THE ROLE OF THE PHYSICAL THERAPIST IN A FALLS PROGRAM Melinda Jaeger, PT Empira Rehab Specialist Aging Services of Minnesota Live From 350 South Conference Call November 3, 2010

EVALUATE Strength/ROM Balance Mobility Pain W/C Positioning New Admissions Significant Change /Decline Post Fall

Significant Change/Decline Struggle with sit → stand- referral for LE strengthening Signs of pain- referral for modalities, nonpharmacologic approach Loss of balance with reaching or during gait C/O dizziness- referral for vestibular eval Poor w/c positioning- referral for core strengthening, proper w/c fit ↓ Endurance ↓ ADL function Elders with dementia or cognition impairments can benefit from therapy intervention.

COMMUNICATE Systems in place to convey information from PT evaluation and or treatment to nursing assignment sheets.

EDUCATE Raise awareness of Fall Risks in the facility Staff, families and residents aware of proper footwear Measure and mark correct bed heights Anti-rollback or auto-lock brakes on w/c

PARTICIPATE Member of falls committee Balance and falls expert Skilled in Root Cause Analysis Astute in recognizing patterns in the recurrent faller How to allocate time to participate with current time/ productivity constraints? Run an effective meeting Assess time management

ADVOCATE The therapist should advocate Fall Prevention Involve NAR in last PT Rx to incorporate reaching, standing, and balance in ADLs Refer to TR after therapy D/C to maintain balance skills by offering standing or reaching opportunities in TR activities Emphasis on balance and ankle strengthening on restorative nursing referrals Why the focus on balance not exercise or walking programs?

“Balance Exercise Reduces Risk of Falling”  Journal of the American Geriatrics Society, December 2008  Strength training alone may not effectively reduce falls since impaired balance is a stronger risk factor for falls than poor muscle strength.  Walking programs did not appear to have much effect in preventing falls.  The greatest effect in preventing falls were seen with exercises that challenged balance.

ANKLES are the ANCHOR for Balance Rock Ankle Exercise Board Use seated for ankle strengthening and ROM

TRANSFER POLE ENCOURAGE STANDING and Safe Transfers

The therapist is a key team member in your falls program GOOD LUCK ON YOUR EFFORTS TO STOP FALLS

I welcome any questions you may have as you continue your goal towards fall reduction Contact information Melinda Jaeger, PT Empira Phone: