Falls and Balance Disorders

Question 1

Identify some intrinsic and extrinsic risk factors for falls

Answer 1

• Intrinsic factors (individual)
  
  • Gait and balance impairment
  • Peripheral neuropathy
  • Vestibular dysfunction
  • Muscle weakness
  • Vision impairment
  • Medical illness (cognitive, depression, neurological, stroke, incontinence, acute illness, Parkinson’s, arthritis, foot problems, dizziness)
  • Advanced age
  • Impaired ADLs
  • Orthostatic hypotension
  • Dementia
  • Drugs (especially neuroleptics and cardiac drugs, or >4)
• Extrinsic factors (environment)
  
  • Environmental hazards - poor lighting, loose rugs, slippery floors, stairs, general clutter
  • Poor footwear
  • Restraints
  • Behavioural factors (interaction between individual and environment)
  • Undertaking risky activities

Question 2

Describe some tests of static balance/gait

Answer 2

• Functional reach test (reach with arms at 90 degrees until overbalance - measure reach distance)
• Romberg
• Hallpike manouvre - rotate head 45 degrees to affected side and lay back on bed with head extended 30 degrees past horizontal over ends of bed. Latent nystagmus/vertigo (30sec) - positive test (diagnostic manouvre)
• Standing on heels and toes - functional strength measure
• Sternal push or shoulder tug (Pastor’s test)

Question 3

Describe some dynamic/functional tests of balance or gait

Answer 3

• Timed up-and-go - standard height chair with back resting on it. Time from moment back leaves chair to walk around cone 3m away
• 10-meter walk test
• Dynamic gait index
• HIMAT - series of timed task

Question 4

Outline some ways that you might manage a person’s falls risk based on their risk factors

Answer 4

• Intrinsic factors
  
  • Improve medical conditions and medications that may be related to falling
  • Vision assessment
  • Gait and balance re-education e.g. retraining to take steps when about to fall
  • Consider strengthening exercise programs
  • Vestibular rehabilitation (useful for Meniere’s BPPV)
• Extrinsic factors
  
  • Appropriate footwear, non-slip socks and foot care (podiatry)
  • Gait aids
  • Home hazard assessment (OT)
• Behavioural factors
  
  • Education
  • Psychological intervention if severe fear of falling

Question 5

What are some ways of minimising falls injuries (e.g. in a person at high risk of falling)

Answer 5

• Osteoporosis treatment
• Hip protectors
  
  • Only of use in residential aged-care facilities in high-risk populations
  • Education on how to get off the floor (prevents rhabdomyolysis, pressure sores, dehydration)
• Falls alarms/sensor mats