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Fall Risk Reduction Program Module #6 of 6

Fall Risk Reduction Program Module #6 of 6. Shelley Thomas, MPT, MBA Dara Coburn, M.S., CCC-SLP. Fall Risk Reduction Program: Review of Modules 1 - 5. In the first module we reviewed the premise of the Fall Risk Reduction Program, including the inclusion criteria for patient selection.

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Fall Risk Reduction Program Module #6 of 6

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  1. Fall Risk Reduction ProgramModule #6 of 6 Shelley Thomas, MPT, MBA Dara Coburn, M.S., CCC-SLP

  2. Fall Risk Reduction Program: Review of Modules 1 - 5 • In the first module we reviewed the premise of the Fall Risk Reduction Program, including the inclusion criteria for patient selection. • The second module reviewed patient assessment • Identifying patients at risk of falling • Evaluating patients in a dual task condition to simulate “real life” situations • The third module covered how to determine which systems of balance were weakest and develop an exercise program for those systems. • The fourth module looked at IM scores and how to utilize them to establish treatment plans, how to advance exercises based on domains of challenge, and how to gauge progress through reassessment. • In the fifth module, we discussed discharge planning and establishing effective home exercise programs.

  3. Module 6 Agenda • Review a case study from start to finish • Patient suitability • Patient evaluation • Determine balance systems impacted • Establish treatment plan • Advancing the exercises • Determining when to discharge • Home exercise planning

  4. Case StudyIs this patient a suitable candidate for an IM Fall Risk Reduction Protocol • 73 year old male with history of three falls in the last two months. • Had L2-5 laminectomy and fusion (July, 2011) • Past medical history significant for CABG x 4 (2010) with documented anoxic event during surgery • Patient and family report cognitive changes after heart surgery. • The patient reports he is still “not quite right”.

  5. Case StudyIs this patient a suitable candidate for an IM Fall Risk Reduction Protocol • Lives alone in 2 story home with 4 steps to enter and 14 steps inside home. • Hires help with housework and cooking. • Receives Meals on Wheels. • Family assists with finances and checks on patient several times per week. • Was participating in regular exercise program until back problems worsened.

  6. Case StudyIs this patient a suitable candidate for an IM Fall Risk Reduction Protocol • Patient described his falls as “stupid” and “exasperating”. • Fall 1: He caught his toe on a change of surface (moving from carpet to linoleum). • Fall 2: Walking to the mailbox and slipped. Reported he “wasn’t paying enough attention”. • Fall 3: In a parking lot. Patient reports he got distracted by another person and “mis-stepped”. • Referred for physical and speech therapy to address balance and cognitive deficits.

  7. Case Study: PT Evaluation • ROM: No significant limitations • Strength: 4/5 throughout upper and lower extremities. • Proprioception: Intact • Vestibular: Unable to walk with horizontal head turns without loss of balance. Also demonstrates LOB with eyes closed activities. • Endurance: Fair – patient reports fatigue after 5-10 reps of exercise

  8. Case Study: PT Evaluation TUG = Timed Up and Go

  9. Case Study: ST Evaluation Subtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills. * Within Normal Limits

  10. Case Study: ST Evaluation Subtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills.

  11. Case Study “Patient Selection Worksheet” from Module 2

  12. LFA

  13. Case Study “Designing an Exercise Program” Worksheet from Module 3

  14. Case Study “Designing an Exercise Program” Worksheet from Module 3

  15. How to Develop and Advance Treatment Plan Strengthening exercises, postural reeducation, balance strategies Challenge cognition/communication, recall, word finding, impulse control, sorting, sequencing, divided and selective attention Uneven surfaces, eyes closed, head turns with gait, spinning, changes of direction

  16. Treatment Plan Received PT and ST, 2x/week x 6 weeks 1 hours sessions per discipline Performed approximately 30 minutes of IM 2x/week x 6 weeks

  17. Advancing the exercises • Cognitive Exercises • STROOP • Increase # of stimuli • Performed while standing on thin piece of foam • Alphabetizing • Increase Alpha difficulty • Performed while sitting on physioball • Sorting • Increase difficulty level of stimuli • Performed while tandem standing • Sequencing • Increase difficulty level of stimuli • Increased reach distance from base of support • Selective & Divided Attention • Increased time on task • Increased # of distracting variables • Cognitive Exercises • Visual Attention • Increase difficulty level of visual stimuli by adding variables • Performed with increased base of support reaching modification • Memory • Increased amount of information to retain • Added multiple auditory distractors during memory task. • Yes/No Questions • Performed activity well in all settings. Discontinued after initial trial. • Following Directions • Increased # of directions • Added in-motion trigger for obstacle course activity.

  18. Case Study: Outcomes

  19. Case Study: Outcomes

  20. Case Study: ST Outcomes Subtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills. * Within Normal Limits

  21. Case Study: ST Outcomes Subtests from the Ross Information Processing Assessment-Geriatric (RIPA-G), were administered to assess memory and processing skills.

  22. Determining when to Discharge • Reassessed using standardized testing • Goals and objectives met • Family support in place • Access to Silver Sneakers Program including transportation to and from and finances to cover

  23. Home Exercise Planning • Recommend 3x’s a week atSilver Sneaker Program • HEP for discipline specific (Physical and Speech Therapy) activities to continue with caregiver support at least 2x’s a week

  24. Post-test • Complete post-test for Module 6

  25. Materials Page • This video • PowerPoint • Case Study Worksheets • www.interactivemetronome.com/index.php/fall-risk-coaching

  26. QUESTIONS?You can call or email us.We’re here to help! • Call 877-994-6776: • Opt. 3 – Education • imcourses@interactivemetronome.com • Opt. 5 – Technical Support • support@interactivemetronome.com • Opt. 6 – Clinical Support • clinicaled@interactivemetronome.com • Opt. 7 – Marketing • newsletter@interactivemetronome.com

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