presented by Michelle M. Lusardi & Mariana Wingood
Once an older adult has been identified as being at risk of falling, Physical Therapists and other health professionals must develop and prioritize a problem list, set meaningful and measurable goals, assess outcomes of intervention, and make plans for discharge. This course will consider each of these factors, with an emphasis on evidence-based interventions and effective documentation and communication, so that Physical Therapists and other health professionals can be as effective as possible in reducing risk of falling for the older adults in their care. This final course in our three course series completes the triad of 1) understanding the neurophysiology of postural control and the age-related and disease related factors that may compromise efficacy of balance systems, 2) determining an older person’s individualized risk of falling using both screening and multifactorial risk assessment strategies and 3) developing evidence-based interventions that will reduce that risk.
For more detail on assessment and intervention for impaired balance and risk of falls, view the other courses in this series:
Dr. Lusardi’s interest in balance and falls in later life has its roots in her early years as a physical therapist on the neurological service at Hartford Hospital, when she noticed that many of her patients with stroke and amputation limited their physical activity because of concern about falling. Seeing the functional consequence of inactivity in the older adults who completed rehabilitation, Dr. Lusardi returned to graduate school to prepare for an academic and research career that has focused on geriatrics and functional mobility. Dr. Lusardi served on the physical therapy faculty at the University of Connecticut from 1981 through 1996, responsible for the neurological curriculum thread, as well as content on prosthetics and orthotics. She moved to the problem based learning Master’s program as a founding faculty member in 1997, coordinative the 2nd semester with its emphasis on neurological rehabilitation across the lifespan. During her time at Sacred Heart, her research produced gender and age-based "norms" for many functional tests and measures used in rehabilitation. Although now a retired Professor Emeritus, Dr. Lusardi has continued to write and teach about physical therapy care for older adults. Dr. Lusardi has authored more than 40 peer-reviewed manuscripts and book chapters, as well as a textbook "Orthotics and Prosthetics in Rehabilitation", now in its 3rd edition. She has presented her research at both APTA CMS and NEXT conferences, as well as the Gerontological Society of America Annual Meetings. Her continuing Education courses on neuroanatomy and functional assessment have been well received in more than 15 different states. Dr. Lusardi has served on the Board of Directors of the Academy of Geriatric Physical Therapy, as Editor of the Journal of Geriatric Physical Therapy, and as chair of the "GeriEDGE" task force on functional assessment. She has made numerous presentations at APTA Combined Sections and NEXT Meetings, as well as at the annual meeting of the Gerontological Society of America. Dr. Lusardi’s contributions to the profession and excellence as an educator have been recognized by the Joan Mills Award and Outstanding Educator Awards from the Academy of Geriatric Physical Therapy, and by the Baethke-Carlin Award and Lucy Blair Award from the American Physical Association. In 2016, she was named a Catherine Worthingham Fellow of the American Physical Therapy Association. Dr. Lusardi is excited to join the MedBridge team with her colleague Mariana Wingood as part of the GCS preparatory efforts, contributing a three course series on Balance and Falls in Later Life.
Mariana Wingood, PT, DPT, GCS, CEEAA is a physical therapist at University of Vermont-Acute Inpatient Department, in Vermont. She is a highly enthusiastic member of the Academy of Geriatrics who is involved in numerous projects including the CPG research group, GeriEDGE Fall Risk Assessment workgroup, Chair of the Balance and Falls SIG, Vermont State Advocate, and Program Committee. Dr. Wingood’s focus is on fall prevention and exercise prescription for older adults. Her professional goal is improving the profession by increasing the knowledge base of evidence based practice. This is why she has taught at University of Vermont and presented at numerous state and national conferences.
This first chapter presents the sets of system-based problems that contribute to risk of falling which may be identified during the physical therapy examination and evaluation process.
This chapter introduces/reminds participants about the resources in The Guide to Physical Therapist Practice, available online (free to APTA members, for a fee to non-members) at the American Physical Therapy Association’s website (www.apta.org/guide).
This chapter presents prognostic factors; reviews concepts of intervention intensity, frequency (dosage) and duration that influence outcomes of intervention; and presents current best evidence (systematic reviews) of multicomponent exercise, home based exercise programs, perturbation training, pilates, exercise and fear of falling, Wii-based exercise, foot and ankle muscle performance, flexibility exercise and PT led, group based exercise.
This chapter provides a brief review of motor learning, as well as the person/task/environment model that forms the basis of Gentiles Taxonomy.
This is the clinically applied and longest chapter in the course. It presents the multiple components/factors that may be addressed to reduce risk of falling and improve postural control.
This chapter prompts the clinician to use minimal detectable change/difference and minimal clinically important difference (where available) for measures used to determine risk of falling (based on cut score), baseline function and documenting outcomes of interventions. It also prompts clinicians to use gender and age-specific performance norms in their documentation to compare patient performance to community living peers. It reviews appropriate G-coding, determination of severity levels, and the timeline required by Medicare for documentation during an episode of care.
Physical therapy care is necessary but not sufficient to sustain changes made during an episode of care to reduce risk of falling for the long term. This chapter highlights the importance of an effective (and doable) home exercise program and accessing community based programs to supplement and support gains achieved during one-on-one physical therapy intervention.