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    Balance

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    Aleena Masood

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    Balance

    Uploaded by

    Aleena Masood
    3 views32 pages

    Original Title

    Balance (2)

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    3 views32 pages

    Balance

    Uploaded by

    Aleena Masood

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    Doctor of Physical Therapy

    Gerontology and Geriatrics


    course code: GGPT893|11
    Credit hours: 2:0
    Presented By,
    Dr. Basita, PT
    UIPT_UOL
    BALANCE AND FALL IN ELDERLY
    (part 2)

    Learning Objectives
    Assessment of Balance and Gait
    Exercise for improving balance
    The Effector System
     The Effector System
     Aging may result in:
    Decreased muscle strength
    Decreased ROM and flexibility
    Increased “stiffness” of connective tissue
    Aging may result in cardiovascular changes
    Influence of other systems
     Cognitive
    &
    behavioral factors…

    Emotional liability  Attention


    Agitation Cognition
    Denial of Judgment
    impairment. Memory
    Depression
    Fall risk factors in older adults
     Classification 1
     Intrinsic (internal) Risk factors
     Extrinsic (external) Risk factors
     Acquired Risk factors
    Classification 2
     ModifiableRisk Factors
     Non-Modifiable Risk Factors
    Classification 1

    Intrinsic (internal) risk factors


    Examples- Age, osteoporosis, vision loss,
    dementia
    Extrinsic (external) risk factors:
    Examples- Medications, footwear, assistive
    devices, environment
    Acquired risk factors:
    Examples- Facility or hospital admission
    due to health change or decline (new
    environment), increased disability due to
    injury.
    Classification 2

    Modifiable risk factors


    Examples: Muscle weakness, poor balance,
    exercise level, medications, environmental
    lighting, footwear
    Non-modifiable risk factors
    Examples: Age, chronic conditions, disability,
    dementia, vision loss
    ASSESSMENT
    BALANCE ASSESSMENT

    Red flags - urgent referrals to physician for workup


    • Unexplained central nervous system signs.
    • sensory, or cognitive changes
    • Unexplained cranial nerve dysfunction
    • Unexplained sudden or unilateral hearing loss
    especially if accompanied by vertigo
    • Two or more falls in the previous 4 weeks
    • Inconsistencies in clinical examination
    Assessment of balance in elderly

     Underlying Components of balance control to be


    assessed include,
    Musculoskeletal
    Sensory
    Motor
    Cognitive
    Continue..

     Balance tasks to be assessed includes


     Self Report Measures
     Quiet standing (static)
     Active standing (dynamic)
     Sensory manipulation
     Vestibular
     Functional scales
     Dual task & Multiple Task
    Assessment of Gate

     It is a multi task test: have 2 parts


    Balance sub test: 9 items (4 static & 5 dynamic)
    Gait sub test : 8 test
     Focused on
    Maintenance of position
    Postural response to perturbation
    Gait mobility
    Equipment needed
    Chair, walk way; patient can use usuan walking
    aid.
    TREATMENT
    Rx.

     Regular exercise
     Medication review
     Vision exams
     Home safety evaluation
    Fall prevention
     Individual risk assessment
     Regular strength & balance exercise
     Gait & assistive device training
     Medication review & management
     Management of chronic conditions
     Vision correction
     Education
     Home safety improvements
    Specific recommendations
    EXERCISE:
     Older people who have had recurrent falls should
    be offered long-term exercise and balance training.
     Tai Chi C’uan is a promising type of balance
    exercise, although it requires further evaluation
    before it can be recommended as the preferred
    balance training
    Environmental modification
     When older patients at increased risk of falls are
    discharged from the hospital, a facilitated
    environmental home assessment should be
    considered.
     Ina subgroup of older patients, a facilitated
    home modification program after hospital
    discharge was effective in reducing falls
    Medication:

    Patients who have fallen should have their


    medications reviewed and altered or stopped as
    appropriate in light of their risk of future falls.
    Particular attention to medication reduction should
    be given to older persons taking four or more
    medications and to those taking psychotropic
    medications.
    Assistive Devices
     Studies of multifactorial interventions that have
    included assistive devices (including bed alarms,
    canes, walkers (Zimmer frames), and hip
    protectors) have demonstrated benefit.
     However, there is no direct evidence that the use
    of assistive devices alone will prevent falls.
    Behavioral and Educational Programs
     Although studies of multifactorial interventions that have
    included behavioral and educational program have
    demonstrated benefit
     when used as an isolate intervention, health or behavioral
    education does not reduce falls and should not be done in
    isolation.
     A structured group educational program among
    community- dwelling older people did not reduce the
    number of falls but did achieve short-term benefits in
    attitudes and self-efficacy .
    Continue..

     Practice guidelines in the emergency department


    did not alter documentation of falls risk factors,
    causes of falls, consequences of falls, or the
    implementation of practice guidelines .
     Bone Strengthening Medications
    It reduce fracture rates. But not reduce the rates
    of falls.
     Visual Intervention
    Fall-related hip fractures were higher in patients
    with visual impairment.
    Footwear Interventions
    For Women: Static and dynamic balance were better
    in low-heeled rather than high-heeled shoes or than the
    patient’s own footwear.
    For Men: foot position awareness and stability were
    best with high midsole hardness and low mid-sole
    thickness. Static balance was best in hard-soled (low
    resistance) shoes.
    The exercises prescribed need to challenge the patient's
    balance and therefore are ones that may make them
    stumble or fall. Upper extremity support changes the
    sequence of muscle activation so that it originates in the
    upper extremities.
     This alteration in the sequence of muscle
    activity is not usually desirable if the goal of
    treatment is independent ambulation without an
    assistive device.
     For standing exercises, having the patient stand
    in a corner of the room with a chair in front of
    them provides a surface on all sides that can
    catch the patient, minimizing the chance of
    injury.
     It is unknown how frequently balance exercises
    need to be performed for maximum
    improvement
    References

     1.Geriatric Physical Therapy by Andre A


     Guccione.
     2. Fundamentals of Geriatric Medicine.
     3.Gerontology for health care professional by
    regula H robbnet/ walter.
     4. Handbook of gerontology by James A Blackburn
    and Catherine N Dulmus
    Learning Outcome

     Students may be able to:

     Assess Balance and Gait in elderly

     Make exercise plan for improving balance in elderly


    THANK YOU

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