Balance and Falls Flashcards
what are the 6 systems which contribute to postural control and balance
biomechanical constraints
limits of stability
anticipatory postural adjustments
reactive postural responses
sensory orientation
stability in gait
what are biomechanical constraints that kinda occur simultaneously as we age
postural adaptations
soft tissue restrictions
soft tissue stretch weakness
why does posture change as we age
lose water –> dec intervertebral spaces
what are postural adaptations seen as we age
forward head posture
inc kyphosis
dec lumbar lordosis / flattened spine
scap protraction/ABD
flexors dominate
- hips, knees, elbows, wrists
what are soft tissue restriction and stretch weakness seen as we age
scap retraction/ADD
glut max
trunk extensors
glut med
DFs
how do biomechanical constraints seen w aging impact balance
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
what happens to our anticipatory postural adjustments as we age
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
how does altered anticipatory postural adjustments with age impact balance
feedforward mechanism is impaired
- altered verticality
- destabilization occurs w inability to properly respond
what happens to our reactive postural responses as we age
sequencing and timing of ms contraction changes
- there is a delay in ms latency and inc co-contraction in antagonistic ms groups
how does changes in reactive postural responses d/t aging impact balance
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
what are normal sensory contributions to maintain equilibrium on a firm surface
70 somatosensory
20 vestib
10 vision
how does vision as a sensory contribution change w aging
dec visual acuity
dec contrast sensitivity
how does somatosensory as a sensory contribution change w aging
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
how does vestibular as a sensory contribution change w aging
loss of hair cells
vestib neurons physiologic changes in VSR and VOR
degen changes in otoconia
what sensory contribution can we rely on the most when we age
vestibular
what happens to our limits of stability as we age and why
dec ms strength
+ postural changes
+ dec ROM
= typical cone of stability altered
dec in eccentric ms control
poorly functioning mechanoreceptors and impaired somatosensation
how does changes in limits of stability d/t aging impact balance
will sway more and sway faster d/t suboptimal corrective torques and over shooting postural responses
= loss of balance
why do we see a change in stability in gait as we age
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
what are common sensory changes as we age that impact stability in gait
dec ability of visual and auditory
dec input from somatosen, proprioceptive, and vestib systems
what are common motor changes as we age that impact stability in gait
dec motor neuron conduction velocity
dec in # of motor fibers
periarticular connective tissue stiffness
how does limitations in ROM and ms strength d/t aging impact stability in gait
slowed reaction time
motor control deficits
what are typical gait changes seen in older adults (8)
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
what is our sixth vital sign and why is it important
gait speed
particularly important in elderly
drives a lot of PT decisions
what has been found on distance requirements for functional amb
lot of ambiguity
>150ft has been found
what is a limitation of short distance gait speed test
may not generalize well to community
how might (I) ambulation demands vary in city vs rural areas
in city will require walking faster and further than in more rural areas
what are additional factors to consider about ambulation in community (7)
depends on task and environmental demands
variation in speed
distance
terrain
obstacle clearance/avoidance
dual or multi tasking
what is a somatosensory health related factor which impacts balance
diabetes
what is a CNS related factor which impacts balance
neurological impairments
- can impact already slowing CNS
what is a vision related factor which impacts balance
age related eye dz
what is a vestibular related factor which impacts balance
vestibular pathology
what are biomechancial related factors which impact balance
stenosis
osteopenia
osteoporosis
joint replacement
what is the definition of a fall
unintentional LOB that leads to failure of postural stability
sudden and unexpected change in position which usually results in landing on the floor
how are recurrent fallers defined
> /= 2 falls in 6 or 12 months
what are 9 risk factors for falling
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
what chronic conditions can inc risk of falling
parkinsons
dementia
stroke
incontinence
diabetes
arthritis
how would a fear of fall inc the risk of falling
if someone is overly cautious and concerned
- may end up w recruitment strategies that are less effective
what side effects of meds could inc risk of falls
dizziness
lethargy
orthostasis
what types of meds inc risk of falls
benzos
antidepressants
antipsych
anti-HTN
anticonvulsants
diuretics - orthostasis
what is the most common bacterial infection seen in older adults
UTIs
who is at inc risk of UTIs
women - shorter urethra
older women - risk for recurrent UTIs d/t changes in vaginal flora secondary to estrogen depletion
frailty
what is an atypical presentation of UTIs and why
confusion
delirium
falls
colonized bacteria travels thru bloodstream and crosses BBB
what can happen if UTIs aren’t treated promptly
sepsis
how can UTIs lead to falls
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
what is key for preventing hospital admission from UTIs
early recognition and treatment
what is frailty
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
what is physical frailty characterized by (5)
fatigue
involuntary wt loss
dec gait speed
dec grip strength
lack of physical activity
what health conditions is physical frailty associated with (3)
osteoporosis
osteopenia
sarcopenia
who is physical frailty prevalent in earlier
women d/t hormonal changes
what is the concern with physical frailty
linked to falls and fall risk
what is cognitive frailty
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
why is there an inc fall risk with cognitive frailty
greater need to recruit prefrontal circuits for tasks
-> resulting in challenges that override ability
what is the result of slowing reflexes and reaction time
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
what are 5 questions you can ask to get a sense of fall risk
fall hx
ADL difficulty
use of AD
concern ab falling
use of psychoactive meds
what score on the geriatric depression scale indicates an inc fall risk
<6
what score on the falls efficacy scale indicates an inc fall risk
> 24
what score on the berg balance scale indicates an inc fall risk
<50
what score on the TUG indicates an inc fall risk
> 12sec
what score for single limb stance time may indicate an inc fall risk (pending more in-depth eval)
<6.5sec
what score on the 5x STS indicates an inc fall risk
> 12sec
what score on the self-selected walking speed may indicate an inc fall risk (pending more in-depth eval)
<1 m/s
if person doesn’t know why they fell what might this tell us
their anticipatory postural adjustments aren’t integrating info the way it has in the past
if a person said they blacked out or lost consciousness w the fall what might this tell us
vascular cause
what are 6 possible explanations for a person to experience an episode of dizziness that led to a fall
anemia
hypotension
GI bleed
middle ear infection
seizure
drug toxicity
what are 2 possible explanations for a person to experience vertigo leading to a fall
labyrinthine dz
drug toxicity
what is a reason a person might be febrile leading to a fall
UTI
what is the key to safe mobility w an AD
proper adjustment and maintenance
