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movement systems 2 > fall and balance prevention > Flashcards

fall and balance prevention Flashcards

1
Q
A
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2
Q

what are the 6 systems for postural control?

A

bimechanical
stability limits/verticality
anticipatory postural adjustments
reactive postural adjustments
sensory orientation
stability in gait

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3
Q

what are the examples given for biomechanics postural system

A

ROM muscle testing and posture

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4
Q

what re the tests and measures for bimechanical systems of postural control?

A

goni, MMT, 30 second chair rise stand, 5x sit to stand

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5
Q

What is the example for stability limits and verticality?

A

reaching , pusher syndrome, ipsiversive pushing

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6
Q

what are the tests and measures given for stability limits and verticality?

A

Seated/standing posture and perceived vertical, Functional Reach Test; part of Berg

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7
Q

what are the examples for anticipatory postural adjustments

A

step initiation, going up / fdoej curbs and stairs

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8
Q

what are the tests for anticipatory postural adjustments

A

parts of Tinetti, Berg (sit to stand, stand on one foot, alternating toe tap), 5x sit to stand, miniBEST

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9
Q

what are the examples for reactive postural adjustments?

A

unexpected perturbations

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10
Q

what are the examples of the sensory orientation

A

instability on compliant surfaces or with eyes closed

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11
Q

want are the tests and measures connected to sensory orientation?

A

Sensation testing, vision testing, mCTSIB (part of miniBEST), Berg/Tinetti components with eyes closed

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12
Q

what are the examples of stability in gait

A

gait instability with head turns, obstacle negotiation

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13
Q

what are the tests and measures that are connected tp stability in gait?

A

DGI, FGA, TUG and TUG-cog, miniBEST

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14
Q

the BEST test examines what of the 6 systems for postural control

A

all 6

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15
Q

what does the miniBEST of the 6 systems for postural control

A

4 not including biomechanics or stability limits

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16
Q

what is the prevalence of falls in the United States and canada

A

22.1 % in the us
19.8% in canada

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17
Q

falls are associated with who

A

women white increasing in age health, and needing increased assistance with ADLS

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18
Q

what are the top comorbities with risk of falls

A

hypertension
arthritis
vision impairments
heart disease
diabetes
incontinence
COPD
Dmentia

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19
Q

what are the nonmodifiables of falls

A

history of falls
cognitive impairments
sex-female

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20
Q

what are the world health definition of a fall?

A

inenvertenantyly coming to rest on the ground, floor, or lower level excluding intentional changes in positions to rest on furniture, walls or other objects

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21
Q

what is the world healths definition of a near fall?

A

slip, trip, stumble, or loss of balance with recovery remaining upright

22
Q

what is the physical therapy definition of falls?

A

any event leading to an unplanned, unexpected contact with a supporting surface

that is not result of an outside force like a shove
Not the result of a medical event, MI, syncope, or fainting

23
Q

what does the physical therapy profession count as a near fall?

A

an event that would result in a fall if significant recovery mechanisms were not activated

24
Q

Near falls must include 2 of of the following compensatory mechanisms : (what are the 5)

A

unplanned movement of arms and legs
unplanned change in stride length
lower the center of mass
unplanned change in stride velocity
trunk tilting

25
Q

what are the common risk factors for falls

A

impaired balance and gait weakness
multiple medications
vision impairments
environmental hazards
postural/orthostatic hypertension
feet/footwear

26
Q

how to balance needs of fall prevention for inpatient environments?

A

migrations strategies including fall prevention plans, safe handling, and early mobility.
think of the seesaw leaning to one side.

27
Q

what is the circle of deconditioning

A

immobility-reconditioning- functional decline- multi system organ functioning- susceptiblility to infection

28
Q

what is the goal of STEADI

A

identify who is at risk

29
Q

low risk on STEADI is someone who?

A

scored above 4 on the stay independent brochure or answered no to all the key questions

30
Q

if the patient did answer yes to a key question or did not score above a 4 on the brochure they can still be low risk how?

