Fall prevention

Question 1

Assessment for fall prevention

Answer 1

1. Home Fast Fall Prevention
2. In-Home Occupational Performance Evaluation (I-HOPE)
   - current in-home activities
   - Priority activities → subjective performance and satisfaction score
   - Performance-based rating of barriers’ influence on performance

Question 2

What to look at in fall prevention?
(Environmental, Biological, Behavioral, Socio-economic)

Answer 2

Environmental:
slippery floor, loose rugs, insufficient lighting…

Biological:
muscle weakness, gait changes, vision impairment, history of previous fall…

Behavioral:
multiple medication use, inappropriate footwear, risk taking behavior, lack of exercise

Socio-economic:
low education level, low income, inadequate living space, live alone

Question 3

Modification of the Environment (Fall prevention)

Answer 3

• freezing: Create an unobstructed walking and turning route
• cognitive problems: Set visual reminders, structuring space and objects/ furniture
• fatigue: Follow ergonomic principles in rearranging space and objects/ furniture
• Adjust transfer height ergonomically to provide proper support from furniture
• Ensure good lighting and sufficient visual contrasts
• Add visual cues on the floor to guide stride length, light navigator and beam kerb
• Moving the laundry room to the main level of home

Question 4

Modification of risk taking behavior (fall prevention)

Answer 4

• Reinforce patients to use focused attention during functional task
• Educate patients to estimate their actual ability
• Avoid leaning forward in daily activities to prevent loss of balance
• Avoid any recognized exacerbating movements where possible
• Educate on upper limb support before doing lower body activities
• Educate on stress management skills in coping with environmental demand

Question 5

Coping with Fear of Fall

Answer 5

• Ask patient to practice stop-think-plan-do before action
• Educate and practice stress and anxiety management
• Chart the time and duration of “on-off” periods, the relation to the use of medication, teach how to adapt and schedule daily routines accordingly
• Advise and train the caregiver to provide just-made level of supervision and support
• Provide psychological support
• Develop active lifestyle to maintain confidence and ability

Question 6

Fall prevention esp. for Parkison’s

Answer 6

1. Behavioral strategies
   - Take wider turns during turning
   - Re-establish posture
   - Step out to re-initiate gait
   - Use visual imagery “kerb” in front to re-initiate gait
   - Use assistive devices provide continuous cueing, e.g. Laser beam on walking frame
2. Gait training
   - Focus attention on pacing and proper gait mechanics
   - Using floor strip and metronome as visual and auditory cues
   - Dual task training such as walking and upper limb functional task training for PwP in initial stage