Falls Prevention: Current Perspectives, Tools with proof

Falls Prevention: Current Perspectives, Tools with proof -

Overview

falls remain a public health problem of emergency, more and more important with the boomer rapidly emerging and increasingly aging population. Older people supporting a forward fall are 3 times more likely to suffer another fall within a period of 12 months compared with those without a prior fall. Falls commonly occur in older people who have no apparent balance deficit and those with visible disabilities or easily detected representing the leading cause of nonfatal injuries and damaging the leading cause of visits to emergency departments, admissions in the hospital, and the detrimental death. The consequences of a damaging fall emphasizes the health system, functional mobility often initiaiating a downward spiral. reduction / prevention of fall risk is a priority health care programs including the development and implementation of comprehensive assessment tools and multifactorial interventions based on evidence. The need for early identification of increased risk of falling in the elderly community life is essential to achieve a reduction in the rate of fall, injuries and deaths from falls. ^1,2,3

Definition

Despite the lack of consensus, falls are generally defined in the literature as an involuntary loss of balance during routine activities resulting in contact with the ground or a lower level side. acute medical event and extreme environmental causes are generally excluded

A scale of autumn report, the 4-Point Hopkins falls ranking Scale (HFGS) was developed and validated: Grade 1 - nearly sliding fall. trigger or no contact with the ground; Level 2- fall to the ground or lower level no medical attention; 3- grade not fall hospitalization medical care; . Grade 4 - Autumn and hospitalization ⁴

Fall Risk Factors

Intrinsic non-modifiable: age, sex, race and chronic diseases.

Intrinsic modifiable :. acute disease, incontinence, falling impairments history, walking / mobility, visual / sensory deficits

modifiable extrinsic: polypharmacy-drug / side effects, home hazards, shoes, behavior. ⁶

Aging

Age- related changes include: deficiencies deficits of visual integration and sensory somatosensory and responsiveness of mechanical and vestibular receptors mediated causing dizziness and instability; nerve conduction velocity slower; decrease the response amplitude; increase in reaction time, response latency muscles, postural sway velocity and the anteroposterior swing. These factors may have a negative impact on safety, awareness of body position and responses to disturbance, ^7.8 increasing the width of the tread, reduced walking speed, stride variability in the aftermath, the deviation from the path of travel. ⁹ changes related to the age of the physical condition include loss of 20-40% of maximum strength by sedentary adults age 65; decreased ankle dorsiflexion strength, hip strength and strength of knee extensors are associated with falls among the elderly ¹⁰ Other changes associated with age possibly associated with modifiable high fall risk include :. reduced lung volume and capacity; reduced cardiac output; increased systolic blood pressure and peripheral resistance; prolonged recovery time with the pace of work more compared during physical activity; increased reliance on anaerobic metabolism; the reduced flexibility due to decreased tissue elastin and collagen increased muscle. Available data generally indicates an inverse relationship between fitness and falls. ⁶

AGS Guidelines

American Geriatrics Society (AGS) Revised Guidelines state for people 65 and older screened for risk of expanded annual fall and evaluation to include the story of the fall, balance and evaluation of the march, with a full assessment of multifactorial falls risk performed by a trained clinician human presence conclusions balance / positive approach . AGS guidelines recommend people reporting a single fall, demonstrating results on / negative balance does not require a multifactorial evaluation. ¹¹ Considering that it only takes a drop producedeleterious effects, it may not be appropriate to recommend "without intervention" as an option when addressing the importance of public health falls prevention in the elderly. People with modifiable risk factors without a prior fall, benefit from treatment ¹²

