centers for medicare & medicaid services (cms) · 2017-07-25 · interactive metronome &...
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To comply with professional boards/associations standards:• I declare that I (or my family) do have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.
Session 402: Improve Cognition & Reduce Falls with Interactive Metronome & FitLight
Shelley Thomas, MPT
Leading the Way in Continuing Education and Professional Development. www.Vyne.com
Centers for Medicare & Medicaid Services (CMS)
Have identified falls as an event that should never occur
Have identified falls and injury as an Hospital Acquired Condition (HAC), which means limited reimbursement
Have identified falls as an event that should never occur
Have identified falls and injury as an Hospital Acquired Condition (HAC), which means limited reimbursement
Video – UMC Fall Risk
https://youtu.be/A7EcprAXtREhttps://youtu.be/A7EcprAXtRE
The Truth About FallsAccording to the Centers of Disease Control for older adults (65+)
1 out of 3 older adults (over age 65) falls each year
Falls are the leading cause of both fatal and nonfatal injuries in this population
In 2013, 2.5 million nonfatal falls among older adults were treated in the ER (734,000 hospitalizations!)
A fall is one of the 20 most expensive medical conditions in older adult populations
1 out of 3 older adults (over age 65) falls each year
Falls are the leading cause of both fatal and nonfatal injuries in this population
In 2013, 2.5 million nonfatal falls among older adults were treated in the ER (734,000 hospitalizations!)
A fall is one of the 20 most expensive medical conditions in older adult populations
www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
The Truth About FallsAccording to the Centers of Disease Control for older adults (65+)
30 – 35% of patients that fall sustain an injury
Adds 6.3 days to the hospital stay
In 2012, direct medical costs of falls were $30 billion and is expected to more than double by 2020, estimated at $67.7 billion!
Medicare costs per fall averaged between $13,797 and $20,450 (in 2012 dollars).
Fall Related injury is the #1 loss in Hospitals & SNF’s
30 – 35% of patients that fall sustain an injury
Adds 6.3 days to the hospital stay
In 2012, direct medical costs of falls were $30 billion and is expected to more than double by 2020, estimated at $67.7 billion!
Medicare costs per fall averaged between $13,797 and $20,450 (in 2012 dollars).
Fall Related injury is the #1 loss in Hospitals & SNF’s
Risk Factors
Men are 41% more likely to die from a fall
Older white population is higher risk than black and Hispanic populations
Following a fall, Age 75 and older more likely to be admitted to a Long Term Care facility for one year or longer
Over 95% of hip fractures caused by falls – hip fractures in women is 2 x the rate of men.
Older women are more than twice as likely to suffer a fracture after a fall than men
Men are 41% more likely to die from a fall
Older white population is higher risk than black and Hispanic populations
Following a fall, Age 75 and older more likely to be admitted to a Long Term Care facility for one year or longer
Over 95% of hip fractures caused by falls – hip fractures in women is 2 x the rate of men.
