623 3.1 Balance and Falls in Elderly

falls

Leading cause of injury-related deaths among people age 65 and older

death

Over 3,000 falls per month lead to _________ in adults 65 and older

hip fracture, TBI

highest resulting injuries from falls in those 65 and older

1/4

__/___ adults aged 65 and older falls each year, and half do not tell their doctor

$50 billion

cost of treating injuries from falls per year

fractures

PRIMARY consequence of falls

67

Balance confidence below ___& leads to an increase in falls

32

% of people who end up in the hospital or require assistance w/ activities after falls

sensory impairments, pathologies, cognitive deficits, medications, environment

5 main factors that contribute to falls

4+

number of prescription drugs that increased the risk for falls compared to fewer

dirty/cluttered home, external factors that lead to slipping/tripping/bumping, faulty footwear

Environmental examples that lead to falls

Sensory Environment

The conditions which exist or are perceived to exist in the real world around us that impact balance

ID cause

ID modifiable RFs

Control Environmental Hazards

Education

4 steps to fall prevention

Install handrails, improve lighting, repair steps and flooring, install grab bars, remove clutter, use non-slip mats and treads

Education for fall prevention examples

results from the combined function of multiple sensory, motor, and neural systems

What does it mean for balance to be integrated?

vestibular, visual, proprioceptive

3 sensory systems needed for optimal balance

cerebellum, cerebral cortex, brainstem

three main integration sites of sensory input for balance

all the systems involved in balance constantly communicate and influence each other in real time

What does it mean for balance to be interactive

Gaze stability

ability to maintain gaze or visual focus on an external target during movement

Postural Stability

The ability to maintain the body's center of gravity (COG) over the base of support (BOS) in a given sensory environment

Center of mass

An imaginary point in space that is at the center of the total body mass; unique point where body forces sums to zero (all particles of body are equally distributed)

F (depends on mass distribution, not orientation)

T/F. COM depends on vertical orientation

COM

The point where if a force is applied, it moves in the direction of the force without rotating

Center of Gravity (COG)

The vertical projection of the COM onto the ground; point of origin about which all particles of body are equally distributed

vertical

COG refers only to __________ direction in which gravity acts

Center of pressure

A vertical line projecting downward from the actual center of gravity into the force plate; a representation (indirect measure) of center of gravity

Center of Pressure (COP)

vertical ground reaction force vector; weighted average of all the pressures over the surface of the area in contact witht he ground

between the two feet

If both feet are in contact with the ground, where would the net center of pressure lie?

BOS

The area of the object that is in contact with the support surface (anteroposterior length of the foot and mediolateral width of stance)

COG

When _____ leaves the BOS, people are at highest risk of falling

limits of stability

The furthest distance in any direction a person can lean away from midline (upright vertical) without altering the BOS, reaching or falling

12.5º total, (8º forward, 4.5º backward)

Normal limits of stability AP

16º total (8º R and L)

Normal limits of stability ML

core

strength in what area can help improve limits of stability?

COM over BOS

how to maintain postural stability

motions of COM and COP

how to minimize postural stability

COM & COP back to optimal location

how to restor postural stability

Quiet Standing

Present during quiet standing to maintain balance

Net center of pressure

How is quiet standing measured?

Static Balance

Ability to maintain an upright posture and keep the COG within the limits of BOS

Dynamic Balance

Ability to maintain stability during weight shifting and changes in BOS

dynamic balance

balance in which falls usually occur, and where we would need the most therapy

BOS

Theoretical limits of stability (LOS) during stance are traditionally considered to be dependent on what measure?

static standing (insufficient in dynamic situations)

LOS is valid during what type of balance?

position, velocity

Stability limits depend on what two dynamic factors?

maintains steady balance w/o handheld support

Normal Static Balance

Accepts max challenge and can shift weight easily w/in full range

Normal Dynamic Balance

Able to maintain balance w/o handheld support w/ limited postural sway

Good Static Balance

Accepts mod challenge, balances while picking objects off the floor

Good Dynamic Balance

Maintains balance w/ handheld support, may need occasional min assist

Fair Static Balance

Accepts min challenge, balances while turning head/trunk

Fair Dynamic Balance

Requires Handheld support and mod/max assist to balance

Poor Static Balance

Unable to accept challenge or move w/o LOB

Poor Dynamic Balance

T

T/F: Balance must be maintained to achieve GAIT

keep body COM w/in BOS

Gait Standing GOAL in terms of balance

Body moves over ground w/ one step - balance drastically altered

Gait Initiation changes to balance

COG moves forward as we voluntarily initiate forward falling (accelerated COG ahead of BOS)

Gait Acceleration changes to balance

Move body outside BOS and prevent falling

Gait Goal

COP moves posterior and toward the swing limb (accelerates COG forward)

What happens in the release phase of gait initiation?

rapid activation of stance limb

What happens in the unloading phase of gait initiation?

forward under stance foot

after unloading the stance limb, where does the COP move?

mirror images

How are COP and COM trajectories different in gait termination from gait initiation

w/in BOS

During termination of gait, the COG must move where?

forward along medial border of each support foot

How does COG move relative to the support foot during gait?

accelerated away from support foot toward future position of swing foot

How does COG move relative to the support foot during single limb support of gait?

VOR, motor impulses for postural adjustments and eye movements

Motor output of balance is determined by:

visual, vestibular, somatosensory (proprioception)

sensory systems in dynamic equilibrium for balance

F (always try to improve the area they are deficient in before strengthening leftover areas)

If an individual is deficient in their sensory system, we should try to improve the other two systems first. T/F

ankle muscles, legs/thighs, trunk muscles

Motor systems of dynamic equilibrium

ankle, hip, step

Motor strategies relied on in order from first to last

relay info about head position, linear/rotational/accelerating movements of the head, gaze stability, balance/posture stability, overall orientation in space

Vestibular system function on motor ouput

Fudka Step Test

a balance assessment that helps detect potential problems with the vestibular system. During the test, a person marches in place with eyes closed and arms outstretched

rotation >30º

positive fudka test

must assess balance and vestibular dysfunction for ppl w/ high fall risk

decrease fall risk

decrease injury risk

improve functional mobility

improve QoL

role of healthcare interdisciplinary team in balance