FallProof™ A Comprehensive Balance and Mobility Training Program developed by Debra J. Rose Ph.D. Presented by Cathy Harbidge, Margaret Low, and Janet Schroder Calgary Fall Prevention Clinic 1

Fall Proof™ Provides a multidimensional balance and mobility program. Targets community residing seniors at moderate to high risk for falls. Use eligibility criteria from Appendix A 2 2

Presentation Outline Description of Program. Achieving certification. Present principles of the Fall Proof Program. Assessment tools. Components of exercise program. Outcomes. Calgary Fall Prevention Clinic Application. 3

Goals Improve postural alignment Increase limits of stability Improve integration of sensory information Increase confidence Improve performance of activities of daily living Heighten awareness of risk factors and circumstances Improve walking ability Improve ability to recover from loss of balance

Client Eligibility Able to rise independently from a chair. Able to stand independently for a minimum of 2 min. with minimum supervision. Able to safely ambulate a distance of 500 ft. without a walking aid. This is for the higher level classes which would have a higher instructor to client ratio. You can design the classes for clients who would not meet these criteria. 5

Client Eligibility Absence of cognitive impairment likely to adversely impact judgement and / or decision making abilities. Absence of any unstable medical condition. FallProof exercises use motor learning principles in their progression. This means that random practice of skills is preferred. A skill is performed once, then a different skill or a skill variation is practiced in the next set. A random practice schedule is considered more cognitively challenging to perform. 6

Classes Provided by Certified Balance and Mobility Specialist Instructors. Timing: Classes held 2 sessions per week for 60 minutes duration. Provide 8 weeks of lessons. 7

Certification Program Accepts qualified professionals (Certified Fitness Instructors, Physiotherapists, etc.). Complete on-line learning modules of approx.100 hours. Written competency exams after each module. On-site training to administer the appropriate multi-dimensional assessment tools. 8

Certification Program (cont.) On-site training to teach pre-designed exercise modules. Practical competency exams are held at 2 sites. Required re-certification consisting of documented hours of treatment and assessment. 9

Principles of FallProof™ Knowledge of systems contributing to balance and mobility. Emphasis on client safety. Age associated changes. Extrinsic and intrinsic risk factors. Associating assessment findings with balance and mobility deficits. Applying motor learning principles. Point 4: 10 10

Screening / Assessment Disease / Pathology / Activity Health Activity Questionnaire. 11 11

Screening / Assessment Impairment Senior Fitness Test. Modified Clinical Test of Sensory Integration of Balance (M-CTSIB). 12

Screening /Assessment Disability Composite Physical Function. The Composite Physical Function score comes from the Health Activity Questionnaire. This question is used to determine whether the client is assessed using the Berg or the FAB (<14 the Berg is completed, ≥14 the FAB is completed.) 13

Screening / Assessment Assessment of Functional Limitations Berg Balance Scale. Fullerton Advanced Balance Scale (FAB). Walkie Talkie Test. 50 ft. Walk Test. 14

Exercise Components Center Of Gravity Control Training. Multi-Sensory Training. Postural Strategy Training. Gait Pattern Enhancement and Variation. Strength and Endurance. Flexibility. 15

Ecological Theory of Perception, and Bodily Orientation Seated Moving Standing Task Demands Single Multiple Surface Type Cognition Environmental Constraints Individual Capabilities Strength Get description from powerpoint online. Lighting ROM Visual Flow Sensory Loss 16

Center of Gravity Maintain an upright position in space. Improve postural control within sway envelope. Move the body through space more quickly and confidently. 17

Center of Gravity Control Altering task demands 18

Center of Gravity Control Weight shift 19

Multi- Sensory Training Designed to train each of the 3 sensory systems to function more efficiently. Coordination of eye and head movements. Force use of systems when impairments are temporary or changeable. Compensate or substitute for system impairments which are permanent or progressive. 20

Eye and Head Movements 21

Vestibular Training 22

Postural Strategy Training Designed to enhance the three postural control strategies – ankle , hip and step. 23

Postural Strategy Training This lady is demonstrating the hip strategy. 24

Gait Pattern Enhancement and Variation Training To achieve a gait pattern that is efficient, flexible and adaptable to changing environment demands. 25

Gait Pattern Enhancement and Variation Training 26

Strength, Endurance, Flexibility Identified as essential components of any balance program. Add chair squats 27

Outcomes Demonstrates decreased fall risk with completing one or more rotations of the Program. Improvement in targeted impairments and functional limitations. High compliance rates. Relate back to functional limitations and impairments noted in the original assessment. High compliance rates felt to be related to clients being able to see their improvement, and due to the camaraderie and enjoyment clients experience during the class. 28

Calgary Fall Prevention Clinic Balance Training Completion of first full cycle. Used in small group format. Clients are fallers. Adaptations to program.

Conclusions The Fall Proof concepts can be used for group and individual training. The systematic application of the lesson plans ensure that balance and mobility impairments are addressed. Dr. Rose is working on developing lesson plans applicable for more frail individuals. 30

References FallProof™ by Debra J. Rose Ph.D. Senior Fitness Test by Roberta Rikli and C. Jessie Jones. “Promoting Functional Independence Among ‘At Risk’ and Physically Frail Older Adults Through Community-Based Fall-Risk-Reduction Programs” Debra J. Rose, Journal of Aging and Physical Activity 2002, 10, 207-225. 31

Contact Information Calgary Fall Prevention Clinic, Cathy.Harbidge@CalgaryHealthRegion.ca, Janet.Schroder@CalgaryHealthRegion.ca Calgary Health Region Fall Prevention Project, Margaret.Low@CalgaryHealthRegion.ca