Older women are more than twice as likely to suffer a fracture after a fall than men
Fear of Falling
Self Limit Activities
Reduced Mobility & Fitness
Increase Risk of Falling
Fall
FACTORS ASSOCIATED WITH PATIENT FALL RISK
PATIENT-SPECIFIC ENVIRONMENTAL SITUATIONAL ORGANIZATIONAL
Impaired balance & gait* Furniture on wheels Leaning forward* Staffing
Impaired attention* Cluttered pathways Reaching up* Policies
Impaired executive response inhibition (impulsivity)*
Poor lighting Transferring on/off bed, chair or toilet*
Available equipment (bed/chair alarms, etc)
Impaired memory* Slippery floors Available furniture (low beds, etc)
Weakness Height of furniture
Hypotension How well nurses can see patients from nurse’s station
Depression Medical devices (IV poles, catheters, etc)
Urinary Incontinence
Sedative & CNS effect of medications
Impaired vision
FALL RISK REDUCTION STRATEGIES CURRENTLY EMPLOYED IN HEALTHCARE SETTINGS
PATIENT-SPECIFIC ENVIRONMENTAL ORGANIZATIONAL
Ambulatory aids & assistance Evaluate/adjust staffing patterns Modify physical environment (grab bars, inspect furniture, lighting, flooring that reduces impact of fall)
Physical therapy referral Evaluate/adjust shift reports Policies (noise reduction, interdisciplinary involvement, timely report & review of falls that occur
Adequate footwear Evaluate ability to follow through with staff responsibilities
Purchase equipment (transfers, mobility, surveillance, lower beds, hearing devices for patients)
Maintain mobility Educate staff and work on attitude toward fall risk reduction
Family-friendly patient rooms (cots/recliners, 24 hr visiting, coffee and snacks for visitors)
Keep eyeglasses/hearing aids within reach Maintain patient environment (clutter, clear walkways, spills, keep items well within reach of patient)
Information technology (identify risk factors from online patient records to target specific patients for fall risk reduction; healthcare provider communication)
Use reclining chair, bolster cushions, non-skid gel cushions when seated
Bed/chair/commode alarms – check they are operational each shift
Do not leave unattended in bathroom/bedside commodeAssess for orthostatic/ postprandial hypotension and provide instruction, support stockings and other strategies before risingAssess behavioral/mental status and effect of meds, pain, sensory impairment
Assess ability to remember to call for assistance
Increased frequency of monitoring/surveillanceRestraint (last resort)
Examples of targeted solutions provided by “The Falls with Injury Project”
Currently only environmental factors and awareness are addressed to reduce falls
Schedule Trips to the bathroom
Reminding patients to always ask for help walking
Engaging patient and their families in the fall safety program and the time of admission
Adopting a culture of fall safety
Bringing caregivers to the bedside more often (ie. hourly rounding)
Currently only environmental factors and awareness are addressed to reduce falls
Schedule Trips to the bathroom
Reminding patients to always ask for help walking
Engaging patient and their families in the fall safety program and the time of admission
Adopting a culture of fall safety
Bringing caregivers to the bedside more often (ie. hourly rounding)
* The “Preventing Falls with Injury Project”
Interventions
Interventions need to address physical fitness, motor planning and sequencing, and automaticity of movement to exercise and strengthen the underlying mechanisms of:
Balance Weight Shifting Attention & Divided Attention Visual & Auditory Distraction Cognition Coordination Strength
*Cognitive abilities must be addressed to get to the root of the issue and make permanent gains.
Interventions need to address physical fitness, motor planning and sequencing, and automaticity of movement to exercise and strengthen the underlying mechanisms of:
Balance Weight Shifting Attention & Divided Attention Visual & Auditory Distraction Cognition Coordination Strength
*Cognitive abilities must be addressed to get to the root of the issue and make permanent gains.
Interactive Metronome
Evidence‐based assessment & training tool
Improves timing, rhythm & synchronization in the brain
Objectively measures timing & rhythm
Flexible to meet individual needs
Portable within clinic
Engaging & rewarding
Evidence‐based assessment & training tool
Improves timing, rhythm & synchronization in the brain
Objectively measures timing & rhythm
Flexible to meet individual needs
Portable within clinic
Engaging & rewarding
Slide 13
IM Has Three Goals
1. Improve neural timing & decrease neural timing variability (jitter) that impacts speech, language, cognitive, motor, & academic performance
2. Build more efficient & synchronized connections between neural networks
3. Increase the brain’s efficiency, performance & ability to benefit more from other rehabilitation & academic interventions
1. Improve neural timing & decrease neural timing variability (jitter) that impacts speech, language, cognitive, motor, & academic performance
2. Build more efficient & synchronized connections between neural networks
3. Increase the brain’s efficiency, performance & ability to benefit more from other rehabilitation & academic interventions
Slide 14
Neural Synchronization
Slide 15
Why IM?
Upon evaluation, the Joint Commission, acknowledges the IM Fall Reduction Program as a best practice and a program of “High Interest”.
Upon evaluation, the Joint Commission, acknowledges the IM Fall Reduction Program as a best practice and a program of “High Interest”.
IM DEMO
Slide 17
Slide 18
What just happened?
