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Evidence-Based Balance Rehabilitation and Fall Prevention: Summary
Feedback and Error Correction When unexpected perturbations or errors occur: • Spinal reflexes can correct through use of ankle and hip strategies • Cerebellar control prevents under- and over-correction If perturbation is enough to move center of mass (COM) outside base of support (BOS), step is required • Step must be strong, accurate, and fast Motor Capacity and Control LEARNING TIP! Balance reactions must be:
• Polypharmacy (>3 to 4 meds): Especially antihypertension (HTN), but also sedatives • Psychological issues: Depression, fear of falling (FoF), sedentary lifestyle, cognitive decline • Difficulty with activities of daily living (ADL) • Advanced age • Visual impairments Effects of Aging • Balance is diminished in older versus younger adults • Gait impairments: Decreased step/stride length, and hip extension • Difficulty with unexpected perturbations • Sarcopenia: Especially weakness in hip extensors, knee extensors, ankle dorsiflexion/plantarflexion (DF/PF) • Vestibular function decline: Hair cell loss and neuronal degeneration • Visual decline: Acuity, field of vision, judging distances/spatial relationships • Cognitive decline: Attention (especially with dual tasking) Fear of Falling (FoF) Directly related to lower functional ability and perceived self-efficacy: • A history of falling or even impaired mobility can lead to FoF Strategies to Reduce Fall Risk • Take a systematic and pragmatic approach to therapy: ○ Assess looking for specific impairments based on systems ○ Prioritize and time interventions appropriately • Work as a team: Refer appropriately to SLP, OT, PT, physician, nurse, pharmacist, psychologist/counselor, social worker/case manager, family • Get involved in the community: ○ Screening and education opportunities ○ Exercise and activity groups
• Strong: Force must adequately counteract inertia and gravity. • Accurate: Reaction movement cannot under- or overcompensate. • Fast: Must occur within 400 msec, or a fall will occur.
Muscle strength : • Adequate knee strength to prevent buckling and ankle strength to counter sway: ○ Hip weakness can reduce COM control • Spinal and shoulder girdle weakness can alter posture and effect dynamic balance Range of motion (ROM) : • Ankle contracture/triceps surae tightness results in posterior ground reaction force • Leading to forward posture, which leads to hip/trunk contractures to counteract this force FALLS Risk Factors for Falls • History of falls: How many/frequency, last time, any injuries, location, activity • Gait issues: Slow gait speed (<1.0 m/s); difficulty on stairs, turns; assistive device (AD)
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