Complete Fall risk assessment

Components :. relevant history, physical examination, cognitive and functional assessment, fall history, medication review, gait, balance, mobility assessment, visual acuity, neurological disorders, muscle strength, heart rate and rhythm, postural hypotension, feet and shoes, environmental risks. ²

level A and level B recommended interventions based on evidence AGS

Home modifications; reduction of psychotropic drugs; balance, strength, flexibility, endurance and training to walking exercise; management of orthostatic hypotension; reduction of poly-pharmacy. ¹¹

balance of performance components and fall risk

The primary objective of an intervention program falls prevention is to identify people at risk of falling. Clinical tests and measures must: discriminate between groups, predict an outcome or expected results, and to assess changes over time. In selecting a different screening tool aspects must be considered, including: sensitivity, specificity, reliability, clinical feasibility (cost, time, space), validation populations, significance and results limitations of the instrument

efficient and effective static and dynamic postural control is context specific involving reactive and proactive balance / postural responses

balance of proposed elements include :. biomechanical constraints, limits of stability, transition / adjustment postural anticipatory, reactive posture response, sensory orientation, stability approach. ¹² balance measures to the adult community living elderly should be harder, more discriminating and include elements of a larger task and the complexity of the environment in order to better reproduce postural requirements in real world environments . ¹⁴

Fall Screening and Risk Assessment: tools based on evidence

somatosensory

Semmes- test Weinstein monofilament (touch); fork (vibration), Snellen (visual acuity, static / dynamic); Melbourne edge test (contrast sensitivity PAP component); Dix-Hallpike / horizontal canal (BPPV) VNG, RealEyes x DVR, Micromedical Technologies Inc; clinical trial modification of sensory interaction on balance (MCTSIB) Airex Balance Pad; Sensory organization test (SOT) Equi test, NeuroCom International, Inc; Frailties and Injuries: Cooperative Studies of Intervention Skills - 4 (FICSIT-4); evaluation of dynamic balance (DBA);

Physical Function

computerized dynamic posturography (Smart Equitest Neurocom International, Inc., Balance Micromedical Quest Technologies, Inc;. Evaluation of computerized approach GaitRite, CR Systems , Inc,. limits of technology stability of the platform of strength, MatScan with analysis of Sway, TekScan, Boston; Acceleromerty motion analysis, Mobility Lab, Oregon ODA Tugt; BBS; CIMD; evaluation of the functional approach (FGA); Tinetti POMA; 4 square test of step (4SST) 5 times sit test bench (5XSST) Fullerton Advanced balance Scale (FAB); Gait functional evaluation (FGA) bRIEF-bestest; short physical performance battery (PPBS), voluntary testing of the execution stage, Community Balance and mobility Scale (CB & H), and Remembering walk test (WART) flexion test trunk (Leighton flexometer, Inc. . Spokane) RIPPS balance method (repeated incremental predictable disturbances (GNR rehabilitation, Ocala Fl) [

Questionnaire

the following tools evaluate the components of fear or restriction of activity

fall risk assessment and screening tool (FRAST) .; Modified Falls Efficacy Scale (EMF), as amended Gait Efficacy Scale (FDM) Specific activities Trust Balance short version (ABC-6), Fear of Falling Avoidance Behavior Questionnaire (FFABQ) Survey of activities and fear of falling in people elderly (SAFE), physical functioning Scale short Form (SF) 36.

interventions based on evidence

Before exercising, all fall risk factors should be assessed and sorted appropriately.

exercise interventions should be structured and progressive, adapted to the specific needs of the individual and reach the optimum dose. Recommendations differ for groups living in institutionalized and non-fragile fragile community. ²

Dose

The evidence suggests for seniors living in the community, recommended dose of exercise is to be 50 hours over a period of 3 to 6 month. ²

Mode

moderate to high challenge balance training has been reported to be the only form of exercise that has had a significant protective effect on rate of falls (25% reduction estimate). Other modes of exercise based on evidence include: strengthening, stretching, dynamic training walking, dual-task training, walking, integration, disruption and compensatory approach ²

Adaptation to repeated disruptions and stepper. replies for the identification and development of the balance of intervention strategies healthy risk of falls and seniors with disabilities received recent interest. ^15-23 postural reaction time is a factor of risk of falls. ²¹ strong associations between the release tether- step recovery responses and biomechanical parameters such as the length of the step, the step schedule and joint torques point the importance of neuromuscular capacities that relate to reduce the flexibility of the end, reaction time and strength. Maintaining or improving these basic attributes should be considered when developing the autumn intervention programs based on exercise for older adults.