Five neurological functions exercised at once:1. Controlled Attention & Concentration
2. Working Memory
3. Sensory Integration
4. Motor Planning/Sequencing for Coordination & Functional Motor Control
5. Synchronization of timing in multiple brain regions for increased neural efficiency & performance
Neuroplasticity…“What is fired together, is wired together”
Five neurological functions exercised at once:1. Controlled Attention & Concentration
2. Working Memory
3. Sensory Integration
4. Motor Planning/Sequencing for Coordination & Functional Motor Control
5. Synchronization of timing in multiple brain regions for increased neural efficiency & performance
Neuroplasticity…“What is fired together, is wired together”
Slide 19
IM Training Synchronizes Neural Networks
Timing Network
Dorso Lateral
Pre-Frontal Cortex
TimingMotor Planning
Speech
Basal Ganglia
Timing
Voluntary MotorCoordination
Cingulate Gyrus
Timing
Executive FunctioningModulate Emotions
Cerebellum
Timing
Sense of Body PositionProduction of Speech
The picture can't be displayed.
Slide 20
IM Neuro‐Imaging StudyPresented at 65th Annual American PM&R Conference
MEDIAL BRAINSTEM
Neuro-Motor Pipeline
BASAL GANGLIA
Integrates Thought and Movement
CINGULATE GYRUS
Allows Shifting of AttentionCognitive Flexibility
Alpiner (2004). Results from this pilot fMRI study show IM directly promotes neural efficiency, with bilateral activitation of multiple parts of the neuro-network. Repetitive auditory-motor training, specifically IM, holds promise for
neuroplasticity of higher and lower brain centers.
Slide 21
Marked improvements in patients 60+The Effectiveness of the IM with Healthy Aging Adults Dr. Leonard Trujillo, OTR/L, Eastern Carolina University
Initial findings presented at the 2015 AOTA Conference & 2015 ISNR
N= 9, Health Aging adults (60 – 80 yrs)
Training
Pre‐Assessment 12 sessions over 2 months
Re‐Assessment Break for 6 Weeks
Re‐Assessment 6 sessions over 1 month
Re‐Assessment Overall Post Assessment
30 – 45 minutes per session, never exceeding 275 reps per task
All participants only performed upper extremity exercises and were seated during training for safety precautions
N= 9, Health Aging adults (60 – 80 yrs)
Training
Pre‐Assessment 12 sessions over 2 months
Re‐Assessment Break for 6 Weeks
Re‐Assessment 6 sessions over 1 month
Re‐Assessment Overall Post Assessment
30 – 45 minutes per session, never exceeding 275 reps per task
All participants only performed upper extremity exercises and were seated during training for safety precautions
ResultsAssessment Overall
Improvement
Modified IM Long Form (seated, all upper extremity exercises) 77%
Short Form 31%
Math Fluency (WJII) 23%
Reading Fluency (WJII) 12%
Decision Speed (WJII) 5%
Visual Matching (WJII) 4%
The d2 Test of Attention Implicates improvements in the ability to stay focused and attend to more difficult tasks and task
over time.
16%
Four Step Square Test Implicates improvements in balance, sped, and confidence in independent ambulation and other
daily tasks. This includes ability to dress and bath with confidence.
88% *
The 9 Hole Peg Test Implicates improvements in fine motor, dexterity, sense of accuracy and confidence in
independence in other daily tasks. This includes ability to dress, eat and perform fine motor tasks with confidence.
3%
Marked improvements in patients 60+Effects of IM on Memory Process and Balance with Aging Adults 60+ Population
Dr. Leonard Trujillo, OTR/L, Eastern Carolina UniversityInitial findings presented at the 2015 AOTA Conference & 2015 ISNR Conference
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Most notable gain: Four Step Square Test, 88%
Implicates improvement in
Balance
Speed
Confidence with Independent Ambulation
This has significant meaning adults who are at risk of falling and is a substantial outcome considering all participants only performed upper extremity tasks during training and were seated
Most notable gain: Four Step Square Test, 88%
Implicates improvement in
Balance
Speed
Confidence with Independent Ambulation
This has significant meaning adults who are at risk of falling and is a substantial outcome considering all participants only performed upper extremity tasks during training and were seated
These participants did not perform lower extremity IM exercises nor did they work on standing balance or ambulation, yet a HUGE
effect size was seen!
