Balance and Falls

Question 1

what are the 6 systems which contribute to postural control and balance

Answer 1

biomechanical constraints
limits of stability
anticipatory postural adjustments
reactive postural responses
sensory orientation
stability in gait

Question 2

what are biomechanical constraints that kinda occur simultaneously as we age

Answer 2

postural adaptations
soft tissue restrictions
soft tissue stretch weakness

Question 3

why does posture change as we age

Answer 3

lose water –> dec intervertebral spaces

Question 4

what are postural adaptations seen as we age

Answer 4

forward head posture
inc kyphosis
dec lumbar lordosis / flattened spine
scap protraction/ABD
flexors dominate
- hips, knees, elbows, wrists

Question 5

what are soft tissue restriction and stretch weakness seen as we age

Answer 5

scap retraction/ADD
glut max
trunk extensors
glut med
DFs

Question 6

how do biomechanical constraints seen w aging impact balance

Answer 6

disruption of plumb line –> harder to readjust COP under COM

postural malalignment places inc demands on ms that is working at mechanical disadvantage d/t stretch weakness or tissue restriction
- lose ability of nice co-contraction of flex and ext ms groups

Question 7

what happens to our anticipatory postural adjustments as we age

Answer 7

dec ability of CNS to integrate info regarding body position, mvmt in space, and force generation (from cerebellum)

dec ability to process proprioceptive signals influences postural adjustments needed to initiate mvmt

Question 8

how does altered anticipatory postural adjustments with age impact balance

Answer 8

feedforward mechanism is impaired
- altered verticality
- destabilization occurs w inability to properly respond

Question 9

what happens to our reactive postural responses as we age

Answer 9

sequencing and timing of ms contraction changes
- there is a delay in ms latency and inc co-contraction in antagonistic ms groups

Question 10

how does changes in reactive postural responses d/t aging impact balance

Answer 10

harder time catching themselves w unexpected perturbation

• can’t activate ankle, hip, and stepping strategies effectively - maybe something that was once an ankle strategy is now hip
• when stepping strategy activated, multiple steps required to restore balance - multiple steps bc ability to take one large step dec w age

Question 11

what are normal sensory contributions to maintain equilibrium on a firm surface

Answer 11

70 somatosensory
20 vestib
10 vision

Question 12

how does vision as a sensory contribution change w aging

Answer 12

dec visual acuity
dec contrast sensitivity

Question 13

how does somatosensory as a sensory contribution change w aging

Answer 13

dec in 2 point discrimination, proprioception, and vibration sense

substantial losses in vibration sense has been found in >75yo
- this is why testing vibration to extinction is important in this pop

Question 14

how does vestibular as a sensory contribution change w aging

Answer 14

loss of hair cells
vestib neurons physiologic changes in VSR and VOR
degen changes in otoconia

Question 15

what sensory contribution can we rely on the most when we age

Answer 15

vestibular

Question 16

what happens to our limits of stability as we age and why

Answer 16

dec ms strength
+ postural changes
+ dec ROM
= typical cone of stability altered

dec in eccentric ms control

poorly functioning mechanoreceptors and impaired somatosensation

Question 17

how does changes in limits of stability d/t aging impact balance

Answer 17

will sway more and sway faster d/t suboptimal corrective torques and over shooting postural responses

= loss of balance

Question 18

why do we see a change in stability in gait as we age

Answer 18

multiple changes in sensory, motor, and CNS functioning can bring about predictable changes in gait performance

inaccurate appraisal of environmental demands

erroneous self- assessment of position and/or mvmt

Question 19

what are common sensory changes as we age that impact stability in gait

Answer 19

dec ability of visual and auditory
dec input from somatosen, proprioceptive, and vestib systems

Question 20

what are common motor changes as we age that impact stability in gait

Answer 20

dec motor neuron conduction velocity
dec in # of motor fibers
periarticular connective tissue stiffness

Question 21

how does limitations in ROM and ms strength d/t aging impact stability in gait

Answer 21

slowed reaction time
motor control deficits

Question 22

what are typical gait changes seen in older adults (8)

Answer 22

dec self-selected gait speed
dec step and stride length
inc stance and DL support time
inc step width (not universal finding)
inc variability of gait (step/stride time, length, width)
dec excursion of mvmt at LE jts
dec reliance on ankle kinematics/power
less upright posture

Question 23

what is our sixth vital sign and why is it important

Answer 23

gait speed

particularly important in elderly
drives a lot of PT decisions

Question 24

what has been found on distance requirements for functional amb

Answer 24

lot of ambiguity
>150ft has been found

Question 25

what is a limitation of short distance gait speed test

Answer 25

may not generalize well to community

Question 26

how might (I) ambulation demands vary in city vs rural areas

Answer 26

in city will require walking faster and further than in more rural areas

Question 27

what are additional factors to consider about ambulation in community (7)

Answer 27

depends on task and environmental demands variation in speed distance terrain obstacle clearance/avoidance dual or multi tasking

