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Lifespan > Balance and Falls > Flashcards

Balance and Falls Flashcards

1
Q

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

A

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

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2
Q

what are biomechanical constraints that kinda occur simultaneously as we age

A

postural adaptations
soft tissue restrictions
soft tissue stretch weakness

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3
Q

why does posture change as we age

A

lose water –> dec intervertebral spaces

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4
Q

what are postural adaptations seen as we age

A

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

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5
Q

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

A

scap retraction/ADD
glut max
trunk extensors
glut med
DFs

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6
Q

how do biomechanical constraints seen w aging impact balance

A

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

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7
Q

what happens to our anticipatory postural adjustments as we age

A

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

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8
Q

how does altered anticipatory postural adjustments with age impact balance

A

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

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9
Q

what happens to our reactive postural responses as we age

A

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

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10
Q

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

A

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
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11
Q

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

A

70 somatosensory
20 vestib
10 vision

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12
Q

how does vision as a sensory contribution change w aging

A

dec visual acuity
dec contrast sensitivity

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13
Q

how does somatosensory as a sensory contribution change w aging

A

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

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14
Q

how does vestibular as a sensory contribution change w aging

A

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

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15
Q

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

A

vestibular

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16
Q

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

A

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

dec in eccentric ms control

poorly functioning mechanoreceptors and impaired somatosensation

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17
Q

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

A

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

= loss of balance

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18
Q

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

A

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

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19
Q

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

A

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

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20
Q

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

A

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

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21
Q

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

A

slowed reaction time
motor control deficits

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22
Q

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

A

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

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23
Q

what is our sixth vital sign and why is it important

A

gait speed

particularly important in elderly
drives a lot of PT decisions

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24
Q

what has been found on distance requirements for functional amb

A

lot of ambiguity
>150ft has been found

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25
Q

what is a limitation of short distance gait speed test

A

may not generalize well to community

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26
Q

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

A

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

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27
Q

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

A

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

28
Q

what is a somatosensory health related factor which impacts balance

A

diabetes

29
Q

what is a CNS related factor which impacts balance

A

neurological impairments
- can impact already slowing CNS

30
Q

what is a vision related factor which impacts balance

A

age related eye dz

31
Q

what is a vestibular related factor which impacts balance

A

vestibular pathology

32
Q

what are biomechancial related factors which impact balance

A

stenosis
osteopenia
osteoporosis
joint replacement

33
Q

what is the definition of a fall

A

unintentional LOB that leads to failure of postural stability

sudden and unexpected change in position which usually results in landing on the floor

34
Q

how are recurrent fallers defined

A

> /= 2 falls in 6 or 12 months

35
Q

what are 9 risk factors for falling

A

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

36
Q

what chronic conditions can inc risk of falling

A

parkinsons
dementia
stroke
incontinence
diabetes
arthritis

37
Q

how would a fear of fall inc the risk of falling

A

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

38
Q

what side effects of meds could inc risk of falls

A

dizziness
lethargy
orthostasis

39
Q

what types of meds inc risk of falls

A

benzos
antidepressants
antipsych
anti-HTN
anticonvulsants
diuretics - orthostasis

40
Q

what is the most common bacterial infection seen in older adults

A

UTIs

41
Q

who is at inc risk of UTIs

A

women - shorter urethra

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

frailty

42
Q

what is an atypical presentation of UTIs and why

A

confusion
delirium
falls

colonized bacteria travels thru bloodstream and crosses BBB

43
Q

what can happen if UTIs aren’t treated promptly

A

sepsis

44
Q

how can UTIs lead to falls

A

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

45
Q

what is key for preventing hospital admission from UTIs

A

early recognition and treatment

46
Q

what is frailty

A

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

47
Q

what is physical frailty characterized by (5)

A

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

48
Q

what health conditions is physical frailty associated with (3)

A

osteoporosis
osteopenia
sarcopenia

49
Q

who is physical frailty prevalent in earlier

A

women d/t hormonal changes

50
Q

what is the concern with physical frailty

A

linked to falls and fall risk

51
Q

what is cognitive frailty

A

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

52
Q

why is there an inc fall risk with cognitive frailty

A

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

53
Q

what is the result of slowing reflexes and reaction time

A

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
54
Q

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

A

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

55
Q

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

A

<6

56
Q

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

A

> 24

57
Q

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

A

<50

58
Q

what score on the TUG indicates an inc fall risk

A

> 12sec

59
Q

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

A

<6.5sec

60
Q

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

A

> 12sec

61
Q

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

A

<1 m/s

62
Q

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

A

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

63
Q

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

A

vascular cause

64
Q

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

A

anemia
hypotension
GI bleed
middle ear infection
seizure
drug toxicity

65
Q

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

A

labyrinthine dz
drug toxicity

66
Q

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

A

UTI

67
Q

what is the key to safe mobility w an AD

A

proper adjustment and maintenance

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