I Fell and I Can't Get Up

Question 1

___ = maintaining the body’s center of mass over the base of support

Answer 1

Balance

Question 2

___ = controlling the body’s position in space for the dual purposes of stability and orientation

Answer 2

Postural Control

Question 3

What are the 3 systems perspectives that maintain postural control?

Answer 3

Individual
Task
Environment

Question 4

For individual to have postural control “sensory input and then the integration of sensory information by the ___ and appropriate ____ response are all essential mechanisms required for balance”

The ___ is important for integrating and comparing sensory input and motor output and adapting the response as needed

Answer 4

CNS

Musculoskeletal

Cerebellum

Question 5

What are the steps of feedback control for an individual to maintain postural control?

Answer 5

Sensory input –> Central processing –> Motor output

Question 6

What is involved in the feed forward control for individual postural control?

Answer 6

Anticipatory Postural Adjustments (APA)

Central processing 
(think about doing a task) --> APA Motor Output (stabilizing muscles) --> Motor output (task performance) w/ ongoing sensory feedback

Question 7

What are important sensory inputs required for balance? (x3)

Answer 7

VESTIBULAR
(info about position and movement of head w/ respect to gravity and inertial forces)

VISION
(info about position and motion of the head w/ respect to surrounding objects)

SOMATOSENSORY
(info about position and motion w/ reference to supporting surface and the body segments to each other)

Question 8

___ is the fastest sensory input system we use to maintain postural control.

**we depend on this the most

Answer 8

SOMATOSENSORY

Question 9

An old person has to stop walking to talk to you. What are they demonstrating difficulty with?

Answer 9

Dual tasking (walkie talkie test)

Question 10

Pts w/ cognitive issues will have difficulty w/ ______.

Answer 10

Central processing

Question 11

What components are included in central processing?

Answer 11

• Scan the environment for cues
• Focus and/or switch attention – Dual Tasking
• Anticipate
• Reaction time and speed of processing effect the outcome

Question 12

What components are included in motor output? (x6)

Answer 12

• Joint range of motion (ROM)
• Muscle strength/force
• Latency of muscle firing
• Timing of antagonist and agonist muscles
• Grading of muscle response
• Power

Question 13

What type of pts will have trouble w/ motor output?

Answer 13

Arthritis
Any neuromuscular issues (movement d/o)
Weak frail old people

Question 14

Walking across a street is an (internally/externally) paced task

Answer 14

Externally paced

Question 15

What are components that impact task?

Answer 15

• Task requirements: speed, accuracy, force
• Stability vs. mobility
• Self paced vs external paced
• Dual/multi-task

Question 16

Where do most falls occur?

Answer 16

At home

Question 17

__% of people >65 y/o fall yearly
__% of people >80 y/o fall yearly
__% of older adults who fall, fall repeatedly

Answer 17

30% of people >65 y/o fall yearly
50% of people >80 y/o fall yearly
50% of older adults who fall, fall repeatedly

Question 18

T/F: Falls are a leading cause of death for older adults

Answer 18

True

Question 19

___% of older fallers are injured
___% of older fallers admitted to hospital
___% of fxs in older adults result from falls

Answer 19

20% of older fallers are injured
15 % of older fallers admitted to hospital
87% of fxs in older adults result from falls

Question 20

Falls are the most common cause of ___ (type of injury) in older adults

Answer 20

TBI

Question 21

__ of pts die w/in 12 months of hip fx

___% of pts w/ hip fx have limited functional recovery

Answer 21

1/3

50%

Question 22

What are the consequences of elderly falls?

Answer 22

Decreased independence and QOL
Cause of 40% nursing home admissions
High health care cost
Post fall syndrome (scared of falling)

Question 23

20%-85% of elderly have a fear of ____, but >__% of them have not experienced it.

Answer 23

falling

50%
**60% of elderly pts who have fallen have fear of falling again

Question 24

What are predictors of Fear of Falling (FOF)?

Answer 24

Cognitive impairment
Decreased social activity
Poorer physical function

Question 25

What are self report measures you can use to evaluate fall risk/fear?

Answer 25

ABC | Falls Efficacy Scale

Question 26

50% of older people w/ DM have ____, which makes them 20x more likely to fall

Answer 26

peripheral neuropathy

Question 27

__-__% of people fall in the 1st year post-stroke

Answer 27

40-70%

Question 28

What type of fx are post-stroke pts likely to have and which side is usually impacted?

Answer 28

hip fx Fall to their weak side and break that hip (decreased bone density from less weight bearing)

Question 29

A man has to walk w/ a cane and his L leg is healthy whereas his right is impaired. Which hand should the cane be in?

Answer 29

L hand

Question 30

What are predictors of falls that require medical attention?

Answer 30

Increased age Slower gait (TUG) Depression

Question 31

What vitamin should you monitor to decrease risk of falls?

Answer 31

Vitamin D

Question 32

All elderly adults >__ y/o should be screened annually by health care provider for falls, balance, and mobility impairments. when are other times you need to screen for falls?

Answer 32

>65 y/o Following every hospitalization or transition of care (high rate of falls w/ 2 weeks of hospital d/c)

Question 33

The ____ provides basic information about falls, case studies, standardized gait and balance assessment tests, educational handouts about fall prevention

Answer 33

CDC STEADI Toolkit | STEADI--> Stopping Elderly Adult Deaths and Injuries

Question 34

What are the components of the STEADI algorithm?

Answer 34

1) Stay independent brochure - fall risk questionnaire (>4 = increased risk) 2) Fall risk checklist 3) Key questions - fall in past year - unsteady w/ walking or standing - worry about falling 4) Timed up and go

Question 35

>___ seconds for the timed up an go test indicates an increased fall risk

Answer 35

12 seconds

Question 36

What are pt education recommendations to decrease risk of falls?

Answer 36

1. Exercise regularly 2. Annual medication review 3. Annual vision check up 4. Improve home safety

Question 37

Exercise programs should target 2+ of what 4 components?

Answer 37

Strength Balance Flexibility Endurance

Question 38

What is the recommendation for fall prevention exercises?

Answer 38

High total dose: 50+ hours, 2x/wk for 6 months minimum Additional strength training for people w/ muscle weakness >80 y/o

Question 39

____ is an evidence based balance training program that is individually tailored progressive home-based program of strengthening and balance exercises combined w/ walking

Answer 39

Otago Balance Program

Question 40

What are physical activity components that are targeted using the Otago Balance Program? (give some examples)

Answer 40

STRENGTHENING - Sitting knee extension, standing knee flex, hip abduction, toe raises, heel raises BALANCE - knee bends, backward walking, walking/turning, sideways walking, tandem stance tandem walk, one leg stand, heel walk, toe walk, tandem walk backward, sit to stand, stair walking

Question 41

Fall rate decreased by __% using the Otago Balance Program w/ greatest benefit in people ___ y/o who had fallen in the past year

Answer 41

35% >80 y/o