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211 exam 1
Balance and Falls in the Elderly
| Question | Answer |
|---|---|
| falls are a major cause of ____ and ____ | morbidity, mortality |
| how do falls affect a persons quality of life? | Loss of confidence in one’s ability to do tasks→Restriction in activities/Social isolation / Decreased life space→dependence on others |
| what causes more falls? | increased deconditioning |
| examples of intrinsic risk factors for falls | Strength deficits Balance deficits Mobility deficits Medication errors, mismanagement, and polypharmacy Vision impairment Cognitive impairment Depression Effects of multiple comorbidities |
| what type of factors cause 70% of falls in the elderly? | intrinsic |
| examples of extrinsic factors for falls | Slippery surface Loose rug Poor lighting Obstacles |
| what type of factors cause 39% of falls in elderly? | extrinsic |
| Falling increases as risk factors ____ | accumulate |
| Many falls are a combination of ___ and ____ factors | intrinsic, extrinsic |
| functional reserve | A significant degree of function can be lost before clinical symptoms appear |
| how does age affect functional reserve | Older adult’s functional reserve is diminished ex: more loss of postural strategies |
| Individual’s ____ vary more the older they become | function |
| ___ age and ____ age widen as we get older | biological and chronological ex: One 65 y/o might go nordic skiing 50K and another has difficulty walking to the mailbox |
| When only one ____ component is lost, function is usually maintained. When more losses occur, function may be lost | sensory ex: Decrease proprioception = substitute vision, if both lost = inability to walk. |
| Consequences of impaired mobility in the older person may vary depending on his ___, ____, and ____ resources | social, emotional and behavioral |
| ___ ____ is strongly associated with fall risks | Poor judgment |
| what may reduce fall risk | Strong social support, sound judgment in risk taking |
| 4 approaches to assessing falling syndrome in geriatric pt | Ecological, biomedical, pathophysiological and functional |
| ecological approach to assessing falling syndrome in geriatric pt | Focuses on extrinsic components, Modify environmental factors according to level of ability |
| when may a fall occur with min, mod and severe impairment according to the ecological approach? | Minimal impairment – icy Moderate impairment – uneven surface Severely impairment – walking at home |
| bio medical approach to assessing falling syndrome in geriatric pt | Focuses on medical events that may contribute to falls Identify acute illness, electrolyte imbalances, drug side effects etc. Identifies diseases – CVA, Parkinson’s, etc. |
| the biomedical approach is ____ driven | physician |
| pathophysiological approach to assessing falling syndrome in geriatric pt | Identifies deficits in postural control that adds to instability This includes sensory, effector system (strength, ROM, endurance) and central processing |
| the pathophysiological approach is ____ driven | PT |
| functional approach to assessing falling syndrome in geriatric pt | Identify important routine movements of certain functional activities that the patient has difficulty doing. Example: weight shifts, rolling, Ambulation etc. |
| the functional approach is ___ driven | PT |
| 3 major systems the body uses to maintain balance | visual, somatosensory, vestibular |
| acuity | ability to detect differences in shapes |
| contrast sensitivity | ability to detect differences in shading and patterns (see steps with patterned carpet) – most common to be diminished in the elderly |
| components of visual system | acuity, contrast sensitivity, peripheral vision, depth perception |
| somatosensory system | Proprioceptive input – commonly diminished in elderly |
| vestibular system | head movement and position, interacts with visual and somatosensory information. |
| what does the body use to determine an effective and timely response | central processing |
| CNS maps the location of the ____ and adapts in disequilibrium | COG |
| CNS receives sensory input and processes it according to ____, and responds | previously learned responses |
| feedback | situations when the body is perturbed by an external event (tripping over a rug) and the CNS responds to reset COG. unexpected |
| feed forward | CNS sets up a postural response in anticipation of disturbed COG. (catching a ball) planned response |
| normal responses follow ___ to ___ sequencing | distal, proximal |
| what type of balance strategy is used for mild perturbation? | ankle |
| what type of balance strategy is used for moderate perturbation? | hip |
| what type of balance strategy is used for severe perturbation? | stepping |
| responses in the elderly follow a ____ to ____ sequencing, or have ____ | proximal, distal (backwards) or have co- contraction of mm |
| how do elderly respond to perturbations | Delayed responses to perturbations Ineffective responses to mild or moderate change of COG use stepping, then hip, then ankle strategy (backwards) |
| elderly fallers Have weaker distal lower extremity ___than healthy ones. (knee and ankle) | torque |
| Loss of ____ may lead to ineffective response strategy | flexibility |
| what should be included in the PT eval history? | Onset and number of falls over a given time Environmental conditions Activities at the time of falls Directions of falls – signals postural control faults Meds |
| visual assesment score of __/__ may contribute to instability | 20/200 |
| how to test for visual field | fingers at side of head |
| testing for depth perception | Index fingers together at eye level --> pull fingers apart --> PT moves them back together -->pt tells when fingers are even – if off by 3” problem |
| sensory integration (organizational) test | Cook and Shumway |
| vestibular ocular reflex (VOR) | gaze stabilization, need for driving, reading book while walking, march in place with eyes closed allows us to focus while things around us are moving |
| how to test VOR | Therapist holds finger up patient turns head back and forth rapidly and maintains gaze on finger (deficit may move off target) |
| saccades | eyes 'jumping' while moving gaze across or up and down normal, but if exaggerated can cause problems |
| how to test for saccades | follow finger across visual field or up and down |
| somatosensory assessment | Proprioception Vibration – tuning fork |
| effector system assessment | Strength ROM Endurance – 6 min walk with rests as needed – measure total distance covered. |
| central processing assessment | Check feedforward and feedback Postural Stress Tests – mild, moderate, severe perturbations/check strategies |
| functional assessment - standardized tests | Rhomberg – able to maintain 30sec is normal – see PTA Exam book Functional Reach test Tinneti TUG SOT |
| what should be observed in environmental assessment | Observe function at home Get I&OO favorite chair Observe function at home Open/close high cupboards On and Off toilet etc. Check lighting, cords, clutter, rugs |
| modifiable deficits | Vestibular may be treatable Strength, ROM, Endurance Poor sense of midline or COG things we can identify and treat |
| fixed deficits | Vestibular may not be treatable – use assistive device Vision – refer to geriatric optometrist Proprioception deficit –use vision things we can't directly treat, pt may need to referred out |
| balance is highly ___ specific | task |
| the goal is to maximize ___ ___ within the margins of safety | functional independence |
Created by:
bdavis53102
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