Post on 26-Feb-2016
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Fall Risk Reduction Program Designing an Exercise Program
Module #3
Shelley Thomas, MPT, MBADara Coburn, M.S., CCC-
SLP
Fall Risk Reduction Program: Review of Modules 1 & 2
In the first module we reviewed the premise of the Fall Risk Reduction Program, including the inclusion criteria for patient selection
The second module reviewed patient assessment Identifying patients at risk of falling Evaluating patients in a dual task condition to
simulate “real life” situations
Fall Risk Reduction Program: Module 3
In this module, we will delve furtherinto patient assessment. You have identified patients at risk for falling and evaluated performance under dual task conditions. Now you must further do further assessment to identify the system(s) of balance most responsible for the falls, and develop an plan of care to address the system(s).
Agenda Screening & Assessing Balance Impairments: Information to
gather in order to design an exercise program Exercise selection Designing a program
Agenda Screening & Assessing Balance
Impairments: Information to gather in order to design an exercise program
Exercise selection Designing a program
Multifactorial Risk Assessment
Focused HistoryPhysical ExaminationFunctional AssessmentEnvironmental Assessment
American Geriatric Society Clinical Practice Guidelines: Prevention of Falls in Older Adults
Multifactorial Risk Assessment: Focused History
History of falls – need detailed description of the fall circumstances, frequency, symptoms
Medication review
History of risk factors – acute & chronic medical issues
Multifactorial Risk Assessment – Physical Exam
Physical function - Gait, balance (including postural reflexes), mobility, and lower extremity joint function
Neurological function – Cognitive evaluation, peripheral nerve function, proprioception, reflexes, and tests of cortical, cerebellar, & extrapyramidal function
Muscle strength Cardiovascular status – Heart rate, postural pulse, blood
pressure Visual acuity Vestibular function (oculomotor tests, positional testing) Examine feet and footwear
Multifactorial Risk Assessment – Functional Assessment
Assess activity of daily living (ADL) skills
Perceived functional ability and fear of falling
Multifactorial Risk Assessment – Environmental Assessment
Home safety
Other environment factors as needed
Turning the multifactorial risk assessment into an exercise program – What
to do with all this information?
Stratify the Patient Problems into Systems of Balance
Musculoskeletal System Proprioceptive System Oculomotor System Vestibular System Cognition/Communication
Musculoskeletal System Muscle, tendons, ligaments, bones, joints, and
associated tissues that move the body and maintain form
Key muscle groups associated with walking and upright balance reactions: Hip flexors Hip extensors (especially gluteous maximus) Hip Abductors (especially gluteous medius) Knee extensors (quadricepts Knee flexors (hamstrings) Plantarflexors (gastrocnemius, soleus) Dorsiflexors Upper and lower abdominal muscles
Proprioceptive System
Proprioception is the unconscious awareness of body position. It tells us about the position of our body
parts in relationship to each other and the environment.
It allows us to have a knowledge of how much force and speed the muscle is required to generate in order to accomplish a specific movement which results in appropriately graded muscle control.
Oculomotor System
Is the control system that coordinates the 12 muscles which accurately direct our eye movements.
Three main types of Oculomotor Skills: Saccades – The ability to quickly and
accurately make eye movements or jumps from one target to another.
Fixation – The ability to maintain steady visual attention on a target.
Pursuits – The ability to smoothly follow a moving target.
Vestibular SystemSystem of the body
that is responsible forspatial orientation andbalance.
The vestibular system sends information to the brain about the location of one's head in space.
Vestibular, Oculomotor, Proprioception Systems: Need at least two
In order to maintain balance, at least two of these systems must be sending balance information to the brain at any time.
Examples: If in the dark, brain can use proprioceptive
and vestibular inforamation to remain upright against gravity.
If have lower extremity amputation, can use vestibular and oculomotor systems.
If have labrynthiasis impacting vestibular system, can use oculomotor and proprioceptive information.
Cognition & Communication Systems (involved in dual tasking)
Cognition is the ability to think and process information Attention, memory, processing, problem solving, judgment,
impulse control, and executive skills.
Communication is the ability to exchange and comprehend language. Naming, word finding, following directions, answering
questions, speaking, and writing.