(Sept 23, 2013)
IMPORTANT RESEARCH
Measures and
Results
Effect size
Positive IM effects on neuropsychological and EEG-ERPs in subjects with traumatic
blast injuries
In a Nutshell…
Slide 28
EEG shows increased, efficient neural communication in the brain following IM training including the Arcuate
Fasiculus, Frontal Parietal Lobes and Temporal Areas of the Brain
Resulting In:• ↑ Auditory A en on
• ↑ Processing Speed
• ↑ Motor Reac on
• ↑ Execu ve Planning
• ↑ Visual Speed
• ↑ Working Memory
EEG shows increased, efficient neural communication in the brain following IM training including the Arcuate
Fasiculus, Frontal Parietal Lobes and Temporal Areas of the Brain
Resulting In:• ↑ Auditory A en on
• ↑ Processing Speed
• ↑ Motor Reac on
• ↑ Execu ve Planning
• ↑ Visual Speed
• ↑ Working Memory
Slide 29
Active Ingredients for Effective Neuro‐Motor Rehabilitation
Task practice is the single most important variable for motor learning.
“What” is practiced is more important than mere repetition.
Motivation and meaning are critical to skill learning.
Problem solving and implicit processes are required for skill acquisition.Winstein, 2005 III Step Proceedings Motor Learning: From Behavior to Social Cognitive Neuroscience Perspectives
Task practice is the single most important variable for motor learning.
“What” is practiced is more important than mere repetition.
Motivation and meaning are critical to skill learning.
Problem solving and implicit processes are required for skill acquisition.Winstein, 2005 III Step Proceedings Motor Learning: From Behavior to Social Cognitive Neuroscience Perspectives
Slide 30
Interactive Metronome & Motor Learning
MOTOR CONTROL refers to the neural, physical, and behavioral mechanisms
underlying skilled behavior
arises from complex interaction among cognitive, perceptual, and motor systems within a person, the task, and the environment
Defined as “the ability to regulate or direct the mechanisms essential to movement” (Gilmore, 2001)
MOTOR LEARNING permanent change in behavior as a result of practice and/or
experience (Gilmore, 2001)
MOTOR CONTROL refers to the neural, physical, and behavioral mechanisms
underlying skilled behavior
arises from complex interaction among cognitive, perceptual, and motor systems within a person, the task, and the environment
Defined as “the ability to regulate or direct the mechanisms essential to movement” (Gilmore, 2001)
MOTOR LEARNING permanent change in behavior as a result of practice and/or
experience (Gilmore, 2001)
Slide 31
Interactive Metronome & Motor Learning
There is an observed correlation between improvements in millisecond timing, rhythm &
variability on Interactive Metronome exercises and improvements in functional movement.
Four factors contribute to motor learning:1. stages of learning2. task type 3. practice4. feedback (Gilmore, 2001)
There is an observed correlation between improvements in millisecond timing, rhythm &
variability on Interactive Metronome exercises and improvements in functional movement.
Four factors contribute to motor learning:1. stages of learning2. task type 3. practice4. feedback (Gilmore, 2001)
StagesThe speed at which skill performance improves tends to be great
at the beginning of practice because there is room for improvement. However, later in practice there is not much left
to improve on in a task and positive change slows down.
The speed at which skill performance improves tends to be great at the beginning of practice because there is room for
improvement. However, later in practice there is not much left to improve on in a task and positive change slows down.
Slide 32
Task Type
“Successful performance of a task requires
clients to adapt to changing
environments”
(Gilmore, 2001).
“Successful performance of a task requires
clients to adapt to changing
environments”
(Gilmore, 2001).
Slide 33
Slide 34
Practice: Effect on Motor Learning
Motor Learning… Cannot be achieved without repetitive practice Heavy emphasis on cognitive processes Large amount of information held in working memory As learning occurs, the motor skill becomes more
automated and the cognitive demand is decreased
Interactive Metronome improves functional movement patterns because the patient performs a high volume of repetitions and receives real‐time feedback during and
after his performance about millisecond timing & variability.