Question 28

what is a somatosensory health related factor which impacts balance

Answer 28

diabetes

Question 29

what is a CNS related factor which impacts balance

Answer 29

neurological impairments - can impact already slowing CNS

Question 30

what is a vision related factor which impacts balance

Answer 30

age related eye dz

Question 31

what is a vestibular related factor which impacts balance

Answer 31

vestibular pathology

Question 32

what are biomechancial related factors which impact balance

Answer 32

stenosis osteopenia osteoporosis joint replacement

Question 33

what is the definition of a fall

Answer 33

unintentional LOB that leads to failure of postural stability sudden and unexpected change in position which usually results in landing on the floor

Question 34

how are recurrent fallers defined

Answer 34

>/= 2 falls in 6 or 12 months

Question 35

what are 9 risk factors for falling

Answer 35

advanced age hx of falls (esp in past 6mo) ms weakness gait/balance deficits >/= 4 meds visual deficits postural hypotension chronic conditions fear of falling

Question 36

what chronic conditions can inc risk of falling

Answer 36

parkinsons dementia stroke incontinence diabetes arthritis

Question 37

how would a fear of fall inc the risk of falling

Answer 37

if someone is overly cautious and concerned - may end up w recruitment strategies that are less effective

Question 38

what side effects of meds could inc risk of falls

Answer 38

dizziness lethargy orthostasis

Question 39

what types of meds inc risk of falls

Answer 39

benzos antidepressants antipsych anti-HTN anticonvulsants diuretics - orthostasis

Question 40

what is the most common bacterial infection seen in older adults

Answer 40

UTIs

Question 41

who is at inc risk of UTIs

Answer 41

women - shorter urethra older women - risk for recurrent UTIs d/t changes in vaginal flora secondary to estrogen depletion frailty

Question 42

what is an atypical presentation of UTIs and why

Answer 42

confusion delirium falls colonized bacteria travels thru bloodstream and crosses BBB

Question 43

what can happen if UTIs aren't treated promptly

Answer 43

sepsis

Question 44

how can UTIs lead to falls

Answer 44

sx may force alterations of normal physical routine such as getting up frequently and quickly to urinate prolonged infection can dec BP which leads to dizziness and fall

Question 45

what is key for preventing hospital admission from UTIs

Answer 45

early recognition and treatment

Question 46

what is frailty

Answer 46

inability to maintain or recover homeostasis after destabilizing incident (ie surgery, infection) - can't return to baseline - dec physio reserve leading to altered physical functioning

Question 47

what is physical frailty characterized by (5)

Answer 47

fatigue involuntary wt loss dec gait speed dec grip strength lack of physical activity

Question 48

what health conditions is physical frailty associated with (3)

Answer 48

osteoporosis osteopenia sarcopenia

Question 49

who is physical frailty prevalent in earlier

Answer 49

women d/t hormonal changes

Question 50

what is the concern with physical frailty

Answer 50

linked to falls and fall risk

Question 51

what is cognitive frailty

Answer 51

dec in cog reserve associated w development of physical frailty as age, CNS slows down and have to tap into cortex to walk and talk at same time - when younger, walking system is semi-automatic

Question 52

why is there an inc fall risk with cognitive frailty

Answer 52

greater need to recruit prefrontal circuits for tasks -> resulting in challenges that override ability

Question 53

what is the result of slowing reflexes and reaction time

Answer 53

inc burden of injury with falling as difficulty breaking fall w hand/arm - prox fx of humerus - facial bone fx - inc level of injury - head traumas

Question 54

what are 5 questions you can ask to get a sense of fall risk

Answer 54

fall hx ADL difficulty use of AD concern ab falling use of psychoactive meds

Question 55

what score on the geriatric depression scale indicates an inc fall risk

Answer 55

<6

Question 56

what score on the falls efficacy scale indicates an inc fall risk

Answer 56

>24

Question 57

what score on the berg balance scale indicates an inc fall risk

Answer 57

<50

Question 58

what score on the TUG indicates an inc fall risk

Answer 58

>12sec

Question 59

what score for single limb stance time may indicate an inc fall risk (pending more in-depth eval)

Answer 59

<6.5sec

Question 60

what score on the 5x STS indicates an inc fall risk

Answer 60

>12sec

Question 61

what score on the self-selected walking speed may indicate an inc fall risk (pending more in-depth eval)

Answer 61

<1 m/s

Question 62

if person doesn't know why they fell what might this tell us

Answer 62

their anticipatory postural adjustments aren't integrating info the way it has in the past

Question 63

if a person said they blacked out or lost consciousness w the fall what might this tell us

Answer 63

vascular cause

Question 64

what are 6 possible explanations for a person to experience an episode of dizziness that led to a fall

Answer 64

anemia hypotension GI bleed middle ear infection seizure drug toxicity

Question 65

what are 2 possible explanations for a person to experience vertigo leading to a fall

Answer 65

labyrinthine dz drug toxicity

Question 66

what is a reason a person might be febrile leading to a fall

Answer 66

UTI

Question 67

what is the key to safe mobility w an AD

Answer 67

proper adjustment and maintenance