2. 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.
3. 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
4. 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.
5. 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.
6. 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
7. 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
8. Who Will Benefit?
Individuals Who:
- Complain of dizziness or lightheadedness
–Have problems with the senses, such as impaired
vision, numbness or neuropathy
–Demonstrate muscle weakness
–Have neurological or arthritic/orthopedic conditions that
limit physical abilities
9. 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
11. 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
12. 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
13. 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
14. Imbalance
• If any of these systems are compromised
may lead to imbalance and subsequent
falls
15. Physical Therapy Evaluation
• Identify impairments
– Outcome measures
• TUG, BERG
– Movement assessment
• Range of motion, Strength
• Identify risk factors
– Intrinsic versus extrinsic
16. 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
18. 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
20. What Can Physical Therapy
Do to Help?
• Address the following Impairments
– ROM
– Strength
– Coordination
– Gait
– Endurance
– Safety
21. What Can Physical Therapy Do
to Help
• Address vestibular dysfunction
– Vestibular Treatment, Habituation Exercises
• Assess need for assistive devices
22. 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
Editor's Notes
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
