Fall Risk Assessment 081004
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Fall Risk AssessmentFall Risk Assessment
Jamie LauJamie Lau
Senior Physiotherapist, PWHSenior Physiotherapist, PWH20082008
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Mobility at the expense of Stability
Stable quadriped Unstable biped
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Increase inIncrease in
Postural SwayPostural Swaywith Agewith Age
BrocklehurstBrocklehurstJC et al. ClinicalJC et al. Clinical
correlates of sway in old age:correlates of sway in old age:sensory modalities. Age Ageingsensory modalities. Age Ageing
1982;11:11982;11:1--10.10.
Meansway
Age in years
40 60 >80
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Fall Risk AssessmentFall Risk Assessment
ContentContent
Patient interviewPatient interview Physical examinationPhysical examination
Functional mobility testingFunctional mobility testing Demonstration & practicalDemonstration & practical
Pilot screening in PWPilot screening in PW
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Patient interviewPatient interview
History of fallHistory of fall
Last 3 fallsLast 3 fallswhen? What time? Where? Whichwhen? What time? Where? Which
room? What were they doingroom? What were they doingturning? Getting up?turning? Getting up?Hanging clothes?Hanging clothes?
What do they think triggered the falls?What do they think triggered the falls?
Effects off the fallEffects off the fall
LOC?LOC? InjuriesInjuriesfractures / lesions / bruises?fractures / lesions / bruises?
How did they get up from the floor? If not, what didHow did they get up from the floor? If not, what didthey do?they do?
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Patient interviewPatient interview
Call for helpCall for helpAlarm available? Where was it?Alarm available? Where was it?
OR shout? Bang on floor?OR shout? Bang on floor? Confidence ofConfidence ofmobilisationmobilisation after the falls?after the falls?
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Physical examinationPhysical examination
Joint mobility and muscle strengthJoint mobility and muscle strength
KneeKneequadricepsquadricepsAnkleAnkledorsiflexesdorsiflexes,, plantarflexesplantarflexes
Integrated testingIntegrated testing
Get up from seat height of seat without handsheight of seat without hands
supportsupport
Get up and down on their toesGet up and down on their toes
on both legs or one legon both legs or one leg
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Physical examinationPhysical examination
Abnormalities of balance and gait suggestingAbnormalities of balance and gait suggesting
patients at high risk of fallingpatients at high risk of falling
Take 5 stepsto turn round
Prolong doubleleg stance (>10%)
Shuffling
gait
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Functional mobility testingFunctional mobility testing
Modified Functional Ambulation CategoriesModified Functional Ambulation CategoriesCategoriesCategories StageStage DefinitionDefinition
II LyerLyer WalkWalk
/assist to sit/ sit without/assist to sit/ sit withoutsupport>1minsupport>1min
IIII SitterSitter sit without support >1min/ walksit without support >1min/ walk
with 1 personwith 1 person
IIIIII DependentDependent
walkerwalker
Walk with 1 personWalk with 1 personlevel groundlevel ground
(continuous manual contact to(continuous manual contact tosupport body weight)support body weight)
IVIV AssistedAssisted
walkerwalker
Walk with 1 personWalk with 1 personlevel groundlevel ground
(continuous or intermittent manual(continuous or intermittent manualcontact)contact)
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Functional mobility testingFunctional mobility testing
Modified Functional Ambulation CategoriesModified Functional Ambulation Categories
CategoriesCategories StageStage DefinitionDefinition
VV SupervisedSupervised
walkerwalkerWalk with standby guarding from 1Walk with standby guarding from 1
personpersonlevel groundlevel ground
VIVI IndoorIndoorwalkerwalker
Transfer, turn & walk on levelTransfer, turn & walk on levelground independently, needsground independently, needs
assistance on stairs/inclinesassistance on stairs/inclines
VIIVII OutdoorOutdoorwalkerwalker
Walk independently on level or nonWalk independently on level or non--level surfaceslevel surfaces
This classification does not take account of any aid used.This classification does not take account of any aid used.
