Objectives. Saturday Morning Cartoon Memories! Too Bad It s Not That Funny. Golden Years in the Golden State? Not According to Data for California

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P R E S E N T E D B Y The OC (Anaheim), CA August 12 16, 2009 August 14, 2009 Session 230 Exercise Program Design for Falls Prevention Dr. Christian Thompson & Rodney Corn Objectives 1.

Explain the balance control mechanisms present in the human body and how they work together to reduce falls risk. 4. Implement three simple screening protocols to identify falls risk in older clients.

Identify appropriate exercise progression and regression strategies to use with older clients to reduce falls risk. SENIOR PARTNER Saturday Morning Cartoon Memories!

1 P R E S E N T E D B Y The OC (Anaheim), CA August 12 16, 2009 August 14, 2009 Session 230 Exercise Program Design for Falls Prevention Dr. Christian Thompson & Rodney Corn Objectives 1. Describe the prevalence of falls and falls-related injuries and the costs associated with them. 2. Identify intrinsic and extrinsic risk factors for falls. 3. Explain the balance control mechanisms present in the human body and how they work together to reduce falls risk. 4. Implement three simple screening protocols to identify falls risk in older clients. 5. Develop a comprehensive falls prevention exercise program consisting of exercises for mobility, strength, balance, and gait enhancement. 6. Identify appropriate exercise progression and regression strategies to use with older clients to reduce falls risk. SENIOR PARTNER Saturday Morning Cartoon Memories! Too Bad It s Not That Funny Over 1/3 of people aged of 65+ fall each year In 2004, over 1.8 million seniors were treated for fallrelated injuries at emergency rooms Approx. 400,000 fractures per year due to falls Over 20% of hip fractures result in death in 1 yr Problem will only continue to increase with the Graying of America & their changing health status Sources: CDC, 2007; Kannus et al., 2005; Ngyuen et al., 2007 Golden Years in the Golden State? Not According to Data for California Risk Factors Affecting Falls Almost 12% of older Californians fell more than once & 34% fell at least once in 2005 Diagnosed diabetes increased from 15% in 2001 to 17.5% in 2005 Diagnosed hypertension increased from 53% in 2001 to 60% in 2005 A coincidence PROBABLY NOT!!! Source: UCLA Center for Health Policy Research, 2008 Extrinsic Factors External Issues Weather or outdoor conditions House clutter and obstacles Poor lighting Lack of adaptive devices in the home Inappropriate footwear/clothing Intrinsic Factors Internal Issues History of Falling Chronic Diseases & Medical Conditions Sensory/Vestibular Impairments Medication Effects Functional Level (Strength, Flexibility, Gait) Risk linearly with number of risk factors present Sources: (Rose, 2003; Tinetti et al., 1988; Carter, 2001; Lehtola et al., 2006)

Our THREE Balance Protective Mechanisms That Tend to Malfunction with Age! And ONE Amazing and Adaptable Body!

Three simple, validated assessments 1. Functional Reach Test 2. Timed Up and Go Test 3. 30 Second Chair Stand Test FRT developed by Duncan & colleagues (J.

Requires stabilization of lower extremity during active reach with upper extremity Outcome measurement is anterior COP displacement (± 0.

2 Our THREE Balance Protective Mechanisms That Tend to Malfunction with Age! And ONE Amazing and Adaptable Body!!! IDENTIFY the Balance Control Deficit(s) CONSTRUCT Corrective Strategies MODIFY Based on Functional Capabilities Source: Carter, Kannus, & Kahn, 2001 IDENTIFY Assessment #1 Functional Reach Test Three simple, validated assessments 1. Functional Reach Test 2. Timed Up and Go Test Second Chair Stand Test FRT developed by Duncan & colleagues (J. Gerontology,1990) Measures limits of stability ability to control sagittal COP mvt. Requires stabilization of lower extremity during active reach with upper extremity Outcome measurement is anterior COP displacement (± 0.25 ) Poor ankle dorsiflexion, poor hamstring flexibility, impaired lumbar, thoracic & cervical spine mechanics, sensory/vestibular impairments Functional Reach In Action Assessment #2 Timed Up and Go Test TUG developed by Podsiadlo & Richardson (JAGS, 1991) Modify by increasing walking speed to fast but safe Measures several aspects of function including lower body strength, ambulation, & postural control Outcome measure is time (± 0.01s) Break down to individual task demands (Seated to Standing, Ambulation, Cone Turn, Preparation to Sit, Standing to Seated) Flexibility restrictions, gait abnormalities, sensory/vestibular Impairments, eccentric control deficits

3 Timed Up and Go In Action Assessment #3 30 Second Chair Stand Test CS developed by Rikli & Jones (JAPA, 1999) Measures lower body muscular strength Outcome measure is completed repetitions in 30 seconds Flexibility restrictions, muscle activation asymmetries, sensory/vestibular impairments, eccentric control deficits 30 Second Chair Stand In Action CONSTRUCT: Mobilization The ANKLE & HIP are KEY!!! Subconscious utilization of ankle strategy during quiet standing Reactive utilization of hip strategy during movement Isolated non-loaded mobilizations Ankle Circles Hip Circles Loaded integrated mobilizations TADAs Mobilizations CONSTRUCT: Muscle Strengthening Ankle Circles Hip Circles More than just gaining strength Enhance neural recruitment & increase lean tissue mass Challenge postural control and improve stabilization capacity Emphasize eccentric control during movement deceleration of gravitational forces is essential for falls prevention Selected exercises Chair squats DB Cobra TADAs

Muscle Strengthening CONSTRUCT: Gait Enhancement Chair squats with forward reach Standing DB Cobra WHY do older people walk the way they do?

