I’m presenting a CEU with a colleague and the director of the residency program tomorrow on balance and falls. Part of my portion is on adherence to fall risk recommendations – I can’t go in depth in this CEU as I have at other times (when the topic was specifically adherence), and it has been a while since I’ve really dug into the literature on adherence in general other than monitoring it via PubMed’s weekly update email. One of the adherence models used is the Transtheoretical Model (stages of change), which uses Motivational Interviewing, or MI. In refreshing my memory, I found two good videos on this that I’ll post here. Watching them reminded me how I found the TTM and MI intriguing, and that I’d like to take a class on it to get better.
I received a tweet this morning – “Telerehab+fall predict platform= Game changing. Effective?” (I tried to embed it but it wasn’t working). The American Telemedicine Association is having their meeting in Minneapolis this week, and it will include telehealth platforms for seniors. Two quick thoughts about the idea before I get ready for work (I’d love your comments and thoughts in the comments or on Twitter).
First, I agree with the author of the article that cost will be a huge issue. Those on a fixed income are not going to have much wiggle room, and those who are poorer and rely on SS definitely will not. This will be an increasing concern with the Baby Boomers given the data out there on their savings (or lack of) for retirement.
Second, will THEY want to wear it/ use it? There is a great section of dialog in Jurassic Park where the grandfather is defending all he has done to the scientists, that he spared no expense, and Ian (Jeff Goldblum’s character) says something to the effect of your scientists were so busy asking if they could they didn’t ask if they should. In the same vein, are we so busy asking if we can do all this great tech we aren’t asking whether they want it? Yes, there are those who love tech and will embrace the idea, but are those the ones that are having the falls, experiencing incontinence, not eating well, etc? It reminds me of the Fitbit – those who use it are often the ones who are already fit. Will they view it as an invasion of their privacy, of one extra step closer to an ALF or a nursing home, despite assurances that the tech is “to keep them as independent as possible for as long as possible”?
I think the technology has the potential to be effective, and to be a game changer for many. But I think that for many others the financial cost and the resistance against the tech intrusion will require continued personal monitoring and involvement by family and the home health community.
Photo credit: “Old and New” by Sparky
Selection of good footwear is important in balance for older adults, and a fall reduction/ prevention program should include a review and discussion of footwear. In going through an older journal I had set off to the side, I came across this interesting article examining “Effects of Foot Orthoses on Balance in Older Adults” (JOSPT July 2012). This is definitely something to consider, and it would be interesting to see a prospective RCT for looking at the impact of orthotics on falls in older adults.
A few interesting links came across my desk recently, and I thought I would pass them on.
- Mobility Compendium Focused on Older Adults – “…a compendium of measures to support research and practice addressing the mobility of community-dwelling older adults with cognitive impairment or physical disabilities. The compendium includes self-reported, performance-based, and instrumented measures.”
I’m catching up on journals (part of a New Years resolution to reduce/ eliminate the collection I have) and came across two good articles, so I thought I would share briefly.
The first is “Use of the Theoretical Domains Framework to Develop and Intervention to Improve Physical Therapist Management of the Risk of Falls After Discharge” in the November 2014 issue of PTJ. If you have input into programs at your facility, or you have initiated a program but then had limited change in therapist behaviors, you may want to read this. I found it interesting as I’m currently reading through “Better” (see previous posts).
The second is “Reliability and Validity of the Balance Evaluation Systems Test (BESTest) in People with Subacute Stroke” in the same issue of PTJ. If you see patients with subacute stroke (or Parkinsons) and you haven’t checked out this test, you can read more about it here.
Brain injury is regularly in the news, with the focus on concussions and Chronic Traumatic Encephalopathy (CTE) in sports, or for soldiers returning with traumatic brain injury (TBI) and more from roadside bombs, etc. What is overlooked and that people may not be aware of is that older adults can have a brain injury as well from a fall, in fact “adults aged 75 years and older have the highest rates of TBI-related hospitalization and death.” (www.cdc.gov/traumaticbraininjury/statistics.html) March is Brain Injury Awareness Month, so I wanted to write a brief post to help increase awareness.
One in three adults over the age of 65 fall each year. If you associate falls with fractures, you would be correct – fractures are the most common injury from a fall. But most TBI’s are caused by falls and these are a definite concern. The Centers for Disease Control and Prevention (CDC) has a pretty good handout about TBI’s.
Symptoms of mild TBI include:
• Low-grade headache that won’t go away
• Having more trouble than usual remembering things, paying attention or concentrating, organizing daily tasks, or making decisions and solving problems
• Slowness in thinking, speaking, acting, or reading
• Getting lost or easily confused
• Feeling tired all of the time, lack of energy or motivation
• Change in sleep pattern—sleeping much longer than before, having trouble sleeping
• Loss of balance, feeling light-headed or dizzy
• Increased sensitivity to sounds, lights, distractions
• Blurred vision or eyes that tire easily
• Loss of sense of taste or smell
• Ringing in the ears
• Change in sexual drive
• Mood changes like feeling sad, anxious, or listless, or becoming easily irritated or angry for little or no reason
Symptoms of a moderate to severe TBI include:
• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Inability to wake up from sleep
• Dilation of one or both pupils
• Slurred speech
• Weakness or numbness in the arms or legs
• Loss of coordination
• Increased confusion, restlessness, or agitation
Photo credit: A100319_MAMC_TBI 1, originally uploaded by Joint Base Lewis McChord
Is gaming technology for balance impairments passe? The Wii and video game rehab seems to have waned in popularity in rehab magazines and popular culture (our OT’s have one, not sure how much it is used). I came across this study looking at step time using a similar idea to Dance Dance Revolution, and the Kinect system has a similar game (just not for the geriatric population). I have used the Kinect for a research project in my residency – it is currently gathering dust in our family room. I would consider trying it out again, but one conclusion I had is that a therapist can get more reps of a balance challenging activity in using traditional methods compared to the video games I used. Just because it is tech and new doesn’t mean it is relatively effective, although this study was something patients could do at home. Another study would be how to motivate them for carryover instead of it becoming another piece of equipment gathering dust.