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

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


1
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

2
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.

3
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

4
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

5
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)

6
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).

7
Consequences of Falls
  • Death
  • Injuries
  • i.e. hip fractures
  • Hospitalization
  • Traumatic Brain Injury

8
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).

9
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!

10
Common Risk Factors
  1. Seizures, behavior and medications
  2. History of Falls
  3. Muscle Weakness
  4. Gait Deficit
  5. Balance Deficit
  6. Use of Assistive Device
  7. Visual Deficit

11
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

12
2. History of Falls
  • There are two important things to consider when
    someone previously suffered a fall
  • 1. Predisposition
  • 2. Previous Fall

13
Therefore, we need
  • Documentation
  • Tracking method
  • Periodical check-up

14
Signs of a Fall
  • Fracture
  • Bruising
  • Soreness
  • Limping
  • Inactivity
  • Any others?

15
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

16
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

17
Common Walking Problems
  • Scissoring gait
  • Walking on toes
  • Inability for leg to clear the floor
  • Hip drop
  • Shuffling

18
Dynamic Gait Index Profile
  • Clinical measurement of walking function in
    people with balance and vestibular disorders.
  • 8 item or 4 item (short form) test

19
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?

20
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

21
Balance Assessments
  • Balance Berg Scale
  • Tinetti
  • Timed Up and Go (TUG)

22
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

23
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.

24
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.

25
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

26
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

27
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

28
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?

29
Test and Measure Table (Give Handouts)
Gait Balance Muscle Strength

Dynamic Gait Index Balance Berg Scale Informal Assessment
Tinetti
Timed Up and Go
30
Interventions
  • Interventions should be
  • Comprehensive
  • Performed by trained individuals
  • Accessible to those who need it

31
Comprehensive Interventions
  • Home modification
  • Exercise
  • Balance
  • Strength
  • Aerobics
  • Education
  • Medical Intervention

32
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

33
2. Exercise
  • Have been shown to improve function
  • Target
  • Balance
  • Strength
  • Aerobic endurance

34
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.

35
3. Education
  • Should include education on the following
  • Proper use of assistive device
  • Falls prevention
  • What to do in the event of a fall

36
Who could be involved?
  • Physicians
  • Nurses
  • Physical Therapists
  • Occupational Therapists
  • Psychologists
  • Family
  • Caregivers

37
  • Transferring Tips

38
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

39
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.

40
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!

41
  • Lets Practice!

42
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.

43
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.

44
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.

45
(No Transcript)
46
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

47
THANK YOU!
  • Contact Info
  • www.dchrp.info
  • VRL2_at_DUKE.EDU
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