balance exercise for elderly

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Balance and FallsBalance and Falls

Nancy V. Karp, Ed.D., P.T.

[email protected]

mailto:[email protected]

mailto:[email protected]



Normal Postural ControlNormal Postural Control

Postural control involves controlling the

body’s position in space for:

Stability

Orientation



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



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.



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



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



Falls are a result of loss of

postural control.

Falls are a result of loss of

postural control.



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



Normal Postural ControlNormal Postural Control

Adaptive postural control requires

modifying sensory and motor systemsto changing tasks and environmental demands.



Postural Control During Quiet

Stance

Postural Control During Quiet

Stance

Body aligned to minimize the effect of

gravitational forces.

Muscle tone

Postural tone



Quiet StanceQuiet Stance



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.



Limits of Stability Limits of Stability



Cone of

Stability

Cone of

Stability



Cone of

Stability with Assistive

Device

Cone of

Stability with Assistive

Device



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.



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.



Perturbed BalanceMovement Strategies


The “ankle strategy” occurs

with minimal perturbance of balance.

Control is distal- to-proximal





Moderate instability leads tothe “hip strategy”.

Control is proximal-to-distal





The “stepping strategy” is

used with greater perturbance.



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).



Perturbed Balance

Central 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.



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.



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




Sensory System


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.




Sensory System


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.




Sensory System


Sensory System

The “Postural Dyscontrol” Test will be

performed in class.

“Foam and Dome Test”

O’Sullivan, p. 193




Sensory System


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




Sensory System


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.



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.




Sensory System


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.



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



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



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.



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.



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.




Control


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



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)


Performance-Oriented Assessment of

Mobility I (Tinetti)




Other AssessmentsOther Assessments

Environmental Assessments

Chapter 12, O’Sullivan

Psychosocial Assessment Cognitive assessments

Social work assessments



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.



Some balance exercises for

older people.

Some balance exercises for older people.

Exercises - National Institute on Agingl

http://nihseniorhealth.gov/exercise/exercisestotry/01.html

http://nihseniorhealth.gov/exercise/exercisestotry/01.html



TandemWalking



Fall PreventionFall Prevention

The purpose of assessment and intervention is to prevent the next fall.



Balance and FallsBalance and Falls

The End

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