Some Statistics

• Of people at the age of 65 or older, 25-35% of them will fall one or more times in a year.

• Falls are considered the leading cause of death of the elderly.

• Of the elders that survive, 20-30% will result in debilitating injuries.

Body Systems that Affect Balance

• Somatosensory System• Vision• Vestibular System

Common Causes of Falls

Environmental Hazards such as:

Uneven Surfaces

Insufficient Lighting

Rugs (loose or raised)

Bed Skirts

Loose Cords

Toddlers

Pets

Pets

Other Causes of Falls Include

• Inappropriate footwear• Unstable bed or chair transfer• Gait disturbance• Balance impairment• Muscle weakness• Low Endurance

Inappropriate Footwear

Gait Disturbance or Balance Impairment

Muscle Weakness

More Causes of Falls• Pain ( injury, arthritis, chronic illness etc…)• Hypotension• Vertigo• Dizziness • Medications (especially multiple meds)• Use of alcohol• Acute illness

Pain

Hypotension

Dizziness

Vertigo

Medications

Mixing Medications with Alcohol

Acute Illness

More Causes of Falls

• Poor Posture• Visual Disorders• Disorders of the Central Nervous System

(Alzheimer's, Parkinson’s, stroke, Cerebral Palsy) • Dementia (due to cognitive impairment and

confusion)

Poor Posture

Visual Disorders such as:

• Impaired Vision • Glaucoma• Macular Degeneration• Cataracts• Diabetes Mellitus

Glaucoma

Macular Degeneration

Cataracts

Diabetic Retinopathy

Diabetes MellitusAffects vision in this way

Parkinson’s

Nervous System Disorders

Confusion and Dementia

Interventions for Fall Risk

• Center of gravity control training• Standing balance training• Somatosensory balance training• Vestibular balance training• Eye-Head coordination• Postural strategies• Strength and endurance

Center of Gravity Control

• Seated on backless chair• Dynadisk • Balance Ball• Arm lifts – single, double, diagonal• Lateral Rotation• Lean forward and backward• Add bouncing, resistance and perturbations to

progress

Standing Balance

• Standing Read out loud• On foam toss ball hand to hand• Stand one foot on ball• March with head turn• Stepping over objects• Four corner toe touch

Somatosensory SystemDecreased self-perception

Decreases ability to sense body parts in both static and dynamic movement

Somatosensory

• Seated on ball, dynadisk, backless chair

• Weight shift, eyes closed (focus on pressure felt)• Toss and catch ball, follow object with eyes and head• Read while walking• Stand on tip toes reach for object• Standing place objects from one shelf to another.

Vestibular

• Progressions: • Seated: backless chair, dynadisk, ball, • Standing: feet on floor, feet on foam, feet

together, feet in tandem, single leg• Moving: Arms, legs, ambulation• eyes open, eyes closed

Eye-Head Coordination

Progressions:Seated, Standing or MovingFollow object with eyes only, add head, add weight shifts.Direction of eyes and head: up, down, side to side, diagonal

4 Postural Strategies

• Ankle and Hip Strategies• Stepping Strategies• Moving Strategies• Pool Strategies

Ankle and Hip Strategies

• Chair in front and in back of pt. • (close for ankle farther apart for hip strategy) • Patient leans back and forth• Progress by adding foam, ½ foam roll or

balance board

Stepping Strategy

• Patient leans forward, backward and sideways until they need to take a step.

• Place tape on the floor to encourage them to take bigger steps

• Progress using foam, ½ foam roll, or balance board

Moving Strategy

• Ambulate using:• Narrow steps• Wide steps• High March• Abrupt starts, stops and turns• Progress: hold object in hands, stepping on to

foam or ½ foam roll

Pool Strategies

• Pool are a great environment for balance exercises as the provide

• naturally occurring perturbations • Patient safety, will not fall to floor• Reduces the fear factor associated with falls• Buoyancy of water provides support to

patients suffering with pain.

Strength and Endurance

Balance, Strength and Endurance can be worked on at the same time

• Use a theraball, ankle weights, hand weights or theraband.

• Incorporate normal exercises while on the ball• Pools offer the same advantage

Place colored tape on the edges of steps for visually impaired patients.

Make sure patients have handrails installed at home.

Remember to connect patients back to the movement sensor.

Remind patients of safety techniques during transfers and ambulation.

Useful Tidbit

• Fallers have less muscular strength in the quadriceps and ankle dorsiflexors and plantarflexors compared to non-fallers (Orr et al., 2008)

Six Critical Issues

• Six critical issues that must be considered when developing an all-inclusive strategy for optimizing balance training and fall prevention among older clients.

1. Multi-component training is superior to single-component balance training.

• . A well-designed exercise program should feature concurrent performance of balance exercises and additional tasks.

• Example: In addition to performing heel-toe walking, the client may simultaneously be asked to complete a cognitive task, such as counting backward from 100 by increments of three.

•The client could be asked to balance on one leg while playing catch with a light medicine ball.

• Multi-task balance training more closely replicates the activities of daily living in which a client’s balance performance is most likely to be challenged by a disturbance.

2. Simulate loss of balance during training.

• Focus on balance-recovery reactions (Mansfield et al., 2007).

• Ultimately it is the capability—or lack thereof—to recover from a balance perturbation (loss of balance) that eventually determines whether or not a client falls.

• Reaching out to grab a supporting object or stepping forward with a lower limb are compensatory mechanisms aimed at preventing a fall.

• Effective training programs will be those that replicate sudden and unpredictable balance disturbances.

3. Couple resistance training with balance training.

• A Systemic review has shown that only one out our five had increased balance with resistance only. (Orr et al., 2008)

4. Correctly sequence balance exercises.

• Research has reported that participation in either resistance or flexibility activities prior to balance exercise can negatively impact performance (Behm et al. 2004; Moreland et al. 2004)

• For best results use balance training (when combined with resistance and flexibility activities) should be performed first or following aerobic activity.

5. Create innovative balance exercises.

• Some Ideas.• Innovative Video games (Wii)• Tia Chi with hand and ankle weights• Fitness Ball with weights• Bowling with cones• Fishing (no hook)• FIND OUT WHAT YOUR PATIENT LIKES TO DO.

6. Change the availability of sensory cues.

• Many falls happen when sensory cues are not available.

• Try taking some cues away when working on balance to prepare patient for these circumstances.

• Wear sunglasses or close eyes completely.• Use unleveled surfaces, foam, bosu, etc

TIA CHI

• http://vimeo.com/32545970• http://vimeo.com/32548976• Gathering and storing (energy)(root feet) arms

circular• Washing Machine• Pushing up the sky• Following the moon• Wild Goose• Pulling in the wave