Motor Learning… Cannot be achieved without repetitive practice Heavy emphasis on cognitive processes Large amount of information held in working memory As learning occurs, the motor skill becomes more
automated and the cognitive demand is decreased
Interactive Metronome improves functional movement patterns because the patient performs a high volume of repetitions and receives real‐time feedback during and
after his performance about millisecond timing & variability.
Slide 35
Feedback:Effect on Motor Learning
Feedback increases the rate of improvement
Feedback enhances performance on tasks that are over‐learned
Participants report exercises seem less fatiguing and more interesting when feedback is provided (Gilmore, 2001)
Feedback increases the rate of improvement
Feedback enhances performance on tasks that are over‐learned
Participants report exercises seem less fatiguing and more interesting when feedback is provided (Gilmore, 2001)
There is NO other form of training for neural timing and synchronization that provides the necessary feedback so that synchronization can take place!
There is NO other form of training for neural timing and synchronization that provides the necessary feedback so that synchronization can take place!
36
Feedback
More fine-tuned Synchronization increase in efficiency and speed of communication along white matter tracts improvement in
cognitive, sensory & motor skills
Synchronized timing of key neural networks is vital for: Speech perception and
production Language Fine and gross motor
coordination Visual saccades Cognitive processing Attention Working Memory Executive Functions
Feedback
Interactive Metronome provides two types of feedback:
Knowledge of Results – KR Knowledge of Performance ‐ KP
“For learning to take place, the [patient] must be actively involved in the process and practice the pertinent skills. The person must learn to sense the behavior or movement and gain KP [knowledge of performance]”
(Gilmore, 2001).
Interactive Metronome provides two types of feedback:
Knowledge of Results – KR Knowledge of Performance ‐ KP
“For learning to take place, the [patient] must be actively involved in the process and practice the pertinent skills. The person must learn to sense the behavior or movement and gain KP [knowledge of performance]”
(Gilmore, 2001).
Slide 37
Feedback‐ KR – Knowledge of Results
Slide 38
Real‐time millisecond feedback
Auditory‐motor synchronization engages neural networks for motor coordination, attention, working memory & executive functions
Leads to better internal timing & synchronization in the brain
Specific scores are provided at the end of each exercise & can be compared to previous scores
Compare scores to objective and clinical assessments to monitor for changes in function
Real‐time millisecond feedback
Auditory‐motor synchronization engages neural networks for motor coordination, attention, working memory & executive functions
Leads to better internal timing & synchronization in the brain
Specific scores are provided at the end of each exercise & can be compared to previous scores
Compare scores to objective and clinical assessments to monitor for changes in function
Slide 39
Feedback ‐ KP ‐Knowledge of Performance
Feedback given about the quality of movement patterns used to perform the activity.
i.e., guide sounds are heard while patient performs IM, providing KP feedback about the accuracy of each trigger hit
The challenge with providing KP feedback is speed! Typically, by the time a therapist has said something, the motor plan has passed.
IM provides KP feedback immediately following each hit, working directly on millisecond and interval timing skills.
Feedback given about the quality of movement patterns used to perform the activity.
i.e., guide sounds are heard while patient performs IM, providing KP feedback about the accuracy of each trigger hit
The challenge with providing KP feedback is speed! Typically, by the time a therapist has said something, the motor plan has passed.
IM provides KP feedback immediately following each hit, working directly on millisecond and interval timing skills.
Slide 40
Interactive Metronome and Movement
Movement patterns emerge as a result of the interaction between the patient’s abilities, environment, and the goal.
“The role of the therapist therefore is not to treat the client in a passive sense but to design learning situations to facilitate the problem solving and exploration of alternative strategies, as well as providing opportunities for repetition.” (Mastos, 2007)
Interactive Metronome provides clinicians with a tool to design learning situations.
Movement patterns emerge as a result of the interaction between the patient’s abilities, environment, and the goal.
“The role of the therapist therefore is not to treat the client in a passive sense but to design learning situations to facilitate the problem solving and exploration of alternative strategies, as well as providing opportunities for repetition.” (Mastos, 2007)
Interactive Metronome provides clinicians with a tool to design learning situations.
