Module 7 Flashcards
Rate of falls increases with age over
60
Falls are ___ an inevitable consequence of aging
Not
___ of those 65 and older experience a fall related incidence per year
1/3
Rate of occurance of falls is __
44%/year
In over 80 the rate is ___ times higher vs community dwelling older adults ages 70-74
2.5
Nursing home residents fall ___ times vs community dwelling adults
3 times
Having fallen in the past __ to __ months is a significant risk factor for more falls with ___% of fallers falling more than ___ per year
6 to 12, 40%, once
There is a cluster of falls observed in the
Few months preceding death
___ are the leading cause of injury death and disability over 65
Falls
Fall related injuries occur in about ___% of falls
15%
___ fracture is one of the most common fall related injuries
Hip
More than ___% of hip fractures are caused by falling
95
In 2010 there were _______ hospital admissions for hip fractures among those 65 and older
285,000
About ___ of patients who sustain a hip fracture who were independent prior to the injury never regain their former independence
Half
___% of hip fractures are related to a fall
90
What is the mortality rates for men and women within one year of a hip fracture
Male 31% and female 17%
Difficulty getting off the floor or ground after a fall is associated with ____
Substantial morbidity
Study factors in rising from a fallen position
Initial body position and assistive devices
It takes __ to __ times longer to get off the floor for elderly compared to younger
2 to 3
In tinetti’s study only __% of community dwelling fallers were able to get up after a fall without assistance
49
__ of fallers with alarms did not active their alarm
80
Researchers found __% of people who fell were unable to get up and __ % had stayed on the floor for ______ when alone
80, 30, over one hour
___% of older adults who had remained on the floor after a fall for longer than __ hours died within __ months
50, 6, 6
___% of falls occur at home
85
Most common place for a fall
Home
Falls occur most often at this time of day
Daytime
About 50% of household falls were attributed to
Accidental or environmental causes
Frailty is what kind of risk factor
Intrinsic
What is the most common intrinsic risk factor
Weakness
An intrinsic risk factor concerning gait
Increases in variability of stride length
__ risk factors contribute up to 36.9% of falls
Extrinsic
Extrinsic factors effect _____
More mobile adults
What are the extrinsic institutional risk factors
Time of day, staffing levels on nursing floor, room distance from nurses station
Functional impact may predispose to __ risk of falls
Increased
___ posture contributes to propensity to fall in osteoporotic individuals
Kyphotic
There is a link between ___ and ______
Declining cognition and increased number of falls
Physical function for falls determined by what two tests
Chair standing test and TUGT
Chair standing test of how many seconds indicated physical function
12.9 seconds
Important score for TUGT
12.5 seconds
The three psychological impacts of falls
Fear, anxiety and loss of confidence
Tinetti’s definition of the fear of falling
Lasting concern about falling that leads to an individual avoiding activities that the person remains capable of performing
What are the three levels to the fear of falling
Absence of fear, fearful but still active, fearful to the point of decreasing activity
Fear of falling is independently associated with what two things
Slow timed physical performance and depressive symptoms
Gait changes in fear of falling
Shorter stride length, increased base of support, prolonged double limb support time and slower gait speed
In a tinetti’s study they found that the number of persons falling increased from __% with no risk factors to ___% with ___ or more risk factors
8%, 78%, 4
The use of __ or more medications increases fall risk by
4,30%
5 risk factor hierarchy for falls
Muscle weakness>history of falls> gait deficit> balance deficit> use of an AD for ambulation
The postural control system receives
Information from receptors in proprioceptive, visual and vestibular systems which must be intact for optimum balance control
What are the three postural control system sensory sources
Somatosensory, vestibular, visual
The three proprioceptive factors in PCS
Static awareness of joint position, kinesthetic awareness, closed loop efferent reflex response required for regulation of muscle tone and activity
What is kinesthesia
Perception of motion and joint position sensibility or perception
PCS postural synergies function in either ___ or _____
Feedback or feed forward
What is feedback
