BALANCE & MOBILITY STRENGTH TO STRENGTH. Kate Wignall (OT) Caroline Lubach (OT) Kristy Lucas (AHA)

Transcription

1 BALANCE & MOBILITY STRENGTH TO STRENGTH Kate Wignall (OT) Caroline Lubach (OT) Kristy Lucas (AHA)

2 THE GROUP UP UNTIL NOW Group began in 1999 Previously run once a week In 2012, 5 people registered, 3 people attending consistently Followed a structured repetitive schedule for the 60 minute class Utilised gym equipment Seated strength exercises with leg weights No standing targeted balance exercises BERG balance assessment used on entering and exiting the group Poor follow through of exercise at home

3 AIMS OF GROUP Maintain or improve current level of functional balance & mobility. Prevent degeneration of muscles, maintain range of movement, strengthen through weight training, exercise and activity. Support and encourage a greater wellbeing; Self Esteem, Optimism, Belonging, Satisfaction, Purpose, Support keep our participants independent and active at home and in our community! Embrace all clients in our community and adapt our exercises to be inclusive no matter the medical or physical impairment.

4 EVIDENCE BASE Draws upon the same evidence Stepping On & the Otago Exercise Program Evidence Risk of falls increases when aged 65 years+ Falls can be prevented Stepping On/ Otago Program are clinically effective in falls reduction, Otago has reduced falls by 35% From the Australian Institute of Health & Welfare reported 96,385 people aged 65 and over were hospitalised for a fall-related injury. Predicted to rise from 3 million to 8.1 million people from 2010 to 2050 The total estimated cost of health care associated with medically treated fall injuries in older people in NSW in 2006/07, was estimated at $558.5 million Both programmes consider falls prevention holistically (environment/co-morbid health conditions/sensory impairments/medications/continence/ physical & cognitive status)

5 CHANGES IN PLACE Expansion of 3 groups per week (11am-12pm) Assessments in place now every three months, first occurring prior to starting the group (BERG balance assessment) Maintained scheduled 60 minute class Across all groups seated or standing warm up, Otago Program Leg Strength with weights/core Strength Ball exercise Risk Management Tools Moved away from machine based exercise

6 WHAT IT LOOKS LIKE Monday group Low BERG score, most walk with gait aid Chair based warm up Otago Program Leg strength with weights Station based functional balance and cardio activities Core activity with exercise ball Seated stretching

7 Thursday group Mid score on BERG, may walk with gait aid Standing warm up utilising whole room Otago Program Leg strength with weights Week to week focus on different area - Example: Obstacle course Forward Reaching Peripheral Vision Dexterity activity

8 Tuesday group High score on BERG, does not use gait aid Standing warm up Otago Program Leg strength with weights Various balance activities, usually rotated around in a circuit style allowing each participant 4-5 minutes on each activity Ball activity Standing Cool down

9 THE 3 TIERS OF FALLS PREVENTION Balance & Mobility Group Tai Chi Class Community Exercise Group Score of <55 on BERG balance assessment High falls risk & medically complex Benefit from short-term strength & balance before moving to Tai Chi Needs transport to access group (available on Mon) Cognitive difficulties making Tai Chi inappropriate Score of >55 on BERG balance assessment Low to medium falls risk Cognitively able to follow Tai Chi demonstration in group Endurance for standing program Score of 58+ on BERG balance assessment Low falls risk No/ minimal cognitive deficit None complex client

10 RISK MANAGEMENT TOOLS GP FORM & MONITORED VITAL SIGNS : Notification to GP of client wishes to join the group request for client vital sign norms. PARTICIPATION CONSENT : Agreement to participate in group, highlights client responsibility to inform staff of changes in health. VITAL SIGN CONCERNS: Vital Sign Form is copied with an attached letter outlining concerns to GP. CLIENT FILE NOTES: Documentation occurs after every group. EXAMPLE FORMS CAN BE FOUND IN HANDOUT.

11 MOVE TO FUNCTIONAL EXERCISES

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14 BERG Balance scale score 60 Optimal Score CLIENT OUTCOMES Client BERG Balance Assessment Initial and Most Recent

15 EVALUATION OF CHANGES Raising awareness and empowering clients Increased communication with the Client, GP and referrers regarding outcomes Motivation to continue to attend based on feedback of outcome measures Increase information gathering and referrals Client goal focused activities Self initiated exercise at home

16 CHALLENGES Managing genders across the groups and inherent competition Moving people through the program and onto community groups Managing non-attendance Providing education component crucial to best practice Completion of paperwork by GP in timely manner Managing transport and meals on wheels

17 USEFUL LINKS How safe are you from falling South Australia Falls Prevention - Able bodies balance training Sue Scott Otago Exercise Program - Stepping On falls prevention program - Never Leave the Playground Watson W, Clapperton A, Mitchell R. The incidence and cost of falls injury among older people in New South Wales 2006/07. Sydney: NSW Department of Health, AIHW (Authoritative information and statistics to promote better health and wellbeing) - For any questions please contact us at: occupational.therapy@ydhs.com.au or on