fall risk reduction program module #6 of 6
DESCRIPTION
Fall Risk Reduction Program Module #6 of 6. Shelley Thomas, MPT, MBA Dara Coburn, M.S., CCC-SLP. Fall Risk Reduction Program: Review of Modules 1 - 5. In the first module we reviewed the premise of the Fall Risk Reduction Program, including the inclusion criteria for patient selection. - PowerPoint PPT PresentationTRANSCRIPT
Fall Risk Reduction Program
Module #6 of 6
Shelley Thomas, MPT, MBADara Coburn, M.S., CCC-SLP
Fall Risk Reduction Program: Review of Modules 1 - 5
In the first module we reviewed the premise of the Fall Risk Reduction Program, including the inclusion criteria for patient selection.
The second module reviewed patient assessment Identifying patients at risk of falling Evaluating patients in a dual task condition to simulate “real life”
situations The third module covered how to determine which systems of balance
were weakest and develop an exercise program for those systems. The fourth module looked at IM scores and how to utilize them to
establish treatment plans, how to advance exercises based on domains of challenge, and how to gauge progress through reassessment.
In the fifth module, we discussed discharge planning and establishing effective home exercise programs.
Module 6 Agenda
Review a case study from start to finish Patient suitability Patient evaluation Determine balance systems impacted Establish treatment plan Advancing the exercises Determining when to discharge Home exercise planning
Case StudyIs this patient a suitable candidate for an
IM Fall Risk Reduction Protocol
73 year old male with history of three falls in the last two months.
Had L2-5 laminectomy and fusion (July, 2011) Past medical history significant for CABG x 4
(2010) with documented anoxic event during surgery
Patient and family report cognitive changes after heart surgery.
The patient reports he is still “not quite right”.
Case StudyIs this patient a suitable candidate for an
IM Fall Risk Reduction Protocol
Lives alone in 2 story home with 4 steps to enter and 14 steps inside home.
Hires help with housework and cooking. Receives Meals on Wheels. Family assists with finances and checks
on patient several times per week. Was participating in regular exercise
program until back problems worsened.
Case StudyIs this patient a suitable candidate for
an IM Fall Risk Reduction Protocol
Patient described his falls as “stupid” and “exasperating”. Fall 1: He caught his toe on a change of surface (moving
from carpet to linoleum). Fall 2: Walking to the mailbox and slipped. Reported he
“wasn’t paying enough attention”. Fall 3: In a parking lot. Patient reports he got distracted by
another person and “mis-stepped”.
Referred for physical and speech therapy to address balance and cognitive deficits.
Case Study: PT Evaluation ROM: No significant limitations Strength: 4/5 throughout upper and lower
extremities. Proprioception: Intact Vestibular: Unable to walk with
horizontal head turns without loss of balance. Also demonstrates LOB with eyes closed activities.
Endurance: Fair – patient reports fatigue after 5-10 reps of exercise
Case Study: PT Evaluation
TUG = Timed Up and Go
Test Patient Score
At High Risk for Falling if:
TUG alone: 11 seconds > 14 seconds
TUG Cognitive:
16 seconds > 14.5 seconds
TUG Manual: 18 seconds > 15 seconds(Shumway-Cook, Brauer, & Woollacott, 2000)
Case Study: ST EvaluationSubtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills.
* Within Normal Limits
Subtest Standard Score Severity Rating
Immediate Memory 9 ModerateRecent Memory 13 MildTemporal Orientation 12 ModerateSpatial Orientation 8 ModerateOrientation to Environment 13 MildRecall of General Info 15 WNL*Problem Solving and Reasoning 13 Mild
Case Study: ST EvaluationSubtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills. Subtest Standard Score Severity Rating
Organization of Information
8 Moderate
Auditory Processing and Comprehension
13 Mild
Problem Solving and Concrete Reasoning
16 WNL
Naming Common Objects
19 WNL
Functional Oral Reading
19 WNL
Case Study “Patient Selection Worksheet” from Module 2
LFA
Case Study “Designing an Exercise Program” Worksheet from Module 3
Case Study “Designing an Exercise Program” Worksheet from Module 3
How to Develop and Advance Treatment Plan
Problem
Areas
Musculoskeletal System
Proprioceptive System
Vestibular System
Oculomotor System
Cognition, Communicati
on
Strengthening exercises, postural reeducation, balance strategiesChallenge
cognition/communication, recall, word finding, impulse control, sorting, sequencing, divided and selective attention
Uneven surfaces, eyes closed, head turns with gait, spinning, changes of direction
Treatment Plan
Received PT and ST, 2x/week x 6 weeks
1 hours sessions per discipline