The reaction to a specific stimulus, mechanoreceptor detection of Altered support surface
What is feed forward
Preparation for voluntary movement which requires balance adjustment, anticipating center of mass change from previous experience
Quickly adapting receptors are responsible for proving ___ and ___ kinesthetic sensation in response to _____ or ______
Conscious and unconscious, joint movement or acceleration
____ adapting mechanoreceptors provide continuous feedback and thus proprioceptive information relative to joint position
Slowly
The ankle strategy uses type ______ mechanoreceptors
II Pacinian
The hip strategy proximal uses type ____ mechanoreceptors
I Ruffinini
Hip strategy is used with
Larger perturbations
In the hip strategy the hip works with the ___ and ___ to maintain COG over BOS
Trunk and ankle
The stepping strategy is commonly used in ______ and it
Older adults and it re aligns the BOS over COM
The biggest cervical limitations in the older adult
Rotation and extension
What are the concerns of dehydration on the vestibular system
Self restricting fluids to prevent in continence , medical restriction of fluids related to diuretics, medications may cause dehydration
Impairments of _____ and ______ mobility were significantly related to gait speed variability
Dynamic balance and upper extremity mobility
Increased ______ is associated with CNS impairment
Stance time variability
______ is associated with sensory impairment
Decreased step width variability
Gait speed is a strong predictor for ___ and ___
Fall risk and disability
By age _____ gait speed declines at a rate of ____ per decade
60, 12-16
A person will be dependent on one or more ADLs with a gait speed of
Less than 1 mph
Optimal control of balance is maintained until age
60
After age 60 the ___ becomes less automatic
PCS
After age 60 there is a ___ increase in latency
50%
What is the least important of the three vestibular, somatosensory, and visual
Vestibular
The component of motor function controlled by vestibular system input is
Muscle activity
What are the four basic domains of fall assessment
Specific patterns and injuries, physical function and functional activity level, psychological consequences and their activity restrictions and health related quality of life
The screening tool for fall risk you should use for frail elderly
TGUG
The screening for fall risk you should use for a new patient
Morse fall scale
Two important cardiovascular symtoms that may cause a fall
Syncope and orthostatic hypotension
How do you measure supine and sitting BP
Measure BP and HR after they have been lying supine for 5 minutes, then measure again immediately after they stand and then again after 3 minutes of standing
The three medications most commonly associated with falls by community dwelling older adults
Benzodiazepines, beta blockers and diuretics
Study of drug risk reduction helped reduce falls by __% in combination with gait training and reducing environmental hazards
30
What is sensitivity
The ability to detect falls when they are present
In higher sensitivity…
Fewer people are incorrectly classified as non fallers who go onto fall ( false negative)
What is specificity
the ability to correctly identify the absence of falls
Higher specificity means
fewer peaople are incorrectly classified as fallers who do not go on to fall (false positives)
You want both predictive values to be..
high
what is positive predictive value
how well the tool predicted falls compared to the actual number of falls
what is negative predictive value
how well a negative test correctly predicts the abscence of falls
The Morse Fall Scale is currently used in
VA facilities and acute care settings
The Morse Fall Scale takes how long to complete
less than 3 minutes
The Morse Fall Scale takes into account
history of falls, AD, gait/transfer status and mental status
Total score on the Morse Fall Scale is
125
No risk on the Morse fall scale is between
between 0 and 24
Low to moderate risk on the Morse Fall Scale is
25-45
High risk on the Morse Fall Scale is
46+
What is the sensitivity of the Morse Fall Scale
72%
The Morse Fall Scale has a - Predictive value of ___ and a + predictive value of _____
81% and 38%
the limitations of the Morse Fall Scale are
it has a low ceiling effect and over estimates potential fallers
What is an aspect missing from the Morse Fall Scale
does not take into account medications that may increase fall risk
The Timed Single Legged Stance Test is excellent for
community dwellers
What is the normal for the timed singled legged stance
10 seconds with eyes open
The percent of community dwellers that get to the norm on the Timed Single Legged Stance
89%