!!! (contracts the sphere of function) Pathological conditions (only in a small % of OAs) Gait Enhancement Enhancing the proprioceptive input Increasing awareness at long distance Selected Exercises

Christian Thompson Department of Exercise & Sport Science University of San Francisco 2130 Fulton Street San Francisco, CA 94117 cjthompson@usfca.

4 Muscle Strengthening CONSTRUCT: Gait Enhancement Chair squats with forward reach Standing DB Cobra WHY do older people walk the way they do??? Reduced mobility of ankle & hip joint (reduced sensory input) Gravity is winning the battle FEAR!!!! (contracts the sphere of function) Pathological conditions (only in a small % of OAs) Gait Enhancement Enhancing the proprioceptive input Increasing awareness at long distance Selected Exercises Side Stepping Ladder Drills Gait Enhancement Questions???? Side Steps Ladder Drills Thank You!!!! Functional Reach Test (FRT) Dr. Christian Thompson Department of Exercise & Sport Science University of San Francisco 2130 Fulton Street San Francisco, CA cjthompson@usfca.edu (415) The FRT is an indicator of limits of stability. It is meant to determine the distance that a person can move his/her center of gravity in the anterior direction before needing to take a compensatory step. Instructions: 1. Provide the following instructions to the participant: Reach forward as far as you can at the level of the yardstick by shifting your weight forward on your feet. Hold your endpoint until I tell you to stop. Do not step forward and keep your heels on the floor. You may not touch the yardstick. Keep the other arm at your side. Have the participant repeat the instructions to you to ensure understanding. 2. Have participant stand next to a wall free of obstructions with the feet hip width apart. The dominant arm should be closest to the wall. 3. Tape a yardstick to the wall at the level of the mid-shoulder capsule. Have high values of yardstick closest to the subject. 4. Have participant extend his/her arm to the front at ~ 90o of shoulder flexion (at shoulder height). Have participant make a fist with the lifted arm. The participant MAY NOT touch the yardstick or wall. Instruct pt. to simply lift the arm, but not to reach forward. Watch for any scapular protraction and correct the participant. 5. Measurement based on total distance traversed by longest knuckle of reach hand (subtract starting from ending position). Measure to the nearest ¼. Use straight edge to determine start and end point. 6. Practice for 2 trials, provide feedback. Record 3 official trials and calculate mean. Trial 1: Starting Point: Ending Point: Total: Trial 2: Starting Point: Ending Point: Total: Trial 3: Starting Point: Ending Point: Total: Mean Value:

5 Timed Up and Go Test (TUG) Chair Stand Test (CS) The Timed Up and Go test measures, in seconds, the time taken by an individual to stand up from a standard folding chair (approximate seat height of 46 cm), walk a distance of 3 meters (approximately 10 feet), turn, walk back to the chair, and sit down again. Instructions: The subject wears his/her regular footwear. If a participant usually uses a cane, he/she should use it during the test, but this should be indicated on the data collection form. No physical assistance can be given. Setting up the test area: Determine a path free from obstruction. Place a standard folding chair at one end of the path. Ensure that the chair is supported from behind and will not tip over. Mark off a 3 meter distance using a tape measure from the base of the chair. Put a piece of masking tape at the 3 meter mark Place a cone on the inside of the tape to delineate turn-around point. Participant starts with their back against the chair, their hands resting on their lap, and walking aid in hand. Start the test: Speak clearly and slowly. Inform participant of sequence and outcome: When I say go, you will stand up from the chair, walk to the mark (cone) on the floor, walk around the cone, walk back to the chair and sit down. Walk as fast as you can, safely, without falling. I will be timing you using a stopwatch. Ask participants to repeat the instructions to make sure they understand. Use a cue like Ready, Set, Go! Start the stopwatch upon saying the word Go. Stop the stopwatch as soon as the subject s buttocks contact the chair at the end of the walk. Record result to nearest 0.01 second. Perform two trials. Circle fastest time. Performance Time: Trial 1: seconds Trial 2: seconds The Chair Stand test measures the total number of sit-to-stands that can be completed by an individual in 30 seconds. The objective is to stand up fully from a standard arm chair (approximate seat height of 46 cm), return the buttocks to the chair, and repeat for as many times possible in 30 seconds. Setting up the test area: Determine a path free from obstruction. Place a standard folding chair at one end of the path. Ensure that the chair is supported from behind and will not tip over. Start the test: Speak clearly and slowly. Inform participant of test sequence and outcome: When I say go, you will fully stand up from the chair and sit back down making sure that the buttocks contact the chair on each repetition. Perform as many repetitions as possible and continue until I say Stop. You may take a break during the test if you need to, but please perform as many repetitions as possible. I will be timing you using a stopwatch. Ask participants to repeat the instructions to make sure they understand. Participant starts with their back against the chair with their hands crossed over their chest. The hands must stay in this position the entire test. Use a cue like Ready, Set, Go! Provide encouragement throughout the test, but do not give time indicators. Use a stop-watch to time the performance and count the number of completed trials in 30 seconds. Record the number of COMPLETED repetitions on the data sheet. If participant is performing incorrectly, stop the test, explain the correction, and begin again. Scoring: Trial 1: repetitions

Volunteer Instructions

Volunteer Instructions Body Mass Index (1 Volunteer / 2 Minutes) The athlete s weight and height will be measured to determine their Body Mass Index (BMI). Portable Weighing System or Scales, Measuring Tape Set-Up: Remove Portable