Interactive Metronome and Movement
The IM engages the patient as he The IM engages the patient as he attempts to make timely and accurate trigger hits (in sync with the auditory beat).
The more normalized the movement pattern becomes, often the more accurate the trigger hits become.
The patient receives immediatereal‐time feedback about accuracy, and subsequently demonstrates more normalized movements.
Slide 41
Interactive Metronome and Movement
IM settings can be adjusted by the clinician to expose the patient to more positive & rewarding feedback to shape behavior.
As the patient understands the objective of IM and demonstrates the ability to modify motor patterns, the clinician can then tighten parameters to further modify & normalize motor patterns.
Slide 42
“Rhythm serves as an anticipatory and continuous time reference on which movements are mapped within a stable temporal template. The fast‐acting physiological entrainment mechanisms between auditory rhythm and motor response serve as coupling mechanisms to stabilize and regulate gait patterns.”
Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, Bolay HV & Fetter M. (2007). Rhythmic Auditory Stimulation Improves Gait More Than NDT/Bobath Training in Near‐Ambulatory Patients Early Poststroke: A Single‐Blind, Randomized Trial. Neurorehabilitation and Neural Repair, 21, 455.
“Rhythm serves as an anticipatory and continuous time reference on which movements are mapped within a stable temporal template. The fast‐acting physiological entrainment mechanisms between auditory rhythm and motor response serve as coupling mechanisms to stabilize and regulate gait patterns.”
Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, Bolay HV & Fetter M. (2007). Rhythmic Auditory Stimulation Improves Gait More Than NDT/Bobath Training in Near‐Ambulatory Patients Early Poststroke: A Single‐Blind, Randomized Trial. Neurorehabilitation and Neural Repair, 21, 455.
“Because motor performance is mediated by an internal timing mechanism (Buhusi & Meck, 2005;
Lewis & Miall, 2006; Mauk & Buonomano, 2004), researchers have reduced impairments using rhythmic auditory signals (Getchell, 2007).”
Beckelhimer, S. C., Dalton, A. E., Richter, C. A., Hermann, V., & Page, S. J. (2011).Brief Report Computer‐based rhythm and timing training in severe, stroke‐induced arm hemiparesis. American Journal of Occupational Therapy, 65, 96‐100.
“Because motor performance is mediated by an internal timing mechanism (Buhusi & Meck, 2005;
Lewis & Miall, 2006; Mauk & Buonomano, 2004), researchers have reduced impairments using rhythmic auditory signals (Getchell, 2007).”
Beckelhimer, S. C., Dalton, A. E., Richter, C. A., Hermann, V., & Page, S. J. (2011).Brief Report Computer‐based rhythm and timing training in severe, stroke‐induced arm hemiparesis. American Journal of Occupational Therapy, 65, 96‐100.
IM Fall Risk Reduction Protocol
Design Ambulatory & Non‐Ambulatory
Inpatient & Outpatient Clinical Setting
Protocol Easy, Medium & Hard Training Plans
18 minutes of activity per session
Train 3 times per week
Duration: 5 – 8 weeks
Design Ambulatory & Non‐Ambulatory
Inpatient & Outpatient Clinical Setting
Protocol Easy, Medium & Hard Training Plans
18 minutes of activity per session
Train 3 times per week
Duration: 5 – 8 weeks
A Team Approach
Born out of interdisciplinary committee recognizing that each discipline can help identify the root cause of conditions that contribute to fall risk.
Risk Managers, Patient Safety Coordinators, PT, OT, ST, RN members on committee
Utilizes traditional exercises that have been shown to impact balance systems.
Incorporate exercises with IM to get the benefit of working balance systems and timing structures simultaneously
Born out of interdisciplinary committee recognizing that each discipline can help identify the root cause of conditions that contribute to fall risk.
Risk Managers, Patient Safety Coordinators, PT, OT, ST, RN members on committee
Utilizes traditional exercises that have been shown to impact balance systems.
Incorporate exercises with IM to get the benefit of working balance systems and timing structures simultaneously
Why IM?
