FALLS IN THE ELDERLY CONTINUE TO RISE. IT IS DEVASTATING. The implications of falls have long been brought to light by researchers and statisticians alike. The economic impact upon the government is staggering.
The estimated cost to treat injuries sustained from these falls is estimated to exceed $50 billion dollars from the year 2015 and may reach $67.7 billion in the year 2020. Furthermore, Medicare and Medicaid shouldered 75% of these costs.
Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
The enormity of the problem has prompted diverse programs involving over 70 national organizations involved in Fall prevention, The Falls Free National Action Plan by the NCOA.
The plan includes action steps of reducing the impact of medications as a risk factor, promoting physical mobility, and improving home safety. Fall risk assessment and screenings, promoting evidence-based programs also is a major component of this national initiative.
More Fall Prevention Programs have surfaced and a majority of these promote exercise programs designed to reduce falls in the elderly. Tai Chi has been widely recognized as an effective exercise program for fall prevention.
As released by the CDC in a PDF Form on its principles and why:(Source: CDC.gov)
Tai Chi Principles for Falls Prevention in Older People
The following notes are suggestions for incorporation into a Tai Chi program specifically targeting fall prevention in older people.
BALANCE
The key element in preventing a fall. Balance has been shown to decrease with age; however, some aspects of balance can be enhanced through training.
Key elements to incorporate into a Tai Chi program:
Relaxation
> relaxes muscles > lowers the center of gravity Lowered center of gravity > increases load on lower limbs > over time increases sensation and awareness of lower limb movement.
• Transfer of Weight:
Shifting body weight from leg to leg through incremental movements. Start with a small range of movement and gradually build up to a wide, square base stance.
• Muscle strength
Muscle bulk and therefore strength decrease with age. A bent-knee stance and movement work to strengthen lower limb muscle (particularly the quadriceps muscles) (however, always work to an individual’s limitations. If a bent knee stance is too difficult, then do the movement without bent knees).
• Instability
This involves issues such as increased body sway, low mobility, and postural instability. Increasing age is also associated with reduced sensation in lower limbs and is consequently associated with a loss of righting reflexes and an increase in body sway, which can lead to falls.
o Gait:
Decreased stepping height and decreased stride length. Women tend to have a narrow walking and standing base, closer foot placement, erect posture > difficulty stepping down from stools/benches. Men tend to have a small-stepped gait, wider walking and standing base, and stooped posture.
Tai Chi addresses gait problems by teaching the “correct” movement of lower limbs. This is done by lifting lower limbs from the knee rather than the foot; lifting lower limbs without misaligning the pelvis, and teaching to place heel down first when moving forward (toes first when moving back). Also, teaching movement with appropriate weight transfer, posture, and slightly bent knees improves stride length
Posture:
Tai Chi also teaches participants to maintain a relaxed posture with an elongated spine.
• Coordination/Mobility:
Tai Chi consists of moving from one stance to another in a slow, coordinated, and smooth way. This trains students in improved mobility and increased body awareness.
C. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
D. Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
The enormity of the problem has prompted diverse programs involving over 70 national organizations engaged in Fall prevention, The Falls Free National Action Plan by the NCOA.
It is no surprise that initiatives have been in place focused on Fall Prevention in the elderly. Fall screens are being implemented to assess a patient’s risk for falls. Examples for these balance and fall risk assessments are the TUG (Timed Get Up and Go Test), The Berg Balance Test, The Tinetti Balance Assessment, Functional Reach, Dynamic Gait Index, and many more.
The John Hopkins medicine organization has come up with their assessment tool for the assessment and identification of fall risk patients in the acute setting.
This article, however, will discuss more prevention and will provide helpful exercise tips to improve balance. There are many exercise equipment and tools available for use in the physical therapy/rehab setting. Will be sharing more of them in the future. The focus of this article, however, is the Airex Foam Balance Pad. It is easily available in stores and Amazon. They come in different sizes, and lately, in different colors.
These are now available in different brand names available in the market. They are widespread in gyms, in gymnastics and dance schools, in elite sports performance facilities.
They come in different shapes nowadays: Square, rectangular, oval, and long/balance beam type shape. The square ones are the most popular. It is easily available in stores and Amazon. Lately, in different colors too.
