Fall Risk Management & The Moore Balance Brace Presented by Josh White, DPM, CPed.
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Transcript of Fall Risk Management & The Moore Balance Brace Presented by Josh White, DPM, CPed.
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Fall Risk Management & The Moore Balance Brace
Presented by Josh White, DPM, CPed
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Common Fears Among Elderly Patients• Falling / fractures• Burden to family• Loss of
independence
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Presentation Objectives
Understand patient demographic & market
demand1
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Presentation Objectives
Why podiatric physicians should be addressing this
problem2
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Presentation Objectives
How podiatric physicians can get involved in fall
prevention3
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Fall Facts• Leading cause of injury-related death in seniors • Leading cause of hospitalization for injury in adults
65+• Over 95% of hip fractures are caused by falls. In
2010 there were over 258,000 hip fractures • 67% of fall victims (65+) are discharged to nursing
facilities; 50% of whom will never live independently again
• Direct medical costs associated with falls >$30B annuallyReference: www.cdc.gov
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Why podiatric physicians should focus on fall prevention
• Most podiatric physicians treat patients at risk for falling
• Four of the leading risk factors associated with falling can be treated by podiatric physicians*.1. Muscle Weakness2. Gait Deficits 3. Balance Deficits4. Arthritis
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Most Common Fall Risk Factors*
*Guideline for the Prevention of Falls in Older Persons. American Geriatrics Society, British Geriatrics Society, and the American Academy of Orthopedic Panel on Falls Prevention: JAGS, 49;664-672, 2001
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The Causes*
FALLS
EXTRINSIC FACTORSINTRINSIC FACTORS
Medical and neuropsychiatric
conditions
Impaired vision and hearing
Age-related changes in
neuromuscular function, gait and postural reflexes
Improper prescription and/or
unintended interaction of medications
Improper use of assistive devices
Environmental Hazards
*Kane, Robert L.; Ouslander, Joseph G.; Abrass, Itamar B., Essentials of Clinical Geriatrics, 5th Edition, Copyright 2004 McGraw-Hill
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Start Early
• Early intervention to prevent the loss of muscle strength is critical
• Balance and strength can be improved with exercise
• Get screened and, if needed, treat for osteoporesis
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Key Components of Podiatric Fall Risk Prevention Program
• Objective multifactorial assessment tool• Referral for medical, physical, occupational,
auditory and vestibular therapy and home healthcare
• Prescription for footwear, canes, walkers, AFOs
• Patient education
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It all starts here…
The Assessment
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Foot and ankle conditions that increase fall risk in seniors*
• Reduced ankle flexibility• Hallux valgus deformity• Decreased tactile sensitivity• Decreased toe plantar
flexor strength • Foot pain
*Hylton B. Menz, Meg E. Morris, and Stephen R. Lord, Foot and Ankle Risk Factors for Falls in Older People: A Prospective Study. Journal of Gerontology Vol. 61A, No. 8, 866–870
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Shoes pose increased risk for falls. Some characteristics include:
• Cause Pain • Poorly fitting• Smooth slippery leather soles and heels • Too thick or too heavy soles • High heels • Mules • Slippers • Flip-flops • Sandals
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Balance Footwear
• Light weight• Non-slip soles• Supportive• Well-fitting• Adjustable• SafeStep shoe
catalog
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Postural Sway
• Constant displacement and correction of the center of gravity over the base of support
• Factors found to be correlated with increased postural sway include:o Reduced peripheral sensationo Poor near visual acuityo Slow reaction time
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Postural Sway
• Increased postural sway is a significant risk factor for falling
• Can be reduced with appropriate footwear and by increased support around the foot and ankle
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AFO mechanisms of action in improving balance
• Ankle joint stabilization• Improved proprioception• Decreased postural sway in frontal plane• Support of foot longitudinal arch• Decreased foot pain• Increased confidence
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The Moore Balance Brace
• Increases sensorimotor function via its custom molded shape and textured fabric
• Decreases postural sway• Provides stabilization in the
presence of muscle fatigue, osteoarthritis and pain
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The Moore Balance Brace
• Addresses orthopedic conditions that can affect balanceo Muscle weakness (728.87)o Ankle instability (718.87)o Gait abnormality (781.2)o Mild dropfoot (738.20)
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Moore Balance Brace Features
Padded tongue for maximum comfort
Easy to reach Velcro straps
Polypropylene shell provides lightweight support around the foot and ankle
Post designed to maximize balance & stability
Padded heel & arch
Custom orthosis provides longitudinal arch support & midfoot stability
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Casting for an MBB
• The MBB is best fabricated using mid-calf, STS casting socks
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Balance improvement in older adults using customized ankle foot orthoses*
Using the Moore Balance Brace along with proper footwear on elderly patients, was shown to "reduce postural sway by more than 50%" and "improves
postural stability in the medial-lateral direction by 18% without influencing reach and distance or TUG times".
Discussion & Conclusion
The Effect of Customized Ankle Foot Orthoses (AFO) on Gait and Balance in Older Adults
*Sai Vikas Yalla , Jacque Ortiz , Ryan T. Crews & Bijan Najafi (2013) Balance improvement in older adults using customized ankle foot orthoses, Footwear Science, 5:sup1, S119-S120, DOI: 10.1080/19424280.2013.799593
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Fall Risk Management Protocol Overview
• The MBB is part of a larger comprehensive fall risk management protocol.
• Four key components of this protocol:1. Fall Risk Assessment2. DME Assistive Devices (footwear, canes, AFO)3. Strength and Balance Training (i.e. PT/OT)4. Patient Education
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Medicare & Medical NecessityThe Social Security Act specifies that “medical necessity” is a prerequisite for Medicare to cover any service. Medical necessity is defined in Sec. 1862. [42 U.S.C. 1395y] (a)
"...reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
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PDAC Assigned L Codes: Reimbursement fee schedule
L 1940$557*eaL 2330$442*eaL 2820$97*ea1 MBB = $1,098
$1,098 x 2 MBBs = $2,196/Patient*Reimbursement fees vary by state
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Register for the ‘balance’ of the series covering these topics:
• Fall risk assessment & casting for the MBBo Tuesday, November 4 @ 8PM pm EST
• How to implement a comprehensive fall risk management protocol into your practiceo Tuesday, November 25 @ 8 pm EST
• How to educate your patients and other practitioners about fall preventiono Tuesday, December 9 @ 8 pm EST
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SafeStep MBB Post-Webinar Starter Kit
• MBB Sample• STS casting socks • Fall Risk Assessment
Tear off Pad • Tips on talking to your
patients • Exercise Tri-fold
• Compliance Docs• Order Forms• UPS labels • MBB Patient Brochures • MBB Poster• WorryFreeDME Flyer• SafeStep Shoe Catalog
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Schedule a free Training Session with a DME Expert at SafeStep.net
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Questions?