1. Some Statistics • Of people at the age of 65 or older, 25-35% of them will fall one or more times in a year. • Falls are considered the leading cause of death of the elderly. • Of the elders that survive, 20-30% will result in debilitating injuries.

2. Body Systems that Affect Balance • Somatosensory System • Vision • Vestibular System

3. Common Causes of Falls Environmental Hazards such as:

4. Uneven Surfaces

5. Insufficient Lighting

6. Rugs (loose or raised)

7. Bed Skirts

8. Loose Cords

9. Toddlers

10. Pets

11. Pets

12. Other Causes of Falls Include • Inappropriate footwear • Unstable bed or chair transfer • Gait disturbance • Balance impairment • Muscle weakness • Low Endurance

13. Inappropriate Footwear

14. Gait Disturbance or Balance Impairment

15. Muscle Weakness

16. More Causes of Falls • Pain ( injury, arthritis, chronic illness etc…) • Hypotension • Vertigo • Dizziness • Medications (especially multiple meds) • Use of alcohol • Acute illness

17. Pain

18. Hypotension

19. Dizziness

20. Vertigo

21. Medications

22. Mixing Medications with Alcohol

23. Acute Illness

24. More Causes of Falls • Poor Posture • Visual Disorders • Disorders of the Central Nervous System (Alzheimer's, Parkinson’s, stroke, Cerebral Palsy) • Dementia (due to cognitive impairment and confusion)

25. Poor Posture

26. Visual Disorders such as: • Impaired Vision • Glaucoma • Macular Degeneration • Cataracts • Diabetes Mellitus

27. Glaucoma

28. Macular Degeneration

29. Cataracts

30. Diabetic Retinopathy

31. Diabetes MellitusAffects vision in this way

32. Parkinson’s

33. Nervous System Disorders

34. Confusion and Dementia

35. Interventions for Fall Risk • Center of gravity control training • Standing balance training • Somatosensory balance training • Vestibular balance training • Eye-Head coordination • Postural strategies • Strength and endurance

36. Center of Gravity Control • Seated on backless chair • Dynadisk • Balance Ball • Arm lifts – single, double, diagonal • Lateral Rotation • Lean forward and backward • Add bouncing, resistance and perturbations to progress

37. Standing Balance • Standing Read out loud • On foam toss ball hand to hand • Stand one foot on ball • March with head turn • Stepping over objects • Four corner toe touch

38. Somatosensory SystemDecreased self-perceptionDecreases ability to sense body parts in both static and dynamic movement

39. Somatosensory • Seated on ball, dynadisk, backless chair • Weight shift, eyes closed (focus on pressure felt) • Toss and catch ball, follow object with eyes and head • Read while walking • Stand on tip toes reach for object • Standing place objects from one shelf to another.

40. Vestibular • Progressions: • Seated: backless chair, dynadisk, ball, • Standing: feet on floor, feet on foam, feet together, feet in tandem, single leg • Moving: Arms, legs, ambulation • eyes open, eyes closed

41. Eye-Head Coordination Progressions: Seated, Standing or Moving Follow object with eyes only, add head, add weight shifts. Direction of eyes and head: up, down, side to side, diagonal

42. 4 Postural Strategies • Ankle and Hip Strategies • Stepping Strategies • Moving Strategies • Pool Strategies

43. Ankle and Hip Strategies • Chair in front and in back of pt. • (close for ankle farther apart for hip strategy) • Patient leans back and forth • Progress by adding foam, ½ foam roll or balance board

44. Stepping Strategy • Patient leans forward, backward and sideways until they need to take a step. • Place tape on the floor to encourage them to take bigger steps • Progress using foam, ½ foam roll, or balance board

45. Moving Strategy • Ambulate using: • Narrow steps • Wide steps • High March • Abrupt starts, stops and turns • Progress: hold object in hands, stepping on to foam or ½ foam roll

46. Pool Strategies • Pool are a great environment for balance exercises as the provide • naturally occurring perturbations • Patient safety, will not fall to floor • Reduces the fear factor associated with falls • Buoyancy of water provides support to patients suffering with pain.

47. Strength and Endurance Balance, Strength and Endurance can be worked on at the same time • Use a theraball, ankle weights, hand weights or theraband. • Incorporate normal exercises while on the ball • Pools offer the same advantage

48. Place colored tape on the edges of steps for visually impaired patients.

49. Make sure patients have handrails installed at home.

50. Remember to connect patients back to the movement sensor.