balance exercise for elderly
TRANSCRIPT
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 1/46
Balance and FallsBalance and Falls
Nancy V. Karp, Ed.D., P.T.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 2/46
Normal Postural ControlNormal Postural Control
Postural control involves controlling the
body’s position in space for:
Stability
Orientation
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 3/46
FallsFalls
Falls in the elderly are a major cause of: morbidity
Mortality
The underlying causes of falls is a complex interaction of:
Biomedical factors Physiological factors Psychosocial factors Environmental factors
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 4/46
Incidence and Cost of Falls in the
Elderly
Incidence and Cost of Falls in the
Elderly Falls of people 65+
One third of people 65+ fall each year.
Elders > 75 account for 60% of fall-related deaths. 25% of elders who fracture their hip in a fall will diewithin a year.
Costs Falls account for 70% of all injury-related costs for the elderly,
The average cost for a fall injury is $20,000.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 5/46
Falls in the Elderly Falls in the Elderly
Most falls result in minor or no injury.
Repeat fallers tend to fall in the same manner as they did in the previous fall.
A single fall results in: Fear of falling and loss of confidence Restriction in activities Social isolation Dependence on others
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 6/46
Identification of Fall Risk Factors
Identification of Fall Risk Factors
Risk factors for falls are divided into two categories:
Intrinsic Risk FactorsDizziness, weakness, gait abnormalities, poor balance,confusion, poor coordination, ROM, cognitive impairment
Extrinsic Risk Factors
Floor surface, poor lighting, cluttered furniture, obstacles,non-level surface, poor shoes
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 7/46
Falls are a result of loss of
postural control.
Falls are a result of loss of
postural control.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 8/46
Normal Postural Control
(Balance)
Normal Postural Control(Balance)
Balance requires keeping the “Center of Mass” (COM) over the “Base of Support” (BOS) during static and dynamic situations.
Neural components of postural control: Sensory processes
visual, vestibular, somatosensory
Central processing a higher-level integrative process
Effector component sometimes referred to as the neuromuscular component postural alignment, ROM, muscle force, power &
endurance
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 9/46
Normal Postural ControlNormal Postural Control
Adaptive postural control requires
modifying sensory and motor systemsto changing tasks and environmental demands.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 10/46
Postural Control During Quiet
Stance
Postural Control During Quiet
Stance
Body aligned to minimize the effect of
gravitational forces.
Muscle tone
Postural tone
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 11/46
Quiet StanceQuiet Stance
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 12/46
Limits of Stability (LOS)Limits of Stability (LOS)
The maximum angle (from vertical) that can be tolerated.
How far you can shit from front toback and side to side without loosing balance? This is often called your
“Cone of Stability.” “Postural Sway” refers to small postural
shifts from front to back and side to
side, during quiet stance.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 13/46
Limits of Stability Limits of Stability
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 14/46
Cone of
Stability
Cone of
Stability
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 15/46
Cone of
Stability with Assistive
Device
Cone of
Stability with Assistive
Device
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 16/46
Postural Sway Postural Sway
The larger the sway path, the greater the postural unsteadiness.
Romberg Test- Closing eyes will decrease visual input. “Standing
Postural Sway” may increase,decreasing balance.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 17/46
Postural Control During
Perturbed Balance
Postural Control During
Perturbed Balance
The recovery of stability requires
movement strategies that control theCOM over the BOS.
“Limits of Stability” is defined as thedistance a person can move, without losing balance or taking a step.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 18/46
Perturbed BalanceMovement Strategies
Perturbed BalanceMovement Strategies
The “ankle strategy” occurs
with minimal perturbance of balance.
Control is distal- to-proximal
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 19/46
Perturbed BalanceMovement Strategies
Perturbed BalanceMovement Strategies
Moderate instability leads tothe “hip strategy”.
Control is proximal-to-distal
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 20/46
Perturbed BalanceMovement Strategies
Perturbed BalanceMovement Strategies
The “stepping strategy” is
used with greater perturbance.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 21/46
Perturbed BalanceCentral Nervous System
Perturbed BalanceCentral Nervous System
The response can either be protectiveor corrective.
“Anticipatory Postural Control” refers to postural adjustments that are made
before voluntary movements tominimize disturbances in balance (feed forward).
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 22/46
Perturbed Balance
Central Nervous System
Perturbed BalanceCentral Nervous System
“Reactive control” is the response to adisturbance in balance (feedback).
Corrective Strategy, such as the “ ankle strategy”
Protective Strategy, such as covering your head
when you fall This does not correct the fall, but controls the effects of the fall.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 23/46
Perturbed Balance
Movement Strategies
Perturbed Balance
Movement Strategies The CNS activates muscle synergies in
related joints.
Force in one part of the body does not causeinstability in another part of the body.
Leaning over in a chair to pick up a pen, you do not fall
out of the chair. Neck extension during the “hip strategy” prevents the
body from falling forward.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 24/46
Central Processing TestsCentral Processing Tests
Manual Test of Postural Perturbance
Therapist pulls patient, at waist level,several times with varying degrees of
force. See Guccione, p. 287
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 25/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory System
During perturbance of balance:
Adults rely on somatosensory inputs. Children rely more on visual input.
The interaction of the senses allows themodification needed to maintain stability in a variety of environments.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 26/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory System
The three different parts of the sensory
system provide different sources of information about the body’s positionand movement in space.
Each sense provides a different frameof reference for postural control.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 27/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory System
The “Postural Dyscontrol” Test will be
performed in class.
“Foam and Dome Test”
O’Sullivan, p. 193
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 28/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory SystemVision provides information about the positionand motion of the head in the environment.
Acuity- detects subtle differences in shapesSnellen Eye Chart (min 20/200)
Depth perception
Finger Test, Guccione p. 286 Peripheral vision
Finger Test, Guccione p. 286
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 29/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory System T he somatosensory system
provides information about the
body with reference to supporting surfaces.
The somatosensory system
receives information from musclespindles, joint receptors, tendonorgans, and mechanoreceptors.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 30/46
T he Somatosensory systemT he Somatosensory system
Gross Tests of Proprioception Detecting the subtle movement of the big
toe (< 5mm).
Vibration- Placing a tuning fork at the first
metatarsal head.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 31/46
Normal Postural Control
Sensory System
Normal Postural Control
Sensory SystemThe Vestibular System Provides information about the position and
movement of the head, in reference to gravity and inertial forces.
Information is received from the vestibuleresponsible for position and linear acceleration.
Information is received from the semi-circular canal responsible for rotational movement.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 32/46
The Vestibular SystemThe Vestibular System
Gross Functional Tests
Guccione, p. 286 Looking at a object while turning head
Reading a book while walking
Marching in place with eyes closed
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 33/46
Postural ControlPostural Control
Controlling the body’s position in space
is an essential part of functional skills.
Postural control requires all three:
Sensory system Central processing Effector components
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 34/46
Postural ControlPostural Control
The three systems in postural control
are complex and multifaceted. A problem or impairment in one area may affect several other areas, resulting in a
greater affect than the loss of the singleimpairment.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 35/46
The Effect of Aging on
Postural Control
The Effect of Aging onPostural Control
The Sensory System
With aging, vision may decrease in acuity,contrast sensitivity, and depth perception
With aging, the vestibular system may undergo age-related changes, resulting in
dizziness and unsteadiness. With aging, there may be a decrease in proprioception and vibration.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 36/46
Aging Effects on Postural
Control
Aging Effects on PosturalControl
The Central Processing System
Aging may result in a slowing of sensory information. Aging may result in a slowing of nerve conduction
velocity. Aging may result in increased postural sway. Aging may result in an increased incidence of co-
contractions Aging may result in an increased use of proximal-
to-distal control for balance.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 37/46
Aging Effects on Postural
Control
Aging Effects on Postural
ControlThe Effector System
Aging may result in decreased muscle
strength. Aging may result in decreased ROM and
flexibility. Aging may result in increased “stiffness” of
connective tissue Aging may result in cardiovascular
changes
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 38/46
Functional TestsFunctional Tests
Progressive Mobility Skills Assessment Task
Guccione, p. 288
Berg Balance Scale (note that the “Functional Reach Test” is part of this test)
O’Sullivan, p. 208
Performance-Oriented Assessment of
Mobility I (Tinetti)
O’Sullivan, p. 210
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 39/46
Other AssessmentsOther Assessments
Environmental Assessments
Chapter 12, O’Sullivan
Psychosocial Assessment Cognitive assessments
Social work assessments
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 40/46
InterventionsInterventions
Interventions should be based on assessment results.
The ultimate goal will is to maximize independence inmobility and function.
The therapist needs to identify and treat modifiable
deficits.
The therapist needs to identify and help the patient compensate for deficits that cannot be modified.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 41/46
Some balance exercises for
older people.
Some balance exercises for older people.
Exercises - National Institute on Agingl
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 42/46
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 43/46
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 44/46
TandemWalking
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 45/46
Fall PreventionFall Prevention
The purpose of assessment and intervention is to prevent the next fall.
7/29/2019 balance exercise for elderly
http://slidepdf.com/reader/full/balance-exercise-for-elderly 46/46
Balance and FallsBalance and Falls
The End