Original work by DePasquale and Toscano The spring scale test: a valid and reliable tool to explain Fall History . Jl Geriatr Phys Ther. 09, provides evidence of the balance method RIPPS. RIPPS (repeated more predictable interference) is a proactive tool discriminant reactive / clinical disturbance validated on seniors living in the community. The RIPPS percent of total body weight (TBW%) measures of clinical performance stepper quantifies the frequency and responses to TBW% threshold, 10% TBW and limit% TBW milestones for the purposes of risk assessment fall and intervention not induce step. The 10% of the value of the performance of TBW RIPPS was most discriminating condition to fall compared with 4 other measures examined. RIPPS intervention objectives include increasing threshold and directional limit% TBW building strength, and / or reducing the number of steps necessary to maintain effective RIPPS steps of measuring balance with the net effect of development of faster postural responses with better adaptation to repeated disruptions. ²²

Exercise specific tools

Stretching:

Flexometer, Acuflex I, planks inclined adjustable (Stretchwell) ProStretch, elastic straps looped OPTP, kyphosis / forecast management of the head reduction, lumbar roll / OPTP cushion

Building:

Eccentron, BTE, NuStep T4R, ResQup (Safe patient Solutions), an elastic tube and the band (Hygenic, TherapyZone, CanDo) body weight closed units of the chain

Balance :.

Biodex Balance System SD, HUMAC Balance System (SCIM), Korebalance Premiere (Med-Fit Systems Inc), Nintendo Wii Fit (Nintendo of America, Inc.), Bungee Trainer (Neurogym Technologies) RIPPS balance method (GNR), balance-Based Torso Weighting, BBTW (Movement Therapeutics), Wobble and rocker boards (Bosu) Stability of trainers (Hygenic), balance Pads (Airex), Fitter slide mat and Fitter boards soft (International Fitter) Stepping Wolf (Stretchwell). ValSlide discs and plastic booties, stackable platforms, body bars (Hygenic)

Disturbance

RIPPS balance method GNR

Walking :.

by BalanceWear Therapeutics is a movement, device based on strategic proprioceptive neuromuscular evidence torso body weight, developed by a physiotherapist. ²²

GaitRite, CR Systems, Inc. Bungee Trainer Neurogym Technologies; ZeroG Gait and Balance Training System, LLC Aertech

Home Grown :.

Strengthening Swifter pad / sponge mop, padded PVC T-bar to the resistive ankle dorsiflexion ..

Balance

Foam insulation pipe alone or with cane / wiper insert diameters for variable rocker ankle or inclined permanent tasks; telephone directories for the tasks step platform and inclined support tasks; stool for tasks not alternate; plastic covers low friction standing foot sliding tasks; Swifter or Broomstick (bristles down) for the uncertain bearing surface for single member or modified tasks narrow tandem permanent / semi. View Master, hand-held, for sensory integration tasks of visual conflict.

Summary

Thoughtful selection of appropriate measures for the target population, clinically feasible, and its psychometric to assess physical function of older adults -living community and frail older adults is a essential step on a path to practice evidence-based geriatric physiotherapy

References for this article :.