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Functional mobility testingFunctional mobility testing
TimedTimed--upup--andand--go testgo test
2 Walk for 3 meters
Return for 3 meters
Turn around
1Sta
ndup
3
Sit
down
Walking aid and regular footwearis allowed, but no other physical
assistance is given
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Functional mobility testingFunctional mobility testing
TimedTimed--upup--andand--go testgo test A reliableA reliable time scoretime score
Good correlation withGood correlation with BarthelBarthel Index and BergIndex and BergBalance Scale & gait speedBalance Scale & gait speed
PredictsPredicts patientpatients ability to go outside alones ability to go outside alone
safelysafely Reflects patientReflects patientss basic mobility skillsbasic mobility skills (chair(chair
transfer, toilet transfer)transfer, toilet transfer)
Reflects patientReflects patientss extended mobility skillsextended mobility skills(tub/shower transfers, walking 50 yards, climb(tub/shower transfers, walking 50 yards, climb
stairs, going out alone)stairs, going out alone)Podsiadlo D. Journal of American Geriatric Society 39:142-148, 1991
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Functional mobility testingFunctional mobility testing
TimedTimed--upup--andand--go testgo test
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Functional mobility testingFunctional mobility testing
TimedTimed--upup--andand--go test (TUG)go test (TUG)
Kristensen M T. Physical Therapy Jan 2007; 87, 1, 24-30
Patients with hip fracture,
operated and rehabilitated,performed TUG upon discharge
Repeat TUG upon 6 months
follow-up
19 subjects (32%) had 1 or more falls
TUG at discharge with cutoff point 24 significantlypredicted falls during 6-month FU
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Functional mobility testingFunctional mobility testing
Elderly Mobility ScaleElderly Mobility Scale (EMS)(EMS)
Developed as core clinical assessment packageDeveloped as core clinical assessment packagein elderly medicine recommended by the Royalin elderly medicine recommended by the Royal
College of Physicians and British GeriatricCollege of Physicians and British Geriatric
Society (1992)Society (1992) Performance based testPerformance based test
Applicable in busy medical professional clinicsApplicable in busy medical professional clinics
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Functional mobility testingFunctional mobility testing
Elderly Mobility ScaleElderly Mobility Scale (EMS)(EMS)
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Functional mobility testingFunctional mobility testing
Elderly Mobility ScaleElderly Mobility Scale (EMS)(EMS)
TasksTasks Maximum scoreMaximum score
LyingLying sittingsitting 22SittingSitting lyinglying 22
SittingSitting
standingstanding 33StandingStanding 33
GaitGait 33
Timed walkTimed walk 33
Functional reachFunctional reach 44
TotalTotal 2020
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Functional mobility testingFunctional mobility testing
Functional reach testFunctional reach test
Hold theposition for
3 sec.
Measure thedistance
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Functional mobility testingFunctional mobility testing
Functional reach testFunctional reach test
NormsNorms Men (in.)Men (in.) Women (in.)Women (in.)
2020--40 yr40 yr 16.716.7 1.91.9 14.614.6 2.22.2
4141--69 yr69 yr 14.914.9 2.22.2 13.813.8 2.22.2
7070--87 yr87 yr 13.213.2 1.61.6 10.510.5 3.53.5
Shumway-Cook. Motor Control: Theory and Practical Applications 2001Behrman. Archives of Physical Medicine & Rehabilitation 2002, 83,538-42
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Functional mobility testingFunctional mobility testing
Functional reach testFunctional reach test25.4 cm
Not a sensitive
instrument for
identifying
individuals
at risk
For those identified
as at risk is highly
likely at riskto be referred for
falls risk intervention
Criterion for falls riskCriterion for falls risk
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Pilot screening of patients with hip fracture inPilot screening of patients with hip fracture inPWH forPWH for
fall riskafter discharge from rehabilitation hospitalafter discharge from rehabilitation hospital
July to September, 2007July to September, 2007
In Department of PhysiotherapyIn Department of Physiotherapy
n= 14n= 14
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Modified FunctionalModified Functional
Ambulation CategoriesAmbulation Categories
7%14%
29%21%
29%
SitterAssisted
walker
SupervisedwalkerIndoorwalker
Outdoor
walker7%
51%1%
7%
14%Wheelchair
FrameQuadripod
Stick
Nil
Use of Walking AidUse of Walking Aid
n=144 weeks after discharge from Rehabilitation hospital
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012
345
6
/=14 =200
0.51
1.52
2.53
3.54
20
n=14Maximum score =20
n=12in cm.
< 25.4 cm = 1125.4 = 1
Elderly Mobility ScoreElderly Mobility Score Functional ReachFunctional Reach
il i f f ll i k 4 kPil i f f ll i k 4 k
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Pilot screening for fall risk 4 weekPilot screening for fall risk 4 week
after dischargeafter discharge MobilityMobility status for all patients were wellstatus for all patients were well
maintained during the discharged period prior tomaintained during the discharged period prior toscreeningscreening
Patients and their relatives do have a number ofPatients and their relatives do have a number of
questions to clarify upon their home stay periodquestions to clarify upon their home stay periodconcerning mobility issueconcerning mobility issue Stairs? Outdoor activities? Change of walking aid?Stairs? Outdoor activities? Change of walking aid?
ReassuranceReassurancevery fruitful in maintaining andvery fruitful in maintaining andimproving their physical mobility levelimproving their physical mobility level
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