Why Airex Foam? Airex is a specialty cross-linked polymer foam core. It contains millions of air bubbles trapped inside the material; This air is displaced once subjected to force or pressure or loading; Once the force shifts, however, it can return to its original form (Memory).
Unlike memory foam, the Airex foam is more rigid and condensed and can withstand constant use.
Many brands are currently in use at therapy clinics. Moreover, this is a personal assessment: Not all Airex Foams are created equal. They have gotten better over the years. However, some models are still easily worn out and torn.
Airex Foam balance pads have been an excellent adjunct to balance exercise I prescribe to patients I see. It has proved useful in different cases.
APPLICATIONS IN THE CLINICAL SETTING:
1. POST SURGICAL CONDITIONS – In our outpatient setting, we see patients as early as Day 1 Post-op: Knee Replacements, Hip Replacements, Arthroscopic procedures for meniscus tears, ACL tears. (Anterior Cruciate Ligament Tear)/PCL (Posterior Cruciate Ligament tears)
The Airex Foam in these stated conditions allows exercise that is less irritating and painful in recovering soft tissue and joints while still getting the benefit of the high amplitude of muscle contractions supporting or traversing these joints.
2. ARTHRITIC CONDITIONS – For patients plagued by joint pains, especially on the hips and knees, weight-bearing exercises or high-impact exercises can cause significant misery. These activities create too much friction inside a joint that is already inflamed, irritated, and structurally damaged.
Working on lower extremity strengthening using an Airex Foam Pad promotes tolerance to exercises in the standing posture. While weight-shifting and doing exercises on the foam, one can get significant muscle contractions.
The quality muscle contractions triggered is due to the instability that the Airex Foam provides challenging the user to always orient the trunk towards the center of gravity so as not to lose balance.
Since these exercise forms are usually maintained or sustained for a prolonged number of seconds ( 5 – 10 seconds often, and I let the patient count ), there is an increase in the recruitment of muscle fibers necessary for regaining strength, motor control, stability, and proprioception. Proprioception is described as one’s ability to perceive body parts positioning in space while performing specific tasks.
3. PARKINSON’S DISEASE PATIENTS – Parkinson’s patients have incoordination problems and movement disturbance. Tremors are typical in hands, the rigidity of the trunk, and shuffling gait.
Standing on an Airex Foam promotes protective righting reactions during exercises requiring weight shifting. Activities that let the patient do reaching tasks away from the midline also improves the trunk stability needed for fall prevention.
4. VERTIGO & DIZZINESS– Conflicting input to the vestibular pathways cause vertigo. Caused either by problems in the brain or the inner ear, it creates anxiety for fear of falling.
Falls are frequent in dizzy patients due to the diminished ability to regain control of the body during motions that occur with daily tasks. Vestibular exercises using the Airex Foam, in conjunction with Vestibular Rehabilitation in Physical Therapy, can improve the patient’s ability to compensate for balance deficits.
5. PATIENTS WITH WALKING DIFFICULTIES – Gait difficulty and gait abnormality are typical. Often seen in patients with musculoskeletal or neuromuscular conditions.
Those, as mentioned earlier, can be attributed to a generalized weakness or muscle imbalance in the left or right side of the body. A patient or user standing on an Airex Foam while doing balance exercises forces the antigravity muscles to activate.
These muscles are responsible for opposing the effects of gravity. Hence the name. These are the gastrocsoleus, the quadriceps, the gluteus maximus, and the muscles of the back.
6. POST STROKE PATIENTS – The residual deficits from a stroke are very evident. One-sided weakness or paralysis, asymmetry in the facial muscles, slurred speech, and gait abnormality. Often, many sufferers sustain unilateral neglect or inattention. A person is missing the seat or running into one side of the door as they do not perceive objects on the affected hand.
Using the Airex Foam to encourage weight-bearing on the affected side. With the support, of course, this activity improves proprioception. It forces the weak hemiplegic side to participate in the effort.
One might say the residual deficits are too involved, but personally and as to experience, the brain’s neuro-plasticity fascinating. Such is the brain’s ability to re-wire and re-route around the damaged areas of the brain. It also allows for the compensatory ability to restore function using other components not primarily wired for such original use.
