

polypharmacy when there are _- more drugs

Answer 21

4+

Question 22

psychotropic drugs

Answer 22

act directly on CNS

Question 23

psychotropic drug ex

Answer 23

antidepressants
anxiolytics/hypnotics (BZD)
Dementia meds

Question 24

taking psychotropic meds increases fall risk by ___

Answer 24

47%

Question 25

t/f increased incidence of recurrent falls in older people with DM

Answer 25

true

Question 26

pts with DM PN have __ risk for falls

Answer 26

20X higher fall risk than others their age

Question 27

5 factors from DM that increase fall risk

Answer 27

1. decreased ankle muscle strength 2. decreased ankle ROM 3. increase foot and body pain 4. Polypharmacy / psychotrophic meds 5. Symptomatic hypoglycemia

Question 28

__ doubles risk for hip fracture

Answer 28

stroke doubles risk for hip fractures

Question 29

ex of extrinsic fall RF

Answer 29

``` poor lighting objects on floor unstable furniture low furniture or toilets improper footwear assistive device ```

Question 30

low fall risk adults..

Answer 30

refer to community exercise and fall prevention programs

Question 31

when screen old ppl for falls?

Answer 31

1. after age 65 screen each yr 2. after hospitalizations, transfer of care, high rate of falls 3. observation of walking or balance using timed up and go or other balance / gait measures

Question 32

what 3 questions count for fall screen?

Answer 32

fall in past yr? difficulty walking or balance? observe with timed get up and go

Question 33

CDC STEADI test includes

Answer 33

basic fall info case studies standardized gait / balance tests and educational handouts

Question 34

score from stay independent brochure that indicates fall risk

Answer 34

score over 4

Question 35

timed get up and go over 12 sec

Answer 35

high fall risk

Question 36

t/f pacemaker reduced rate of falls in ppl with carotid sinus hypersensitivity

Answer 36

true

Question 37

exercise programs targets 2+ of what..?

Answer 37

strength, balance, flexibility or endurance

Question 38

exercise recommendations

Answer 38

50+ hours total, 2 times per week for 6 mo minimum = high total dose

Question 39

Otago balance Program

Answer 39

home based: strength + balance + walking | sit to stand, stair walking, sitting exercises etc.