Prevention, Assessment and Intervention for Falls in Adults with Developmental Disabilities

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Prevention, Assessment and Intervention for Falls
in Adults with Developmental Disabilities

• Victoria Lamb, SDPT
• Doctor of Physical Therapy Student
• Duke University
• Georgetown University
• Health Resources Partnership

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Objectives

• Identify 3 common risk factors for falls.
• Participate in falls risk assessment.
• Name at least two fall assessment tools.
• Contribute to the development of DC HRP falls
  risk pamphlet.

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Developmental Disability

• Developmental disability (DD) is a term used to
  describe
• severe
• life-long disabilities
• attributable to mental and/or physical
  impairments
• before the age of 22.
• Common developmental disabilities
• Cerebral Palsy
• Down Syndrome
• Mental Retardation
• Autism
• More Information
• http//en.wikipedia.org/wiki/Developmental_disabil
  ity

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Developmental Disability Can Result in

• substantial functional limitations in two or more
  of the following areas of major life activities
• self-care
• receptive and expressive language development and
  use
• learning
• mobility
• self direction
• capacity for independent living or economic
  self-sufficiency
• http//ddrb.org/about/index.html

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What is a Fall?

• An event which results
• In a person coming to rest
• Non-purposely to the ground or other lower level
  and
• Is not the result of the following Sustaining a
  violent blow, loss of consciousness sudden onset
  of paralysis, as in a stroke or an epileptic
  seizure (Kellogg International Working Group)

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Who Falls

• 1/3 of older adults living in the community (gt65
  y.o.) fall each year.
• Men are more likely to die from a fall.
• Women are more likely to have nonfatal fall
  injuries.
• Rates of fall-related fractures among older
  adults are more than twice as high for women as
  for men (Stevens et al. 2005).

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Consequences of Falls

• Death
• Injuries
• i.e. hip fractures
• Hospitalization
• Traumatic Brain Injury

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What about falls and developmental disabilities?

• Individuals with moderate and profound
  intellectual disability (ID) were at a higher
  risk for injury than those with mild or severe ID
  (Spreat Baker-Potts, 1983).
• Higher fracture rates for residents of an
  intermediate care facility for people with mental
  retardation than the general US population
  (Tannenbaum et al., 1989).

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So.

• There is a significant lack of knowledge of falls
  in adults with DD.
• Less evidence on assessment, intervention and
  prevention for people with DD.
• Falls are a significant health risk.
• Therefore, we must be PROACTIVE vs. reactive!

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Common Risk Factors

• Seizures, behavior and medications
• History of Falls
• Muscle Weakness
• Gait Deficit
• Balance Deficit
• Use of Assistive Device
• Visual Deficit

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1. Research focusing on people with developmental
disabilities

• Seizures
• i.e. seizures on a monthly basis?4x at risk for
  falls
• Destructive behavior
• Antipsychotic medications

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2. History of Falls

• There are two important things to consider when
  someone previously suffered a fall
• 1. Predisposition
• 2. Previous Fall

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Therefore, we need

• Documentation
• Tracking method
• Periodical check-up

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Signs of a Fall

• Fracture
• Bruising
• Soreness
• Limping
• Inactivity
• Any others?

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3. Muscle Weakness

• Decrease strength can lead to inability to
  support ones self when changing positions.
• Going to the bathroom
• Getting out of bed
• Signs of muscle weakness
• Unable to stand without help
• Noticeable muscle atrophy and/or wasting
• Poor breathing
• Poor body posture
• Pressure ulcers

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4. Walking Difficulties

• Compromises stability and balance and leads to
  increase risk for falls.
• Common developmental disabilities that affect
  walking
• Cerebral Palsy
• Downs Syndrome
• Mental Retardation
• Autism

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Common Walking Problems

• Scissoring gait
• Walking on toes
• Inability for leg to clear the floor
• Hip drop
• Shuffling

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Dynamic Gait Index Profile

• Clinical measurement of walking function in
  people with balance and vestibular disorders.
• 8 item or 4 item (short form) test

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Gait Video Assessment

• Profile 25 y.o. male with autism
• Walking Assessment
• What do you see?
• What do you think are his impairments and
  functional limitations?
• Compare his walking on the track vs. the pool
  deck?

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5. Balance Deficit

• Decrease balance reduces stability and makes it
  difficult to recover from sudden disturbances.
• Balance can be impaired in many ways
• Ear infections
• Vision deficits
• Poor body movement

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Balance Assessments

• Balance Berg Scale
• Tinetti
• Timed Up and Go (TUG)

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Balance Berg Scale

• Scale used to identify balance impairment in the
  older adults.
• Consist of 14 tasks that are scored on a 0-4
  scale.
• Predictive A score lt45 was predictive of
  multiple falls.
• Estimated time to complete 15-20

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Tinetti

• Measures gait and balance.
• Scoring done on a three point ordinal scale (0 to
  2).
• Maximum gait score 12
• Maximum balance score 16
• Time to complete 10-15 minutes
• Interpretation
• lt 19 high risk
• 19-24 at risk for falls.

