Physiotherapy and Geriatric care management

 FALLS PREVENTION IN GERIATRIC CARE

Definition of a fall

A fall is an event which results in a person coming to rest inadvertently on the ground or other lower level.

This includes a headlong tumble down a flight of stairs, a loss of balance resulting in a fall to the floor into a sitting or lying position, sliding out of bed or slip off the kerb onto the road.

Consequences IMPACT of falls

·         Fractures – approx 96% of fractures follow a fall.

·         Dislocations

·         Lacerations

·         Sprains

·         Deep bruises

·         Joint pain – leading asymmetry

·         Loss of confidence

·         Decreased mobility

·         Soft tissue injury

Costs of falls

·         Falls, falls related injuries and the fear associated with falling have a huge cost, both to the NHS and to the individuals themselves, their family and carers.

(Dolan and Torgerson, 1998)

·         6 months after hip surgery, 50% of patients will have died, entered a nursing home, or will be in hospital again.

·         Only 20% regain full pre-fracture mobility

(Lord 1992)

           Ratio Of age

The incidence of falls is high among the older population:

                      aged 65+  1 in 3 women fall each year &1 in 5 men fall each year

aged 85+  1 in 2 men and women fall each year 

           Risk factors of falls

·         History of falling

·         Medication

·         Impairments of gait and balance

·         Dizziness

·         Neuromuscular factors

·         Dependence in any activity of daily living

·         Low body mass index

·         Chronic diseases

·         Visual impairment

·         Cognitive impairment

·         Physical activity

·         Alcohol

·         Environmental hazards

·         Multiple risk factors – more than 4 – high risk

·         When assessing a falls patient, it is advisable to keep DAME in your mind:

·         Drugs and alcohol

·         Age related physiological changes

·         Medical

·         Environment

Physiotherapy INTERVENTION

·         Gait re-education

·         Improve balance

·         Improve muscle power

Gait re-education

·         Parallel bars –

·         Improves confidence

·         Isolate abnormal points of gait which lead to falls

·         Eg at ankle – toe drag during swing – weak dorsiflexors

·         Foot slap at initial contact – below normal dorsiflexor activity

·         At knee – diminished extension during stance phase – reduced ROM at knee

·         Limited flexion at knee during swing phase – compensating for reduced flex at hip or ankle

·         At hip – hip hiking during swing phase – weak hip, knee or ankle flexor muscles

·         Trendelenburg gait – weak hip abductors

Static and dynamic balance

Static balance is the maintenance of the body mass above the BOS that is not moving. Dynamic balance is when the balance is maintained above a BOS that shifts. An example of static balance is single leg stance. An example of dynamic balance is walking.

Balance strategies

• An adequately functioning balance system is integral to most of our other abilities. Our bodies have developed highly adaptive balance mechanisms and numerous safety systems.
• Information about movement and the environment is supplied to the CNS by vision, proprioception and labyrinthine discharges.
• There are three postural control strategies which counteract challenges to balance:
• Ankle strategy – motion around ankle joint when balance is challenged
• Hip strategy – this is characterised by quick flexion and extension forces generated by the muscles around the hip in an effort to maintain a persons centre of gravity above the base of support.
• Stepping strategy – this is the action of one or more steps as a response to displacement of a persons centre of gravity outside the base of support.

Program

·         Warm up

·         Walk on spot

·         Stretch

·         Calf

·         Hamstrings

·         Hip flexors

·         Strength exercises

·         Dorsiflexion

·         Quads

·         Gluteals

·         Balance

·         Balance recovery sideways/backwards

·         Eye tasks

·         Head/eye movement with object

Equipment used

1.      Weights

2.      Wobble boards

3.      Parallel bars

4.      Steps

5.      Gymball

Dorsiflexion exercises

1.      Tapping toes against the ground

2.      Toe raises

3.      Walking on heels

          

Quads exercises

1.      Knee extension in sitting (with or without weights)

2.      Inner range quads on quads bar

3.      Leg swings

4.      Marching

5.      Stair practice

Hip extensor exercises

1.      Pushing heel into bed/plinth

2.      Bridging

3.      Sit to stand

4.      Posterior leg swing

5.      Squats

6.      Active extension with ankle weight

Hip abductor exericses

1.      Sidestepping

2.      Single leg stance – active abduction

3.      Resistance – ankle weights

Balance recovery

1.      Balance exercises with a gymball

2.      Lateral weight transfer

3.      Front to back weight transfer

4.      Throwing and catching ball

5.      Functional reach exercises

6.      Practise stepping strategy

  

Eye tasks

1.      Point to point, head still

2.      In and out

3.      Tracking

4.      Eyes still, head moves

This is some info that we can use to let the geriatric patient is learning and to improve their function ,fall is one of the risk can cause a lot of problem for elderly , so the prevention measurement is important to take action..wallahuaklam..

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