Falls

Question 1

What risk factors are only relevant with lower functioning adults

Answer 1

Urinary incontinence
Cognitive impairments
Fear

Question 2

Screening process for falls

Answer 2

Every adult 65+ gets asked: have you fallen in last year?
1. They answer no = continue with PT exam
2. They answer YES = ask them: have you fallen in last year AND do you have trouble with balance OR does the patient demonstrate unsteadiness?
3. They answer yes to either of those — proceed to assess them further.
4. They answer no to either of those — proceed to recommend progressive balance and resistance training

Question 3

What is done after you find a positive screen with older adult

Answer 3

SPLATT — ask…
1. Symptoms prior to fall?
2. Previous falls?
3. Location: inside or outside? Inside is bad
4. Activity: what were you doing when you fell?
5. Time of day: night, day, end of day, morning?
6. Trauma: did you have an injury or go to ER?

Question 4

What is included in fall assessment

Answer 4

1. Medical history
2. LE strength — esp hip abductors
3. Balance — all forms
4. Gait — thorough and detailed.

Question 5

What is the biggest risk factor you have to notice during history

Answer 5

• If they report previous falls — has most impact.
• psychoactive meds too

Question 6

What self reported assessments can you use

Answer 6

1. Falls Efficacy Scale — assesses fear component which is a RF in itself. Will impact decision making on progress with volitional vs. Reactive balance training
2. GDS

Question 7

Cutoffs cores for outcome measures

Answer 7

1. Berg — <50 points
2. TUG — >11/12 seconds more valuable in screening lower functioning adults
3. 5xSTS — >12 seconds
4. SLS — <6.5 seconds

Question 8

What guides our treatment

Answer 8

Cumulative Post test probability of BBS+TUG+5xSTS

Question 9

What should be done in addition to PT management following fall risk assessment

Answer 9

1. Must provide/prescribe interventions tailored to the individual based on fall risk level, preferences, and relevant factors.
2. MULTI-MODAL PROGRAM

Question 10

What does a multi-modal program consist of

Answer 10

1. Balance training — volitional and reactive stepping OR tai chi based on pt preference and availability. Should be progressive dose with mod-high challenge for 3days/week and overall 50 hours
2. Progressive resistance exercise but this isn’t required
3. Functional mobility and/or gait to address stability and adaptability of gait
4. Correction of environmental hazards and home assessment
5. Education

Question 11

What two components of multi-modal programs are the most important for patients that are low functioning/high risk?

Answer 11

1. Functional mobility and/or gait
2. Correction of environmental hazards and home assessment

Question 12

Type, frequency, intensity, and time for multi-modal program

Answer 12

1. Type — must be multi-modal for greatest benefit
2. Frequency — minimum effective freq = 2days/week. Most consistent effective freq = 3days/week
3. Intensity — want highest level of difficulty without falling or nearly falling. Also want to make sure patient reaches mastery of each exercise before progressing
4. Time — can be 5 weeks to 2 years. Should be total exercise volume of 50 hours.

Question 13

What works for balance training

Answer 13

1. Leaning beyond BOS and reaching
2. Shifting COM
3. Minimizing UE support
4. Narrowing BOS
5. Changing BOS by stepping

Question 14

What doesn’t work for balance training

Answer 14

1. Lack of a balance training component at all
2. Lack of functional relevance
3. Lack of exercise progression

Question 15

Graded reaching

Answer 15

1. Narrower BOS
2. Further and different directions
3. Down
4. Heavier objects
5. Stepping while reaching
6. Foam

Question 16

Stepping and walking

Answer 16

1. Longer, faster steps, over obstacles
2. Tandem, forward, backward
3. Perturbations in standing or during walking.

Question 17

Describe the most successful exercise programs in the multi-modal world

Answer 17

1. Simple
2. Accessible
3. Low cost