Constant reinforcement and subjection to balance and movement challenges will force the brain to find a way to deal with such a problem. Restoration of movement and function can be re-established. Although not as distinct as the original motion, it allows the person to perform self-care and basic mobility tasks necessary for functional independence.
7. BACK PAIN AND SPINE PATHOLOGIES – Back pain sufferers have one thing in common: altered posture. Altered posture is due to compensatory movements adopted by the body to avoid pain triggers. However, as this becomes a habit, it also marks the commencement of the pain cycle.
Doing core exercises in different postures using an Airex Foam strengthens the core, providing destabilization due to its unstable surface. Muscle recruitment is enhanced due to the body’s compensatory reaction to maintain control and center of gravity during these exercises.
There are more conditions where the use of Airex Foam optimizes results and benefits. The Airex Foam is also being used by elite and high-performing athletes to bring about more strength, flexibility, agility, and power.
Consult with a physical therapist for therapeutic exercises using the Airex Foam that is appropriate for your specific condition or issues.
Again, thank you!
**********
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FALLS IN THE ELDERLY CONTINUE TO RISE. IT IS DEVASTATING.
The implications of falls have long been brought to light by researchers and statisticians alike. The economic impact upon the government is staggering.
The estimated cost to treat injuries sustained from these falls is estimated to exceed $50 billion dollars from the year 2015 and may reach $67.7 billion in the year 2020. Furthermore, Medicare and Medicaid shouldered 75% of these costs.
Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
The enormity of the problem has prompted diverse programs involving over 70 national organizations involved in Fall prevention, The Falls Free National Action Plan by the NCOA.
The plan includes action steps of reducing the impact of medications as a risk factor, promoting physical mobility, and improving home safety. Fall risk assessment and screenings, promoting evidence-based programs also is a major component of this national initiative.
More Fall Prevention Programs have surfaced and a majority of these promote exercise programs designed to reduce falls in the elderly. Tai Chi has been widely recognized as an effective exercise program for fall prevention.
As released by the CDC in a PDF Form on its principles and why:(Source: CDC.gov)
Tai Chi Principles for Falls Prevention in Older People
The following notes are suggestions for incorporation into a Tai Chi program specifically targeting fall prevention in older people.
BALANCE
The key element in preventing a fall. Balance has been shown to decrease with age; however, some aspects of balance can be enhanced through training.
Key elements to incorporate into a Tai Chi program:
Relaxation
> relaxes muscles > lowers the center of gravity Lowered center of gravity > increases load on lower limbs > over time increases sensation and awareness of lower limb movement.
• Transfer of Weight:
Shifting body weight from leg to leg through incremental movements. Start with a small range of movement and gradually build up to a wide, square base stance.
• Muscle strength
Muscle bulk and therefore strength decrease with age. A bent-knee stance and movement work to strengthen lower limb muscle (particularly the quadriceps muscles) (however, always work to an individual’s limitations. If a bent knee stance is too difficult, then do the movement without bent knees).
This involves issues such as increased body sway, low mobility, and postural instability. Increasing age is also associated with reduced sensation in lower limbs and is consequently associated with a loss of righting reflexes and an increase in body sway, which can lead to falls.
o Gait:
Decreased stepping height and decreased stride length. Women tend to have a narrow walking and standing base, closer foot placement, erect posture > difficulty to step down from stools/benches. Men tend to have a small-stepped gait, wider walking and standing base and stooped posture.
Tai Chi addresses gait problems by teaching the “correct” movement of lower limbs. This is done by lifting lower limbs from the knee rather than the foot; lifting lower limbs without misaligning the pelvis, and teaching to place heel down first when moving forward (toes first when moving back). Also, teaching movement with appropriate weight transfer, posture, and slightly bent knees improves stride length
o Posture:
Tai Chi also teaches participants to maintain a relaxed posture with an elongated spine.
Tai Chi consists of moving from one stance to another in a slow, coordinated, and smooth way. This trains students in improved mobility and increased body awareness.
It is based upon these principles that I developed the
The Prime Motionz Book is Upcoming. ******************************************
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