Performed approximately 30 minutes of IM 2x/week x 6 weeks
Sample Case Study Treatment PlanSession #: Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7 session 8 Session 9 Session 10 Session 11 Session 12Total Time: 40 25 28 30 34 33 32 34 35 32 34 47Long Form Assessment 15 15Phase 1, 2, 3 activities 25 25Leg Squats 2 2 2 2Lunges 2 2 2 2Heel Raises 2 2 2 2 2 2 2 2 2 2Long Arc Quads 2 2Taps Ups 2 2Lateral Tap Ups 2 2Alternate Stepping 2 2 2 2 2 2 2 2Stepper with WeightsBridging 2 2 2 2Abdominal Crunch 2 2 2 Postural AlignmentPostural Alignment with Marching 2Clock Uneven Surface with Eyes Open Uneven Surface with Eyes Closed 3 4Clapping with Eyes Closed, Seated 2Clapping with Eyes Closed, Standing UNO Poster BoardVisual MemoryVisual SequencingRecall/recognitionHead Movement in Supine 2 Head Movement in Sitting 2 2 2Head Turns with Reaching Across Midline 2 4 2 2Head Turns with Walking 2 2 2 2 2 2 2RollingSidelying to Sit with Head RotationVisual tracking focal item 2 2In Sitting, Head stationary, Saccades 2 2 2 2 2Using the in-Motion Triggers 6 6 6 6 6Seated, Reaching Across and Behind to hit target 2 2 2 2STROOP Activities 2 2 2 2 3 2 3Aphabetizing 2 2 2 3Sorting 2 2 2 3Sequencing 2 2 2 2 2 2 3Impulse ControlSafety AwarenessSelected and Divided Attention 2 2 2 2 3 3 3 3Visual Attention 2 2 2 3 3Memory 4 4 6 6 4 4 5 5 5 5Yes/No Questions 2 2 2 2NamingWord FindingMelodic IntonationIntelligibility DrillsOral Motor ExercisesPicture IdentificationFollowing Directions 2 2 2 2 2 2 2Setting Table
CO
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N/C
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SC
ULO
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Advancing the exercises Cognitive Exercises
STROOP• Increase # of stimuli• Performed while standing on thin
piece of foam Alphabetizing
• Increase Alpha difficulty• Performed while sitting on
physioball Sorting
• Increase difficulty level of stimuli• Performed while tandem standing
Sequencing• Increase difficulty level of stimuli• Increased reach distance from base
of support Selective & Divided Attention
• Increased time on task• Increased # of distracting variables
Cognitive Exercises Visual Attention
• Increase difficulty level of visual stimuli by adding variables
• Performed with increased base of support reaching modification
Memory• Increased amount of
information to retain• Added multiple auditory
distractors during memory task. Yes/No Questions
• Performed activity well in all settings. Discontinued after initial trial.
Following Directions• Increased # of directions• Added in-motion trigger for
obstacle course activity.
Case Study: OutcomesExercise Pre-LFA Post LFA Ms
ImprovementBoth Hands 166 ms 35 ms 131Right Hand 201 ms 37 ms 164Left Hand 160 ms 36 ms 124Both Toes 229 ms 82 ms 147Right Toe 183 ms 81 ms 102Left Toe 231 ms 85 ms 146Both Heels 305 ms 91 ms 214Right Heel 255 ms 79 ms 176Left Heel 244 ms 77 ms 167R Hand / L Toe 207 ms 89 ms 118L Hand / R Toe 234 ms 90 ms 144Balance R Foot Unable 101 ms *Balance L Foot Unable 121 ms *Both Hands-GDE
252 ms 32 ms 220
Case Study: Outcomes
TestIntake Patient Score
At High Risk for
Falling if:
Discharge Patient Score
TUG alone: 11 seconds > 14 seconds 9 seconds
TUG Cognitive: 16 seconds > 14.5
seconds 13 seconds
TUG Manual: 18 seconds > 15
seconds 13 seconds
(Shumway-Cook, Brauer, & Woollacott, 2000)
Case Study: ST OutcomesSubtests from the Ross Information Processing
Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills.
* Within Normal Limits
Subtest Intake Severity Rating
Discharge Severity Rating
Immediate Memory Moderate Mild
Recent Memory Mild WNL
Temporal Orientation Moderate WNL
Spatial Orientation Moderate MildOrientation to Environment Mild WNL
Recall of General Info WNL* WNLProblem Solving and Reasoning Mild WNL
Case Study: ST Outcomes
Subtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills.
Subtest Intake Severity Rating
Discharge Severity Rating
Organization of Information Moderate Mild
Auditory Processing and Comprehension
Mild WNL
Problem Solving and Concrete Reasoning
WNL WNL
Naming Common Objects WNL WNL
Functional Oral Reading WNL WNL
Determining when to Discharge
Reassessed using standardized testing
Goals and objectives metFamily support in placeAccess to Silver Sneakers Program
including transportation to and from and finances to cover
Home Exercise Planning
Recommend 3x’s a week atSilver Sneaker Program
HEP for discipline specific (Physical and Speech Therapy) activities to continue with caregiver support at least 2x’s a week
Post-test
Complete post-test for Module 6
Materials Page
This videoPowerPointCase Study Worksheets
www.interactivemetronome.com/index.php/fall-risk-coaching
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