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Evidence-Based Balance Rehabilitation and Fall Prevention: Summary
Fall Prevention Programs Keys to successful fall prevention program: • Multifaceted approach: Exercise, education, home safety assessment, medication management, vision screening/ intervention • Multiple disciplines involved as needed • Adequate training and organization of providers • Community buy-in Community Activities and Exercise Groups Senior centers : Frequently provide services such as meal programs, health screenings, counseling, recreational activities, transportation services
Fitness Training Exercise and balance training improve balance and decrease fall risk: • Strength training, yoga, tai chi, Pilates, aerobics, aquatics Community Outreach • Screening/fall prevention programs • Exercise groups and activity resources
Case Example: The Frail Older Adult Faller • Flexibility : Heel cords, hip flexors, upper extremity: ○ History of rotator cuff injury?
• Strength : Hip extensors and abductors almost always weak, fitness training • Vertical orientation : Correction for any posterior or lateral deviation • Balance reactions : Perturbation-based balance training (PBT) and speed training/timed trials; use TUG as guide • Sensory reweighting : Activities to lessen visual dependence • Processing : Dual task training often affected; feedforward work and life scenario simulations • Compensatory strategies : Proper use of assistive devices
Case Example: The Patient with PD
• Flexibility : Heel cords, hip flexors, spinal ROM (especially rotation) • Strength : Hip extensors are often weaker than knee extensors, trunk • Vertical orientation : Recalibration to shift center of balance anteriorly • Balance reactions : PBT and use of rhythmic auditory stimulation • Sensory reweighting : Activities to lessen visual dependence • Processing : Dual task (DT) training—progress incrementally (DT much harder for this group), use rhythmic auditory cues/counting or visual cues to improve initiation, build on well-established motor plans (novel skills will be hard to learn) • Compensatory strategies : Heel posting as needed, proper use of assistive devices (walkers designed specifically for PD)
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