The percent of nursing home residents that get to the norm on the Timed Single Legged Stance Test
45%
The Timed Single Legged Stance is specific or sensitive
sensitive
The most common balance scale used
Berg Balance
The Berg Balance Scale is used to
screen for individuals who would benefit from a PT referral and predict multiple falls in community dwelling and institutionalized older adults
How many tasks are on the Berg Balance Scale
14
How long does the Berg Balance take to administer
15 minutes
What is the scale on the Berg Balance
5 point scale 0-4
A score of 0-20 on the Berg Balance means
the patient is wheelchair bound
A score of 21-40 on the Berg Balance means
they are walking with assistance
A score of 40-56 on the Berg Balance means
they are independent
On the functional Reach test, a person who’s reach is less than ____ is twice as likely to fall
25.4 cm
On the Functional Reach Test, a person who’s reach is less than ____ is 4 times more likely to fall
15.2 cm
People who are unable to reach in the Functional Reach Test are __ times more likely to fall
8
The Modified Clinical Test of Sensory Interaction on Balance was designed to
assess how well an individual is able to avalanche when one or more of their balance related sensory inputs are compromised
The set up of the mCTSIB
Individual stands on both feet under 4 different and progressively more difficult conditions
What are the 4 conditions of the mCTSIB
1) on solid, level surfaces with Eyes open 2) on solid level surface with eyes closed, 3) on foam with eyes open, 4) on foam with eyes closed
How do you calculate the score on the mCTSIB
add the times for each of the 4 conditions
What are the limitations of the mCTSIB
cannot discern the specific patterns of sensory dysfunction and it does not predict falls in active community dwelling adults
The DGI focuses specifically
on postural stability during walking activities and evaluates gait in response to changing tasks
How many tasks are there in the DGI
8
Each item on the DGI is rated from __ to __
0 to 3, 0 being severe impairment and 3 being normal
What is a high risk for fall on the DGI
less than or equal to 24
The DGI is reliable for
effectiveness of intervention for community dwelling older adults and vestibular disorders
The test that was derived from the DGI
The Functional Gait Assessment
How many items are on the Functional Gait Assessment
10
Items on the Functional Gait Assessment are scored on a scale of
0 to 3
What is the max score on the Functional Gait Assessment
30
Higher scores on the Functional Gait Assessment represent
better balance and gait ability
The Functional Gait Assessment has good construct ___ for patients with ____
validity, parkinson’s disease
The Functional Gait Assessment can be used to predict falls within the next ____
6 months
Fall Efficacy Scale (FES) is used for these kinds of people
fear of falling for elderly in long term care
The Modified FES is used for these kinds of people
community dwelling older adults
The two other fear of falling and falls efficacy scales
survey of activities and fear of falling in Elderly (SAFE) Scale and the Activities specific Balance Confidence (ABC) Scale
The FES is what mode of testing
self report screening
There are how many ADLs talked about on the FES
10
What is the scoring on the FES
1 -10, 1 is totally confident and 10 is not confident at all and you total and average the score
A score of greater than or equal to ____ is considered indivative of fear of falling
7
The modified FES added
4 outdoor activities to make the tool more useful for community dwelling older adults
the modified FES uses what kind of scale
visual analog scale
the modified FES scoring scale
0-10, 0 being not confident/not sure and 5 being fairly confident/sure and 10 being completely confident and sure
the Modified FES rates are totaled from ______ and divided by ____
0 to 140 and 14
A score of less than ___ indicates FOF on the mFES
8
a score of over ___ indicates lack of fear on the mFES
8
The SAFE has how many items representing what
11 items, ADLs and IADLs
what 2 subscales are used on the SAFE
activity level and fear of falling
activity level sub scale ranges on the SAFE are
0 is no and 1 is yes
the fear of falling sub scale on the SAFE ranges from
0 is not worried at all and 3 is very worried
Higher total SAFE scores indicates
more fear of falling
ABC scale is what kind of assessment
self report measure of balance confidence
How many items are on the ABC Scale
16
The items on the ABC are rated from
0% (no confidence) to 100% (complete confidence) during ADLs
A score of less than 50 on the ABC indicates
low level of functioning
