Training Postural Control

Question 1

What re multifactorial interventions known to be effective on community-dwelling elders?

Answer 1

1. Gait training / education on device use
2. Review and modification of medication
3. Withdrawal of psychotropic medication
4. Exercise programs (strength and balance)
5. Treat postural hypotension
6. Modify environmental hazards
7. Treat Cardiovascular disorders

Question 2

What are balance training program recommendations for low-to-moderate risk people?

Answer 2

Non-targeted, group exercise programs that include strength, balance, flexibility, and aerobic endurance component

Question 3

What are balance training program recommendations for high risk people?

Answer 3

Targeted interventions, trained professional, long duration / lower intensity, responsive to changing status, complicated patient.

Question 4

Four main components of postural control training?

Answer 4

Individual: Impairment-level, Strategy-level, Task, and Enviornment

Question 5

Evidence-Based Programs?

Answer 5

A Matter of Balance
Stepping On
Otago Home Exercise Program
Tai Chi: Moving for Better Balance
Lifestyle Integrated Functional Exercise

Question 6

What program has the best Return on Investment?

Answer 6

Tai Chi (509%)

Otago (80+) - 127%
Stepping On - 64%

Question 7

What program has the best Fall Risk Reduction?

Answer 7

Tai Chi - 55%

Otago - 35%
Stepping On - 31%

Question 8

According to the Rose article, what are activity recommendations for those with a low fall risk?

Answer 8

Multi-modal group exercise programs with or without home exercise
Moderate-intensity walking program
Tai-Chi class
Other recreational activities with strong balance component (tennis, golf, bike riding, etc)
Dancing (ballroom, line, tango, etc)

Question 9

According to the Rose article, what are activity recommendations for those with a moderate fall risk?

Answer 9

Structured group exercise classes that systemically target identified physical risk factors
Well-designed and progressive home exercise programs
Behavioral component aimed at fostering long-term involvement in fall-prevention activities

Question 10

According to the Rose article, what are activity recommendations for those with a high fall risk?

Answer 10

Individually tailored exercise programs led by healthcare or specially trained exercise professionals who can select and progress exercises based on an individual’s identified risk factors and abilities
Additional intervention strategies as indicated based on comprehensive medical evaluation (e.g. medication management, vision assessment and/or surgical intervention, home assessment and modification, and assistive device training).
Behavioral component.

Question 11

Based on the Rose article, discuss current understanding of what type of exercise intervention is most effective and for whom.

Answer 11

Exercise is effective in reducing the physical risk
factors associated with heightened fall risk and may also
result in lower fall incidence rates among certain fall-risk
groups

There is no “one size fits all.”

More options for those at a lower risk level; fewer options as risk level increases.

Question 12

What is A Matter of Balance?

Answer 12

A Matter of Balance emphasizes practical strategies to reduce fear of falling and increase activity levels.

Primary goal = reduce fear of falling

• minor exercise component
• Strong evidence = reduce fear of falling
• No evidence to show it reduces risk of falls

Question 13

.Features of the LiFE 3 (Lifestyle Integrated Functional Exercise) program

Answer 13

-Incorporate balance and strength training in every day activities

 LiFE is about changing habits and forming new routines
 You need to practice to make the activities part of your day
 Learn the principles and how to apply them to your day
 Keep looking for strength and balance activity opportunities
in your daily routine
 To improve your balance keep challenging your balance
 To strengthen your muscles, load them and keep them
working hard
 Look for ways to put more activities into your day
 Make small changes around the house to remind you to do
the activities
 Increase the amount of physical activity you do

Question 14

What is the Otago Exercise Program? What are the 3 components?

Answer 14

• Exercise program! (Balance and Strengthening)
• Medicare reimbursements?
• Lasts longer (52 weeks) - periodic checks but a PT
• Done at home

The Otago Exercise Program (Otago) is an individually tailored, home-based, balance and strength
fall prevention program that is delivered by a physical therapist over the course of 52 weeks.

Three Components:

1. Strength Training
2. Balance Retraining
3. Walking

Question 15

What is the Stepping On Program? What are the subjects covered?

Answer 15

• Similar to Matter of Balance
• Be an advocate to yourself
• 7-week program
• Only trained by health professionals
• -Better for more severe cases

Stepping On is a program proven to reduce falls and build confidence in older people.

Subjects covered include:

Simple and fun strength and balance exercises
The role vision plays in keeping your balance
How medications can contribute to falls
Ways to stay safe when out and about in your community
What to look for in safe footwear
How to check your home for safety hazards

Question 16

What are some key elements of Tai Chi Moving for Better Balance?

Answer 16

• Teaches mindfulness
• -Cognitive component
• Helps w/ balance and vision
• -dynamic weight shift, LOS
• Evidence: reduces risk of falls

Key Elements:
Program settings can include facilities such as senior centers, adult activity centers, and community centers.
An average class size of 15 is ideal for effective learning and teaching.
For this program to be successful, participants should attend Tai Chi classes at least 2 times a week and participate actively in class.
Tai Chi can also be used in rehabilitative settings where the emphasis is on retraining balance in older adults.