1. Centers for Disease Control Web site. Available at: http://www.cdc.gov/ncipc/factsheets/adultfalls.htm. Accessed July 30, 08.
2. Cumming RG, Nevitt MC, Cummings SR. Epidemiology of hip fractures. Epidemiol Rev. 1997; 19 :. 244-257
3. Arnold CM, Faulkner RA. The fall of history and the combination of timed test and going to fall and almost falls in older people with osteoarthritis. BMC Geriatr. 07; 7:17 (9 pages).
4. Binder EF, Brown M, Sinacore DR, Stega May K, et al. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA. 04; 18 :. 837-846
5. Boulgarides LK, McGinty SM, Justice Willett, Barnes CW. Use of clinical tests and on the basis depreciation predict falls among seniors living in the community. Phys Ther. 03; 83: 328-339
6. Thrane G, Joakimsen RM, Thornquist E. The association between timed and go test and history of falls: The Tromso study. BMC Geriatr. 07; 7: 1 (7 pages)
7. E Nordin, Lidelof N, Rosendahl E, Jensen J, Lundin-Olsson, L. Prognostic validity top timed test and go, a. amended get-up-and-go test, overall judgment of personnel and fall history in assessing risk of falls in residential care facilities. Aging Age. 08; 37 :. 442-448
8. MR Lin, Hwang HF, MH Hu, Wu HD, Wang YW, Huang FC. Psychometric Comparisons of the timed "up and go", stand on one foot, the functional scope and Tinetti balance measurements in the community-dwelling elderly. J Am Geriatr Soc. 04; 52 :. 1343-1348
9. Pai YC, Wang E, D Espy, Bhatt T. Adaptability to disturbances as a predictor of future falls: A preliminary prospective study. J Geriatr Phys Ther. 2010; 33 (2) 50-61.
10. Harris JE, Eng JJ, Marigold DS, Tokuno CD, CL Louis. the balance of relationship and mobility in the fall incidence in persons suffering chronic stroke. Phys Ther. 05; 85 :. 150-158
11. Schultz BW Ashton-Miller JA, Alexander NB. compensatory stepping in response to the size draws women to balance drunk and impaired driving. Gait Posture. 05; 22 :. 198-209
12. Tseng S, et al. adjustments unreactive impaired in the elderly. J Gerontol A Bio Sci Med Sci. 09; 64a: (7). 807-815
13. A Mansfield et al. Effect of a balance training program based on the disturbance compensation approach and handle responses in the elderly: A randomized controlled trial. Phys Ther. 2010; 0: (4). 476-91
14. Pai YC, sliding training Bhatt T. Rpeated: A new paradigm for prevention of slip-related falls among the elderly. Phys Ther. 07; 87 :. (11) 1-13
15. Mansfield A, Peters G, Liu BA, BE Maki. A balance training program-based disruption for the elderly: study protocol for a randomized controlled trial. BMC Geriatr. 07; 7: 12 (17 pages)
16. 16 .. Badke MB, Duncan PW, DiFabio RP. Influence of previous knowledge on automatic postural adjustments and volunteers in healthy subjects and hemiplegic. Phys Ther. 1987; 67 :. 1495-1500
17. Diener HC, Horak F, Stelmach G, et al. Direction and precuing amplitude has no effect on automatic postural responses. Exp Brain Res . 1991; 89 :. 219-223

17. DePasquale L Toscano, L. The test in spring scale: A reliable and valid tool to explain the story of autumn. Geratr J Phys Ther. 09; 32 (4): 159-167
18. Pai YC, Wening JD, Runtz EF, Iqbal K, Pavol MJ. The role of pre-control movement stability by reducing the loss of balance and slip-related falls among the elderly. J Neurophysiol.03; 0: 755-762 ..

The following two tabs change content below

• Bio
• Latest Posts

Louis DePasquale PT, MA

Master of Arts Kinesiology, University of New York
physical Therapy certificate, Columbia University
BS physical Education, Manhattan College

Affiliations:
Good health system Relief , duration Francis Schervier long program Home health
Hebrew Home at Riverdale health Program long-term Home

Practice:
30 years geriatric home care setting

Publications
• DePasquale L, L. Toscano "the test of the spring scale (ESS) A reliable and valid to explain autumn Story." JGPT 09; . 32 (4)
• R Bohannon, DePasquale L. "Operation of the physical scale of the Short-Form (SF) 36 :. internal consistency and validity with the elderly "JGPT 2010. 33 (1)
• DePasquale L," Disturbance neurophysiology. " Advance: for Physical Therapy and Rehabilitation Medicine 2011: October 17.
• DePasquale L, "Security in the balance" Physical Therapy Products November 2011.

Latest posts Louis DePasquale PT, MA (see all)

• preventing falls: current Perspectives, Tools with evidence - April 1, 2014
• performance measures: Does the performance Really Measure Up - April 1 2014
• foreseeable disturbances :? an innovative clinically - September 30, 08