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The Timed Up Go Test (TUG)

• To identify and screen older individuals who are
  prone to falls.
• Tested in 3 different conditions (alone, manual,
  and cognitive)
• Predictive TUG (alone) is 13.5s TUG (manual) is
  14.5s TUG (cognitive) is 15s.

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6. Use of Assistive Device

• Assistive Devices become a risk factor for falls
  when there is
• Improper use
• Faulty mechanics
• Household obstacles and floor coverings
• Broken or faulty equipment
• Solutions proper equipment, education and home
  modifications

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7. Visual Deficit

• For those of us who wear glasses or contacts, how
  great is our vision when we removed those things
  from eyes?
• Vision deficits can affect
• depth perception with stairs
• inability to detect subtle changes in ground
  elevations
• difficulty seeing potential obstacles

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Signs of Visual Deficits

• Red eyes
• Squinting
• Inability to read signs and/or identify objects
  near or far away.
• Delay or avoidance of task
• Increased tearing and watering of the eye
• http//www.aoa.org/documents/QRG-20.pdf

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Breakout Session

• Each table has been given a test or measure.
• Each person should try to perform at least one
  task or skill on the test.
• Record your scores and assess your ability.
• Be able to discuss
• How well you think this test could accurately
  assess individuals with Developmental
  Disabilities?
• What did you like and dislike about the test?
• What do you think should be added to the test or
  measure?

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Test and Measure Table (Give Handouts)
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Interventions

• Interventions should be
• Comprehensive
• Performed by trained individuals
• Accessible to those who need it

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Comprehensive Interventions

• Home modification
• Exercise
• Balance
• Strength
• Aerobics
• Education
• Medical Intervention

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1. Home Modifications

• Should address
• Wet, slippery surfaces
• Uneven, cluttered surfaces
• Unexpected obstacles
• Stairs and curbs
• Improper or inadequate lighting, or sudden
  changes in lighting
• Footwear
• Poorly fitted assistive devices for walking
• Birge, 1993

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2. Exercise

• Have been shown to improve function
• Target
• Balance
• Strength
• Aerobic endurance

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Exercise Contd.

• Balance training produced functional improvement
  for older adults with ID (Carmeli et al, 2004).
• Participation in low-impact aerobic dance program
  increased the cardiovascular endurance of adults
  with ID.

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3. Education

• Should include education on the following
• Proper use of assistive device
• Falls prevention
• What to do in the event of a fall

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Who could be involved?

• Physicians
• Nurses
• Physical Therapists
• Occupational Therapists
• Psychologists
• Family
• Caregivers

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• Transferring Tips

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Transfers

• Transfers Involve moving a person from one place
  to another location.
• Can include, but is not limited to
• bed wheelchair
• wheelchair chair
• chair toilet
• chair car seat

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Key Tips

• Equipment locked
• Establish clear path
• Get close to where you are going
• Keep your back straight (use your legs!)
• Establish a wide base of support
• Get close to the person (you should move as one
  unit!)
• Avoid twisting motions as much as possible (pivot
  instead)
• Do NOT grab on the persons clothing and do NOT
  have them grab onto your clothes as leverage.

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Key Tips Contd.

• If possible have person relax their arms over
  your shoulder (NOT AROUND NECK)
• Give a count (1-2-3-move)
• REQUEST HELP IF YOU NEED IT!

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• Lets Practice!

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What IF Someone Falls?

• Asses the environment
• Make sure its safe to help
• If a person has suffered a serious fall, DO NOT
  MOVE THEM, CALL 911.

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Getting Up From a Fall

• Can be done
• Independently
• With the assistance of 1 or more persons
• With the assistance of sturdy support
• Lets practice
• Safe ways to get up from a fall
• How 1 or more people can safely and properly
  provide assistance.

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Coming Soon

• DC HRP Falls Risk Algorithm
• DC HRP Transfer Video
• American Physical Therapy Association (APTA)
  pocket guide to falls risks assessment,
  intervention and prevention.

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Additional Resources

• http//www.neuropt.org/csm07/13957.pdf
• Falls The assessment and prevention of falls in
  older people. (Developed by the National
  Collaborating Centre for Nursing and Supportive
  Care)
• http//www.cdc.gov/ncipc/factsheets/adultfalls.htm
  
• http//www.aoa.org/documents/QRG-20.pdf

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THANK YOU!

• Contact Info
• www.dchrp.info
• VRL2_at_DUKE.EDU