How much of the “cognitive pie” does mobility take? If maintain balance “hogs” resources, decreases cognitive and communication skills. Places person in an either/or situation – can maintain balance
or focus on cognitive task.
Sample Patient Problem ListMusculoskele
talProprioceptio
n Oculomotor Vestibular Cognition
Peripheral Neuropathy X
Lower extremity strength rated 3/5 X
Flexed posture X X X
Inadequate footwear X
Decreased visual acuity due to diabetic retinopathy
X
Decreased problem solving skills
X
Impaired balance reactions X X X
Now that you have stratified the problems into the systems of
balance, you can design a plan of care that incorporates
Interactive Metronome
Why include Interactive Metronome in the plan of care?
Movement Requires Directed attention Pathologies that disrupt motor timing and
sequencing lead to inaccurate movements IM & Dual Tasking
IM requires a patient to focus on auditory stimuli and make a motor response to hit the trigger on the beat.
Must decide if need to slow down, speed up, or remain consistent.
Computer can measure performance in milliseconds, so act at same speed as muscular contractions.
Helps patients identify their own timing tendency and learn how to counteract own tendencies.
Fall Risk Reduction Program Exercises
This library of exercises are suggestions. Concept is to design exercises, using the Interactive Metronome that target specific problem areas
Center treatment interventions around long and short term goals that are important to the patient. Goal selection was discussed in the second module
Download can be found on course materials page
Musculoskeletal System Exercises*Photos and exercise descriptions available on course materials page
Leg Squats Alternate SteppingLunges Stepper with WeightsHeel Raises BridgingLong Arc Quads Abdominal CrunchTaps Ups Postural Alignment
Lateral Tap UpsPostural Alignment with Marching
Proprioceptive System Exercises*Photos and exercise descriptions available on course materials page
Clock Clapping with Eyes Closed, Seated
Uneven Surface with Eyes Open
Clapping with Eyes Closed, Standing
Uneven Surface with Eyes Closed
Oculomotor System Exercises*Photos and exercise descriptions available on course
materials page
UNO Poster Board Visual SequencingVisual Memory Recall/recognition
Vestibular System Exercises*Photos and exercise descriptions available on course
materials page
Head Movement in Supine Sidelying to Sit with Head RotationHead Movement in Sitting Visual tracking focal itemHead Turns with Reaching Across Midline In Sitting, Head stationary, Saccades
Head Turns with Walking Using the in-Motion Triggers
Rolling Seated, Reaching Across and Behind to hit target
Cognition/Communication System Exercises
*Photos and exercise descriptions available on course materials page
STROOP Activities Yes/No Questions Selected and Divided Attention
Aphabetizing Naming Visual AttentionSorting Word Finding MemorySequencing Melodic Intonation Picture IdentificationImpulse Control Intelligibility Drills Following DirectionsSafety Awareness Oral Motor Exercises Setting Table
Fall Risk Reduction Poster Overview
Fall Risk Reduction Best Practices Kit
Contains: 1 – STOOP Board (12” x 18”) 5 – Fill-in-the-Blank Cards (4” x 11”) 5 – Melodic Intonation Cards (4” x 11”) 15 –Object Cards (7½” x 6”) 1 set – 1 – 12 Numbered Cards (8½” x 4”) 1 set – Yes/No Cards (4” x 8½”) 1 set – 1 – 25 Numbered Cards (4” x 3”) 15 – Word Cards (2½” x 3) 1 set – Various Sized Squares
1 – 12 Numbered
Cards
Object Cards
STOOP Board
Word Cards
Various Sized
Squares
1 – 25 Numbered
Cards
Yes/No Cards
Fill-in-the-Blank Cards
Melodic Intonation
Cards
Integrating Kit Items for Fall Risk Reduction Tasks
Toe Tapping Clock
Visual MemoryMemoryNaming
Picture Identification
STROOP Activities
Alphabetizing
Sorting
Sequencing
Yes/No Questions
Word FindingMelodic
Intonation
"Homework"
Complete following worksheet to develop a plan of care for your patient. Use the same patient as in Module #2.
Post-test
Complete post-test to receive link for Module # 4 of 6
Materials Page This video PowerPoint Module 3 Homework Exercise Guide Poster Best Practices Kit www.interactivemetronome.com/index
.php/fall-risk-coaching
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