“We use IM for the majority of our "fall risk" patients.Almost immediately upon beginning the program, wewere able to recognize the importance of thisapproach to decrease falls. We have been able tocontinually challenge our patients and introduce themto many situations, which simulate the distractionsthat they encounter within their day. As such, theyleave feeling very confident in their abilities tomanipulate their surroundings.”
Allison E.Physical TherapistNational Rehabilitation Facility
“We use IM for the majority of our "fall risk" patients.Almost immediately upon beginning the program, wewere able to recognize the importance of thisapproach to decrease falls. We have been able tocontinually challenge our patients and introduce themto many situations, which simulate the distractionsthat they encounter within their day. As such, theyleave feeling very confident in their abilities tomanipulate their surroundings.”
Allison E.Physical TherapistNational Rehabilitation Facility
Assessment Measures
Fall Risk Assessment
Morse Scale
Gait & Stability Assessments
Dynamic Gait Index (DGI)
Modified Functional Reach
Fear of Falling Assessments
Tinetti Falls Efficacy Scale® (FES)
Activities‐Specific Balance Confidence Scale® (ABC)
Fall Risk Assessment
Morse Scale
Gait & Stability Assessments
Dynamic Gait Index (DGI)
Modified Functional Reach
Fear of Falling Assessments
Tinetti Falls Efficacy Scale® (FES)
Activities‐Specific Balance Confidence Scale® (ABC)
Assessment Measures
Attention Tests
Brief Test of Attention
Digit Vigilance Test
Comprehensive Trail Making Test (CTMT) or Trails A & B
Impulse Control & Executive Functioning
Stroop Color & Word Test
Timing and Rhythm
Interactive Metronome (IM) Modified LFA (Ambulatory or SFT 1 & 2 (Non Ambulatory)
Attention Tests
Brief Test of Attention
Digit Vigilance Test
Comprehensive Trail Making Test (CTMT) or Trails A & B
Impulse Control & Executive Functioning
Stroop Color & Word Test
Timing and Rhythm
Interactive Metronome (IM) Modified LFA (Ambulatory or SFT 1 & 2 (Non Ambulatory)
Templates
Advantages
Can modify/individualize templates
Portable – bedside, gym, outpatient
All disciplines can use (OT, ST, PT)
E‐clinic: Confidential storage in the ‘cloud’
Online and Live Training, CEU’s offered
Support 24/7
Can modify/individualize templates
Portable – bedside, gym, outpatient
All disciplines can use (OT, ST, PT)
E‐clinic: Confidential storage in the ‘cloud’
Online and Live Training, CEU’s offered
Support 24/7
REFERENCES
Tromp AM, Pluijm SMF, Smit JH, et al. Fall‐risk screening test: a prospective study on predictors for falls in community‐dwelling elderly. J Clin Epidemiol 2001;54(8):837–844.
Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare Population. American Journal of Preventive Medicine 2012;43:59–62.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed August 15, 2013.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006a;12:290–5.
Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9.
Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. MMWR 2006b;55.45:1222–24.
Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000;7(2):134–40.
Scheffer AC, Schuurmans MJ, Van Dijk N, Van Der Hoof T. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing 2008;37:19–24.
Bell AJ, Talbot‐Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193.
Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.
Hayes WC, Myers ER, Morris JN, et al. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcified Tissue International 1993; 52:192–198.
Stevens JA, Sogolow ED. Gender differences for non‐fatal unintentional fall related injuries among older adults. Injury Prevention 2005b;11:115–9.
National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at: www.cdc.gov/nchs/hdi.htm. Assessed September 14, 2011.
Gillespie, LD, Robertson, MC, Gillespie, WH, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007146. DOI: 10.1002/14651858.CD007146.pub3.
Moyer VA. Prevention of Falls in Community‐Dwelling Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2012;157(3):197–204.
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Interactive Metronome, Inc13798 NW 4th St., Suite 300
Sunrise, FL 33325Toll free: 877-994-6776
Clinical Support877-994-6776 x 253
avega@interactivemetronome.com
Interactive Metronome, Inc13798 NW 4th St., Suite 300
Sunrise, FL 33325Toll free: 877-994-6776
Clinical Support877-994-6776 x 253
avega@interactivemetronome.com
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