Balance and Fall Prevention in Older Adults Flashcards
Balance Feedback Control
Sensory input to central processing to Motor Output
Feedforward Control of balance is:
Central processing to
APA motor output to
Motor output with ongoing sensory feedback
APA motor ouput aka
anticipatory postural adjusments via stabilizer muscles
central processing is the
thinking about doing a task
3 main ways we get sensory info about positioning
- Vestibular
- Vision
- Somatosenosry
info about position from mvmt of head with respect to gravity and inertial forces
vestibular input
what changes about vestibular input with age?
decrease in DVA (dynamic visual acuity)
info about position and motion of head with respect to surrounding objects
vision input
info about position and motion of body with reference to supporting surface, relationship of body seg to each other
somatosensory
cerebellums role in central processing
integrates and compares sensory input and motor ouput and adapting response as needed
4 key factors CNS does for balance
- scan for cues
- anticipate
- focus +/- switch attention (dual task)
motor output components
- Joint ROM
- Muscle strength/for of muscle force
- latency of muscle firing
- timing of antag/agonist muscle
- grading of muscle response
- power
who might have problems with motor output
arthritis, parkinsons, MS, neuromuscular issue, frail
what is a task?
CNS organiszes around the mvmt goal
3 task requirements
speed
accuracy
force
crosswalks are ex of..
external pacing
dependence, loss of autonomy, depression, decreased confidence in ambulation, fam anxiety about injury, limits moblitiy
all s/s of..
post fall syndrome
Fear of falling predictors (3)
- cognitive impairment
- decreased social activity
- poorer physical function
ex of intrinsic fall risk factors
- hx fall
- sensory loss
- decreased ROM/Strength/rxn time
- mobility prob
- depression
- incontinence
- decreased cognition
- chronic health conditions
- meds
decreased cognition defined as
score of MMSE under 26 = moderate to sever high risk of serious fall related injuries
polypharmacy when there are _- more drugs
4+
psychotropic drugs
act directly on CNS
psychotropic drug ex
antidepressants
anxiolytics/hypnotics (BZD)
Dementia meds
taking psychotropic meds increases fall risk by ___
47%
t/f increased incidence of recurrent falls in older people with DM
true
pts with DM PN have __ risk for falls
20X higher fall risk than others their age
5 factors from DM that increase fall risk
- decreased ankle muscle strength
- decreased ankle ROM
- increase foot and body pain
- Polypharmacy / psychotrophic meds
- Symptomatic hypoglycemia
__ doubles risk for hip fracture
stroke doubles risk for hip fractures
ex of extrinsic fall RF
poor lighting objects on floor unstable furniture low furniture or toilets improper footwear assistive device
low fall risk adults..
refer to community exercise and fall prevention programs
when screen old ppl for falls?
- after age 65 screen each yr
- after hospitalizations, transfer of care, high rate of falls
- observation of walking or balance using timed up and go or other balance / gait measures
what 3 questions count for fall screen?
fall in past yr?
difficulty walking or balance?
observe with timed get up and go
CDC STEADI test includes
basic fall info
case studies
standardized gait / balance tests
and educational handouts
score from stay independent brochure that indicates fall risk
score over 4
timed get up and go over 12 sec
high fall risk
t/f pacemaker reduced rate of falls in ppl with carotid sinus hypersensitivity
true
exercise programs targets 2+ of what..?
strength, balance, flexibility or endurance
exercise recommendations
50+ hours total, 2 times per week for 6 mo minimum
= high total dose
Otago balance Program
home based: strength + balance + walking
sit to stand, stair walking, sitting exercises etc.
