Fall Assessment Outcome Lab

falls & elderly

$50 billion for non fatal, $754 million for fatal

>65 = leading cause of injury and death

intrinsic risk factors

gait & balance impairment

peripheral neuropathy

vestibular dysfunction

muscle weakness

vision impairment

medical illness

advanced age

impaired ADL

orthostasis

dementia

drugs

extrinsic risk factors

environmental hazards, footwear, restraints

postural control

COG over BOS in static and dynamic situations
• Integration of sensory system, CNS, and neuromuscular system

ankle strategy

small disturbance of BOS
• ankle muscle activation

hip strategy

sudden and forceful disturbance
• hip muscle activation

stepping strategy

COG displaced beyond limits of BOS
• forward/backward step

reaching strategy

reaction to large perturbation
• moving arms to grasp or touch object for support

suspensory strategy

lowers COG to enhance postural stability
• flexing knees, lowering COG

home 3 part assessment

• 1) Assess commonly used areas inside and outside the home
• 2) Observe the person moving around the environment
• 3) Determine the person’s fall risk and health status

limitations of MMT

• Ceiling effect of available strength
• Make test: inaccuracies of available strength
• Break test: can be aggressive in frail patients
• Subjective grading
• Patient effort, understanding, willingness affects results
• Testing position may not reflect functional performance (open-chain testing vs closed-chain function)

self report OM

patient perception of impairment, function, QOL
• Falls Efficacy Scale

patient OM

asks patient about impact of condition on activities and roles in life
• DASH

observer rated measures

measures observed by PT
• BESTest

physiological measures

measure single biological entity (ie, cognitive ability, pain, exertion)
• Borg RPE

Functional Performance Measure Considerations

• Validity and reliability
• Floor and ceiling effect
• MDC
• MCID
• Sensitivity and specificity
• Positive and negative likelihood ratio