Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CHI409: Chiropractic skills and principals III > Week 4 Falls > Flashcards

Week 4 Falls Flashcards

1
Q

Define a Fall

A

“an event that results in the individual coming to rest

inadvertently on the ground or floor or other lower

surface”

  • WHO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Los Of Balance

A

Unsteadiness when sitting, standing, or walking that may result in a fall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the epidemiology of falls in australia

  • how much is it costing the Healh care system
A
  • Falls for >65yrs cost the health system $83 million in 2001-2002, approximately 1.5% of the health expenditure in WA.
  • Projected to reach $1,375 million annually by 2051
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Significance of Falls

A
  • Falls and the associated fractures are a significant cause of morbidity and mortality amongst the elderly population.
  • Falls related deaths are the 6th most common cause of death amongst elderly population
  • 75% of people who die from a fall are over the age of 65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Explain the cyclical nature of the Fear Of Falling

A

Person has a fall > Fear of Falling > Loss of confidence > decrease in physical & social activity > balance & walking deteriorate > risk of falling increases

leads right back around to another fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DDx for Loss of Balance and Falls

A

Balance can be affected by diseases involving

  • Cognition, Alertness, Motivation and Planning

​Traumatic causes

Inflammatory causes

Metabolic causes:

Vascular causes

Congenital causes

Neurogenic/psychogenic causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DDx for Dizziness

A

Degenerative causes

Tumor causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List some common traumatic causes of loss of balance and falls

A

Benign paroxysmal positional vertigo (BPPV)

Traumatic brain Injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some uncommon and rare inflammatory causes of loss of balance and falls

A

Uncommon

  • Aseptic
  • Labyrinthitis/Neuronitis
  • MS*
  • Septic
  • Encephalitis
  • Menningitis

Rare

  • Paraneoplastic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List some common and rare metabolic causes of loss of balance and falls

A

Common

  • Diabetic neuropathy

Rare

  • Vestibular ototoxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List some common, uncommon and rare vascular causes of loss of balance and falls

A

Common

  • CVA*
  • Orthostatic hypotension*

Uncommon

  • Cerebral Aneurysm
  • TIA*

Rare

  • Vasculitis*
  • Wallenberg’s syndrome*
  • VBAI*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List some common congenital causes of loss of balance and falls

A

hydrocephalus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some common and uncommon Neurogenic/Psychogenic causes of loss of balance and falls

A

Common

  • Peripheral Neuropathy*

Uncommon

  • Meniere’s disease*
  • Neurological complications of
  • AIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some common and uncommon degenerative causes of dizziness

A

Common

  • Parkinson’s Disease

Uncommon

  • Dementia with Lewy bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List some uncommon and rare tumor causes of dizziness

A

Uncommon

  • Brain and Spinal Primary
  • Brian and Spinal
  • Secondary
  • Benign: NA

Rare

  • Acoustic Neuroma
  • Angiomatosis
  • Neurofibromatosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List some INTRINSIC risk factors of falls

A
  • Previous Falls
  • Balance
  • Mobility
  • Cognitive impairment
  • Incontinence
  • Medications
  • Vision
  • Dizziness and Vertigo
  • Syncope
17
Q

List some EXTRINSIC risk factors of falls

A
  • Obstacles or crowded environment
  • Poor house design
  • Poor lighting
  • Slippery surfaces, loose surfaces
  • Inappropriate assistive devices or heights of chairs
  • Feet or poor fitting shoes
18
Q

What is the role of a Chiropractor in the management and prevention of falls

A

Identify risk factors

  • Balance and mobility
  • Vertigo and dizziness
  • Education or referral
    • Feet/footwear
    • Continence
    • Risking behaviours
    • Managing falls risks
    • HEP
  • Referral
    • Medication review or vision test?
19
Q

Hx questions on Falls

A
  • Falls or near falls
  • Where?
  • What happened immediately preceding fall
  • Was it witnessed?
  • “were you able to get up after the fall?”
  • Environment – trips, slips.
  • Other factors – lighting, rushing, footwear or walking aids
20
Q

What screening tests would you perform to assess balance and mobility in the elderly?

A

Functional reach test - 25cm.

6m Walk Test - >6seconds

TUG >12-15 seconds

Berg Balance <40

FTSST >12 seconds

21
Q

How would you manage the health status of an elderly person with cognitive impairment?

A
  • Regular physical activity
  • Environmental modifications/hazard minimisation
  • Maintain hydration and nutrition
  • Osteoporosis Ax/Mx
  • Medication consolidation where possible.
22
Q

How and why would you manage continence in relation to falls

A

people will take risk to avoid an incontinence episode

Management:

  • Continence screening/assessment
  • Fluid intake management
  • Habit training/timed voiding
23
Q

How can poor footwear increase falls risk and how can it improve balance

A

Poor footwear increases falls risk:

  • Poor fitting
  • Lack of fixation (laces, buckles)
  • High heels
  • Slippers
  • Socks (non grip)

Good footwear improves balance:

  • Thin soles improve foot position
  • Low square heel improves balance
  • Supportive collar improves balance
24
Q

how do you medically assess SYNCOPE

A

temporary loss of consciousness caused by a fall in blood pressure

  • ECG, echocardiogram
  • Holtermonitor
  • Tilt table tests

Decrease in systolic BP > 20mmHg supine to standing after 2/3 minutes is suggestive of
orthostatic hypotension.

