Flashcards in Balance and Transfers Deck (48)
Stats on Falls
• 1 of 3 adults 65+ falls each year
• Falls are leading cause of death for adults 65+
• Falls are most common cause of nonfatal injury and hospital admissions for trauma
• Major healthcare expense/capacity of ERs
Direct Role of OTP in Falls
• Ensuring patient safety during tx, transfers
• Teaching patient to recover from fall
Indirect Role of OTP in Falls
Make patients’ homes safer by:
• Reducing tripping hazards
• Adding grab bars around tub/shower*
• Adding grab bars next to toilet*
• Adding stair railings*
• Improving lighting*
Environmental hazard corrections can reduce falls by 1/3!
*Note: OTP does not install these, just recommends. Some insurance may cover.
Balance vs. Equilibrium
Balance: ability to control equilibrium (either static or dynamic)
Equilibrium: state of zero acceleration where there is no change in speed or direction of body; ability to move/reposition without falling
Static vs. Dynamic Equilibrium
Static: when body is at rest or COMPLETELY motionless.
Dynamic: when all applied and intertial forces acting on the moving body are in balance, resulting in movement with UNCHANGED speed and direction.
The resistance to change in body’s acceleration, or resistance to disturbance of body’s equilibrium. Can be enhanced by determining center of gravity (COG) and changing position accordingly.
Constant downward force; Acting at the center of a body segment.
Center of Gravity (COG) - Definition
Point at which all the body’s mass (weight) is equally balanced.
Center of Gravity (COG) – Determining Factors
Location depends on:
• Proportion of body parts
• Distribution of fat/muscle mass
• Structural deformities (Missing limbs? Limb lengths?)
• External forces (carrying a shoulder bag?)
Center of Gravity (COG) – Typical Location
In upright standing in average adult, COG is a point on the midline (belly button) just anterior to second sacral vertebra.
• In newborn: above umbilicus
• At 2 yo: at level of umbilicus
• At 5 yo: below umbilicus
Factors Affecting Location of COG
GENDER: higher in males bc of muscle distribution (larger upper body); female pelvis is wider/heavier than male.
WEIGHT: if carrying a backpack, COG moves backward as person moves into kyphosis to compensate. If carrying front weight, COG moves forward as person moves into lordosis to compensate.
SUBTRACTION OF WEIGHT: if amputation, COG moves away from amputated limb toward healthy side (ie: amputated leg moves COG up and to opposite side)
Line of Gravity
Gravity’s action line which is visualized as a vertical line projecting downwards from the COG.
Base of Support
Supporting area beneath the body. Includes points of contact with supporting surface and area between them. Points may be body parts (feet) or extensions of body parts (cane).
• Falls occur when line of gravity moves outside of base of support!
Factors Contributing to Stability
• Object is in stable equilibrium when COG lies within base of support.
• Upright body is only stable when line of gravity lies within foot base.
• Carrying a weight at the side of the body means body must shift to keep COG inside base of support (postural shift to accommodate weight)
Factors for Achieving Balance
• Person has balance when COG falls within base of support
• Person has balance in direct proportion to size of base of support (Larger base of support = more balance)
• Person has balance depending on mass (Greater mass = more balance)
• Person has balance depending on height of the COG (lower COG=more balance)
• Person has balance depending on where COG is in relation to base of support (less balance if COG near edge of base of support)
Located in inner ear. Contributes to balance in most mammals, and sense of spatial orientation. Sensory system that provides leading contribution about movement and sense of balance.
Anatomy of the Vestibular System
SEMICIRCULAR CANAL SYSTEM: indicates rotational movements.
OTOLITHS: (in saccule) indicate linear accelerations.
NEURAL: Vestibular system sends signals primarily to neural structures that control eye movements, and to muscles that keep us upright.
Diseases affecting the vestibular system commonly cause vertigo and nausea.
Vestibular Disorders Affecting Balance
• Benign Paroxysmal Positional Vertigo (BPPV)
• Meniere’s Disease
• Secondary Endolymphatic Hydrops
• Labrynthitis and Vestibular Neuritis
• Perilymph Fistula
• Acoustic Neuroma
• Superior Canal Dehiscence
• Vestibular Migraine
• Mal de Debarquement (“Sea Legs”)
• Cervicogenic Dizziness
• Enlarged Vestibular Aqueduct Syndrome
• Vestibular Hyperacusis
• Autoimmune Inner Ear Disease
Non-Vestibular Risk Factors for Falls in the Elderly
• Lack of physical activity (not moving makes body not ready to move!)
• Taking very small steps
• Impaired vision
• Environmental Hazards
Clinical Applications for Fall Prevention
• Walking aids (canes, crutches) increase size of base of support and allow more swaying of body without falling
• CANES are generally used to increase balance, NOT for support
• When assisting a patient, therapist should stand with feet apart (larger base of support) and knees bent to be in stable position to resist added weight of pt.
Common Assessments for Balance
1) Berg Balance Test (most popular, used in hospitals)
2) Clinical Test of Sensory Interaction and Balance (CTSIB) Test
3) Tinetti Assessment Tool
Berg Balance Test
Tests several conditions:
• Sit to stand
• Stand unsupported
• Sitting unsupported
• Stand to sit
• Standing with eyes closed
• Retrieving object off floor
• Standing on one foot
Score 0-4 for each item; 0=needs help, 4=independent
Score of <42 is predictive of fall risk.
Clinical Test of Sensory Interaction and Balance (CTSIB)
• Also known as “Sensory Organization Test”.
• More used in PT
• Assesses static balance under 6 combinations of sensory conditions:
• Stand on firm surface, eyes open/closed/in visual conflict dome (bag over head)
• Stand on foam surface, eyes open/closed/in visual conflict dome (bag over head)
• Patients dependent on vision become unstable without eyes
• Patients dependent on surface/somatosensory input become unstable on foam surface
• Patients with vestibular loss become unstable on foam without vision
• Patients with sensory selection problems become unstable in all but #1-2.
Tinetti Assessment Tool
• Simple, easily administered test that measures resident’s gait and balance. (We did this with Katie’s family videos.)
• Scored on resident’s ability to perform specific tasks.
• Has 16 conditions that assess seated balance, standing balance, and balance during gait.
• Max score is 28; residents scoring <19 are at HIGH risk of falls. 19-24 = risk of falls.
Basic Mobility Skills
1) Rolling side to side in bed
2) Transition from supine to seated
3) Transferring from one surface to another
Functional Mobility Skills
• Enables people to participate in activities such as self care, leisure, work or education
• Begins with understanding of typical movements (everything we’ve covered in kinesiology!)
Whenever we move people—ourselves or others—assisted or unassisted, we MUST start with good body mechanics! Consider:
• Postural control
• Spinal alignment (twisting? Curves?)
• Joint angles
• Base of support
• Core strength
Basic Principles for Lifting Heavy Things
• Lift with straight back and bent knees
• Rotate hips and legs, NOT the trunk
• Both the above shifts weight from tiny back muscles to strong butt muscles
• Use “AP Stance”: anterior-posterior; have one foot slightly behind, one slightly in front.