A

by evaluating their TUG, 30 second sit to stand and 6 minute walk test. if there is no impairment they are low risk

31
Q

when should you looking a multifactorial exam due to a score on the steadI

A

when he patient has fallen 2x in a year or has fallen once that lead to an injury.

32
Q

physical screening for fall risk should include/ what tests?

A

30 second sit to stand
TUG
4 stage balance

33
Q

what is the biomechanics constraint/ ask determinant being observed in the 30 second sit to stand

A

strength

34
Q

what is the biomechanics constraint/ ask determinant being observed in the 4 stage balance test?

A

Base of support

35
Q

what are the things observed by the 30 second sit to stand

A

biomechanical constraints/MSK determinants (strength)
anticipatory postural adjustments/postural movement strategies
observation of sitting and sit-to-stand

36
Q

what are being observed when performing the 4 stage balance test

A

biomechanical constraints/MSK determinants (BOS)
anticipatory postural adjustments/postural movement strategies

37
Q

what is being noticed when performing the TUG

A

Anticipatory postural adjustments/postural movement strategies (STS)
stability in gait
observation of walk and turn

38
Q

what are the American British guidelines for fall prevention?

A

Ask every patient 65 and older about history of falls

The most critical recommendation: ASK!
1) Have you experienced a fall in the last year.
a) If yes:ask about the frequency and circumstances of the fall(s).
b) If no: ask if they areexperiencing any difficulties with walking or balance or if they have felt unsteady at any point in the last year.
2)If no to both questions :no fall risk assessment needs to be performed unless other red flags
3) If yes to either: Multifactorial fall risk assessment needs to be done to screen for balance or mobility deficits

39
Q

what should a pt balance intervention look like?

A

Individually tailored multifactorial exercise program
Strengthening/Resistance Exercise
Remember to avoid under dosing
Is primary focus of intervention for those at high risk of falls
Targeted balance challenges
ROM and Flexibility Exercise
Hip, knee, ankle, spine
Endurance
Home Modifications

40
Q

what are the things in red when it comes to strength in apt intervention for balance

A

Remember to avoid under dosing
Is primary focus of intervention for those at high risk of falls

41
Q

how long should be prescribed for balance training

A

around 50 hours
ongoing exercise is necessary

42
Q

should asking programs be included or not be included?

A

Programs WITHOUT walking training were MORE effective. (38% reduction in falls WITHOUT versus 21% reduction WITH)

43
Q

balance exercises must be ______ to be effective?

A

Exercise must provide a moderate or high challenge to balance.
Standing w/little to no UE support
Reducing BOS
Altering COG

Balance exercise must be of a sufficient dose to have an effect.

44
Q

what is a good time Frame for exercise dosing for balance

A

2-3 hrs/wk for a minimum of 12 weeks

45
Q

what are assertive devices good for and not good for

A

As a SINGLE intervention, does not reduce the number of falls or fallers (Karlsson M, et al 2013)

No adverse effects though
Used as part of multifaceted intervention proves effective for fall reduction
Increase base of support
Provide tactile cues about the ground
Can provide support

46
Q

why would you NOT include a walking program in an individuals plan of care

A

there is insufficient evidence that walking programs help reduce falls.

47
Q

fall risks are….

A

Fall risk is a chronic condition, like other “geriatric syndromes” (e.g., cognitive impairment, frailty), and should be monitored on an ongoing basis

48
Q

how can fall risk be exacerbated?

A

hospitalization

49
Q

how much can fall risk be reduced with the use of evidenced based practice?

A

Fall risk can be reduced by as much as 30% by applying simple, evidence-based interventions

50
Q

fall risk assessments are?

A

Fall risk assessment is a multifactorial problem

51
Q

what is the simple solution to fall prevention and fall rate reduction

A

There is no simple solution to fall prevention or fall rate reduction

52
Q

do PTs need to screen all older adults

A

ALL PTs should be screening older adults for fall risk

movement systems 2 (4 decks)

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