25
Q

How can you assess DUAL TASKING in the elderly

A

Stopping walking whilst talking - Gives an impression of inability to dual-task

Can assess with TUGMan or TUGCog -Timed Up & Go

  • Healthy 60-87yo
  • TUG Mean = 8.39 +/- 1.63
  • TUGman = 11.56 +/- 2.17 (carry cup of water)
  • TUG cog= 9.82+/- 2.39 (mental maths)
  • Normal TUGman should be within 4s of TUG

Frail older adults are more at risk

cog = cognitive

man = manual task

26
Q

How would you assess DIZZINESS & VERTIGO

A

Mc cause is BPPV

Need to exclude central reasons (Oculomotor Ax)

Dix-Hallpike

Treat – Epleys, Semont

27
Q

How does the risk of falls increase by taking MEDICATIONS?

A
  • >4 medications
  • Sedatives (benzodiazepines)
  • Pyschoactive meds
  • Anticonvulsants, antidepressants
  • Adverse reactions (eg dizziness and confusion)
28
Q

What is the BERG BALANCE SCALE (BBS)

A
  • 14-item test and requires no special equipment.
  • Patients are scored on a scale from 0 to 4 on each task.
  • BBS shown to be a valid and reliable measure of balance
29
Q

What Abnormalities are you looking for during the Timed Up & Go Test (TUG)

A
  • unsafe or incomplete transfers
  • poor sitting balance
  • difficulty rising
  • difficulty or unsafe sitting down
  • instability or standing or turning
  • short, discontinuous steps
  • undue hesitancy and slowness
  • excessive truncal sway
  • grabbing for support or stumbling
30
Q

5 Preventative strategies for falls in regard to Gait changes with age

A
  1. Education
  2. Physical training
  3. Footware assessment
  4. Eye examination
  5. Walking aids
31
Q

Name a Falls screening tool

A

FROP-Com Screen

(Falls Risk for Older People in the Community)

  • 1 page
  • Fast
  • Applicable to a variety of settings for the community dwelling elderly
32
Q

list questions you would ask when developing a FALLS ACTION PLAN with your Pt

A
  • Do they live a alone?
  • Personal care alarm?
    • Do they wear it?
  • Need a strategy for each area of the house
    • May not be near a couch eg
    • Bathroom, bedroom, living area, kitchen
  • What chair will they use
  • What if they cannot kneel?
33
Q

What should you consider when constructing a safe balance exercise?

A
  • Controlled environment
  • Must be challenging but still safe.

Consider:

  • Standing position
  • Minimal upper limb support
  • Minimal base of support
  • Controlled movement of COM (stepping, reaching and dancing)
34
Q

What 3 Types of interventions can you employ for Fall Prevention strategies?

A

Single intervention

  • Otago exercise program; no falls exercise

Multiple interventions

  • Stepping on program

Multifactorial interventions

  • Individually tailored programs
  • Targets personal risk factors
35
Q

Describe some SINGLE INTERVENTIONS for falls

A

. Exercises to prevent falls

. Removal of cataracts

. Medication review

. Vitamin D supplementation

. Cardiac treatment

. Home environment intervention

. Withdrawal of psychoactive medications

36
Q

What are OTAGO EXERCISES

A

Type of single intervention for falls

Walkling

Strengthening:

  • Seated – quads;
  • Standing – hamstrings, glut med, plantarflexors & dorsiflexors

Balance:

Knee bends, backwards walking, turning, sideways walks, tandem walks, one leg stand, heel walk, toe walk, heel to walk backwards, sit to stand and stair walk.

37
Q

Describe the stepping on program as part of the MULTIPLE INTERVENTIONS strategy

A

Stepping on program

Education

  • Falls risk
  • Footwear
  • Focus on behaviours, sharing stories etc

Exercise

  • Quads, calf, sit-stand, balance, glut med.
  • Group exercise and HEP

Medications, Vision, and home visit.

38
Q

Why do MULTIFACTORAL INTERVENTIONS generally not work for falls prevention?

A

Pts are less likely to follow it as there are too many aspects to the program

  • people will do 1-3 exercises but if you give 4 ot greater they wont attempt
  • If you really want to proceed with this intervention - take it slowly and don’t overwhelm the patient
39
Q

What muscles will you be targeting to STRENGTHEN for falls prevention?

A

Tripping anticipation

  • HS, pretibials, hip flexors

STS

  • Quads, glut med, max

Standing balance – ap sway

  • Ankles – pretibials and plantarflexors

Tandem stance or cross body

  • Gluteus medius

CHI409: Chiropractic skills and principals III (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions