System wide program designed to identify and treat individuals at risk for falls.
adjust displacement of COG through appropriate changes in BOS
Visual contribute to anticipatory and responsive postural control; includes occulomotor functions relating to balance include conjugation, saccades, smooth pursuit, VOR, nystagmus
Postural control definition : controlling the position or posture of body at rest or when moving Static postural control reflexes: Righting, Vestibulo-ocular reflex (VOR), Vestibulospinal reflex (VSR) Anticipatory: visual feedback, ball thrown Volitional: sports
Ankle Small perturbation, firm support Motor response distal to proximal Requires intact ROM (decreased DF) and strength at ankles Hip Prox to distal Larger or faster perturbations on compiant or smaller surface Hip ext Step Strong to displace COM outside BOS, step to bring support back to alignment under COM
Static and dynamic balance, gait
We are trained to recognize when other factors such as blood pressure or multiple medications or medication types may play a role in balance problems. We would then make the appropriate referral back to the physician
Manual Therapy and exercise to improve motion limitations
Better Balance Program Crystal Myers, DPT Sarah McBride, DPT
Fall Statistics• Falls among older adults are common and dangerous, with known significant morbidity and mortality.• Approximately one-third of community-dwelling older adults will fall each year.• 20-30% of falls result in moderate to severe injuries, including traumatic brain injury (TBI), cervical fractures, and spinal injury.
Fall Statistics• Falls are the most common cause of hospital admissions for trauma among older adults and are the fifth leading cause of death in older adults. – Older adults injured from falls and admitted to the hospital are significantly more likely to be discharged to long-term care than other age-matched patients admitted to the hospital from the emergency department (ED) for other reasons
Cost of Falls– In 2000, $19 billion was spent on fall-related injuries for people aged 65 years and older.– By 2030, nearly 1 in 5 Americans will be aged 65 years or older.
What is the Better Balance Program?• Educational tool guided by evidence based practice to assist in identifying and addressing impairments that may lead to imbalance.
Mission of the Program• Identify individuals who are at risk for falling• Help at risk individuals take steps to reduce falls before they happen• Encourage healthy aging by facilitating older adults to remain mobile and independent• Reduce hospitalizations
Who Will Benefit?• Individuals who: – Have fallen recently – Demonstrate difficulty getting up from a chair – Have difficulty walking or are unsteady – Are physically inactive – Are fearful of falling
Who Will Benefit?Individuals Who:- Complain of dizziness or lightheadedness–Have problems with the senses, such as impairedvision, numbness or neuropathy–Demonstrate muscle weakness–Have neurological or arthritic/orthopedic conditions thatlimit physical abilities
Balance or Postural Control• The ability to locate and maintain one’s center of gravity within or over one’s base of support during static and dynamic tasks• Controlled by interaction of sensory and motor systems – Disruption of these systems leads to imbalance and increased risk for falls
Causes of Balance Problems-Sensory-Motor-Cognitive
Sensory Input– Peripheral Sensory Systems • Visual: detects movement of head or environment, reference for verticality • Vestibular: detects linear and angular head/eye movement and position relative to gravity • Somatosensory: provides info about body’s position relative to surface
Motor Output• Maintenance of postural control – Static Postural Control » Normal sway » Reflexes – Automatic or Reactive Postural Responses » Response to stimuli » Strategies – Anticipatory Postural Responses » Occur before actual stimulus – Volitional Postural Movements » Conscious control, trained responses
Reactive Postural Responses• Occur in response to stimuli• Strategies – Ankle: response to small perturbation – Hip: response to larger or faster perturbation – Stepping: force strong enough to displace COM outside of BOS, step to regain COM
Imbalance• If any of these systems are compromised may lead to imbalance and subsequent falls
Physical Therapy Evaluation• Identify impairments – Outcome measures • TUG, BERG – Movement assessment • Range of motion, Strength• Identify risk factors – Intrinsic versus extrinsic
Intrinsic Risk Factors• >80 • Gait Deficit• Arthritis • History of Falls• Balance Deficit • Impaired ADLs• Cognitive Impairment • Medications• Depression • Muscle Weakness• Dizziness • Sensory disturbances• Fear of Falling • Use of assistive devices
Physical Therapy Treatment• Individualized treatment plan for each patient• Appropriate medical referral if needed – Medication management • Four or more • Classifications linked to increased risk of falls – Benzodiazepines, sleeping medications, neuroleptics, antidepressents, anticonvulsants and class 1A antiarrhythmics – Blood Pressure
Treatment•Education - Extrinsic changes - Awareness of intrinsic factors
What Can Physical Therapy Do to Help?• Address the following Impairments – ROM – Strength – Coordination – Gait – Endurance – Safety
What Can Physical Therapy Do to Help• Address vestibular dysfunction – Vestibular Treatment, Habituation Exercises• Assess need for assistive devices
What CRR has to offer• Computerized balance testing and training – Testing can monitor progress during treatment• Better Balance trained Physical Therapists – 5 Physical Therapists, 3 Physical Therapy Assistants