Fall Prevention: Introduction (12:45)
Shelly Denes introduces herself. Debra Rose created the FallProof program to assess and treat balance-related problems in home care. Men are at an increased risk to fall than women of the same age; after 80 recovery is difficult.
Classification of Falls (12:35)
The three types include accidental, unanticipated physiological, and anticipated falls. Denes provides photographs of rooms that carry increased preventable risks. Most falls occur 30-40 minutes after a visitor or healthcare worker leaves.
Assessment of Falls (11:00)
Look at the environment, medications, cardiac, respiratory, psychological, and neurological health. Benadryl and Ambien should not be given to older adults. Elavil or Trazodone can be used to help patients afflicted with a CVA.
Assessment of Balance (16:51)
Denes and participants discuss the merits and drawbacks of the Tinetti Balance and Gait Study, the Berg Elderly Mobility method, and the Timed Up and Go test. Sit to Stand is one of the key movements when assessing balance. Look at medications, glasses, shoes, cleanliness, and lighting.
Balance Sensors (14:46)
Sensors include the inner ear, eye, and proprioception. Denes discusses how cochlear implants, migraines, and vertigo might affect balance. The ability to detect light touch, position in space, stereognosis, and determining vibrations decrease as people age.
Romberg Test (08:34)
Denes describes the testing method that is present in the Tinetti Balance and Gait Study as well as the Berg Elderly Mobility test. Individuals need two sensory systems working in order to balance effectively. Folic acid deficiencies, alcohol, and thyroid problems can cause reduced proprioception.
Falls: Intrinsic Factors (18:41)
Changes in elderly's vision include glare intolerance, loss of acuity, macular degeneration, decreased contrast, and altered depth perception. Place colored duct tape on stairs, turn dashboard lights down when driving, and paint doorways and toilet seats different colors from its background. Denes and participants discuss osteoporosis in post-menopausal women.
Participants believe approximately believe that 80% of their patients feel pain. Denes discusses neuropathic pain in the diabetic population and those afflicted with transverse myelitis. Keep patients active, in good shoes and support hose; medications include Lyrica, Neurontin, Elavil, serotonin norepinephrine, and reuptake inhibitors.
Urination Issues (10:47)
One home care worker provides her patients with a training video that explains Kegel exercises and keeping a bladder diary. Cut up newborn diapers instead of purchasing depends because it is more cost-effective.
Falls: More Intrinsic Factors (15:55)
Other intrinsic factors include collagen diseases, glaucoma, dehydration, oxygen tube tripping, hearing deficiencies, and dementia. Denes describes snout, glabellar, and palmomental testing.
Chronic Illnesses (17:31)
Diabetes, Parkinson's disease, Multiple Sclerosis, peripheral neuropathy, UTIs, incontinence, and heterotopic ossification cause increased risks of falling. Digital reduces bone formation. A hard end field is when the joint is bone on bone.
Medications that Cause Falls (11:22)
Benzodiazepines, anti-convulsants, anti-Parkinson's, anti-depressants, anti-psychotics, muscle relaxants, and analgesics affect blood pressure. Denes discusses the benefits and drawbacks of each type of medication, citing specific drugs. Have patients take the medication bottles with them to the doctor.
Falls: Extrinsic Issues (11:38)
Environmental factors that can cause issues include slippery floors, improper equipment, similar coloring, rugs, furniture heights, no chair arms, and ill-fitting shoes. Denes describes a checklist for home evaluations.
Keeping Active (07:02)
Movement and Exercise are important for long-term health. Denes discusses Morse, Briggs, and Missouri fall risk assessments. Fear debilitates patients and causes a vicious cycle of falling.
Balance Strategies (10:51)
Denes explains ankle, hip, and stepping strategies to prevent falls. Muscle spindles regulate balance during quiet posture; the center of gravity is normally around L4. Literature is conflicted over the efficacy of hip protectors.
Minimizing Fall Risk (15:12)
Minimize medications, compression socks, abdominal binder, exercise, reachers, elastic shoelaces, and manage footwear, silver mother, wheelchair alarm, floor mats, and granny alarms. Bed Alarms bother roommates, are not fast enough, and patients can turn it off.
New Balance Equipment (13:05)
Place tape on the walker to denote whether a person can walk independently, need help, or should not get up. Use Lofstrand crutches to help promote trunk rotation. Michael Graves designs orthotic equipment and furniture for patients.
Provide Education (10:26)
Calling 911 after a fall and asking for an ambulance assist in Chicago will not cost anything. Denes reviews strategies how to fall and get back up; physiological falls can cause self-efficacy issues. The American Physical Therapy Association created a list for home evaluations.
The FallProof Program (20:38)
Debra Rose created a balance and mobility program for the assessment and treatment of balance-related problems based upon motor control theory. Older adults exhibit squelched righting reactions. Denes demonstrates different exercises to perform with patients.
Hospital Beds (17:02)
Most patients should return to a regular flatbed after discharge. Denes explains the benefits of turning a person prone or to their side.
Afternoon Break (08:45)
Denes checks her computer to see if she included the file in her Dropbox and answers questions from participants.
Nutrition and Gait Speed (14:45)
People who fall tend to have poor nutrition. PT Blue cross guidelines only provide ten visits for falls; use community resources for your clients. Get patients walking as quickly as they can safely.
Gait Pattern (10:13)
Inspect a client's reciprocal arm swing. Denes reviews proper mechanics of walking and posture. Strength training will improve balance.
Gait Balance (10:02)
Rehabmeasures.org provides the Tinetti Balance and Gait Study, functional gate index, functional reach, the Berg Elderly Mobility method, and Timed Up and Go tests as well as assessment procedures. On the TUG test monitor n-block turning and other movement patterns.
Forward Head (07:51)
Watch a video on a forward head movement. Create a lengthening posture in patients. Denes and Participants discuss other exercises to improve forward head.
Denes describes several types of braces including TLSO, KAFO, and AFOs. An incomplete paraplegic woman begins to walk after three months of therapy. Watch a video of improvement with a "Blue Rocker" toe-off for foot drop.
Shoes, Soft Tissues, and Trendelenberg (21:52)
Denes recommend minimus shoes for elderly patients. Make sure the toes can spread. Techniques to perform on your patient as an intervention include myofascial release
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