A score between 50 and 80 on the ABC indicates
medium level of functioning
A score greater than 80 on the ABC indicates
high level of functioning
the ABC discriminates better than the ____ scores of _____
FES, high versus low mobility participants
the Center for Epidemiological Studies Depression Scale is a
short, self report scale used to assess general psychological impairments (depression)
How many statements are on the CES-D
20
The maximum score on the CES-D is
60
A score of greater than or equal to ___ indicates a probable major depression on the CES-D
22
A score of __ to __ indicates mild to moderate depression on the CES-D scale
15-21
A score of less than ___ indicates absence of depression on the CES-D scale
15
The Geriatric Depression Scale Long Form is a
30 item questionnaire
The Geriatric Depression Scales asks
yes or no questions about how they felt over the past week
The Short form GDS has __ questions
15
score of _ to _ indicates normal on the GDS
0-4
Score of _ to_ indicates mild depression on the GDS
5-8
Score of _ to _ indicates moderate depression on the GDS
9-11
Score of _ to _ indicates severe depression on the GDS
12-15
The maximum score on the Mini Mental State Exam is
30
A score of below __ indicates cognitive decline on the Mini Mental State Exam
24
precaution for OA strength
start with isometric strength
most important joint for mobility in balance
ankle
Three types of balance exercises
1) Postural control or response to perturbations 2) Weight shifting 3) anticipatory adjustments to limb movements
Perturbations provoke postural adjustment that brings the ____ back over the ____
COG , BOS
pushing on the shoulders or the sternum with a small backward force will stimulate
ankle DF and hip flexor activation
A Forward push from back facilitates
ankle PF and hip extensor activation
The first motor response occurs in ___
50 ms
The first motor response uses the _____ to activate _____
spinal cord, automatic reflexes
In the first motor response what reacts unconsciously
proprioception and neuromuscular control
the impulse technique isometric stabilization uses a
medicine ball for perturbations to activate the first motor response
The Oscillating Technique Isometric Stabilization uses
bad resistance and body blade
Two techniques for first motor response training
Impulse Technique Isometric Stabilization (ITIS) and oscillating Technique Isometric Stabilization (OTIS)
The 2nd motor response occurs in what time
70-120 ms
The 2nd motor response uses the _____ to activate ________
brainstem, co contraction
The progression in the 2nd motor response starting from bilateral
Bilateral to SLS to Eyes open to eyes closed
The progression in the 2nd motor response starting from stable
stable to unstable to head turning
Mechanoreceptor fire increases muscle _______ stabilizing the joint
co-contraction
the OTIS stimulates what two kinds of activity
mechanoreptor activity and muscle spindle activity
the OTIS facilitates increased _____ and _____ by using ___, ____ pulling of bands in an _____ manner
joint stability and automatic reflexes, short, rapid, oscillating
Example of OTIS in single leg
leg is stabilized and doesn’t move, it reacts to weight shifting generated by the arms increasing proprioception
ITIS uses ___ and _____ , ____ and ______ or impulses by tossing a ___
quick and repetitive loading and unloading, med ball
the ITIS med ball toss facilitates the _______ which stimulates ______ and ______
mechanoreceptors, joint proprioceptors and reflex adaptation
Researchers found that older adults when walking use less _________ and generate more energy from the ____ and _____ as a compensation for reduced _______ power output
Ankle power, hip and low back, plantar flexor
Fallers demonstrated only __% knee extensor strength and _% ankle plantar flexor strength compared to non falling peers l
37% and 10%
How long of an exercise program is recommended to increase LE strength, walking endurance and function in those at risk for disability
3 months
Studies show resisted lateral stepping around the ______ was effective for ________
Ankle, frontal plane strengthening for the glut medius
During gait the glut med fires rapidly during ____ and must develop an adequate level of force in milliseconds while producing an ______ contraction
Mid stance, isometric-eccentric
Placing the band around the forefoot is selective for the ___ over the ____ by adding an ___ effort to the hips
Glut med, TFL, ER
Tai Chi uses
A set of movements that stresses balance, controlled movement, synchronized breath control and awareness of body alignment
Participants of tai chi felt an increase in q
Confidence
