Remember!!
You need to have good balance & strength to prevent falls
Good form is important for every exercise. Good form means: using the correct muscles of the exercise & performing safely & decreasing risk pain
 Slow & steady.. don’t hold breath
 Good sitting, standing, and walking postures helps your body maintain balance
 A well-rounded exercise program consists of aerobic/endurance, strength, flexibility, & balance. All four components are important in maintaining & promoting healthy
aging in addition to helping those who are physically weak & frail to improve their functional ability.
 What’s tired… Muscles? 3 more reps then you can sit down or Breathing? SOB? Sit down
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Advancing the Exercises:
The exercises need to keep changing so you can keep improving your balance & strength. By making the exercises challenging, you will continue to benefit.
As your balance & strength improves, the exercises will become easier.
 Balance exercises can be more challenging if you:  amt of external support, hold position longer/more reps, change foot placement
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Safety
Challenge your balance safely! Never do standing exercises holding onto an object that can move (chair). Always hold onto something stable (counter, table).
When you do exercises w/o holding on, stay near the counter or table so you can touch it when needed. If you have difficulty letting go, you should keep holding on.
 For balance exercises, many ppl start with holding on & gradually hold less & less.
 You may feel a bit stiff at first. This is quite normal & happens b/c you’re using muscles that are not used to working in this way. It is important to keep exercising. The
stiffness will leave as your body becomes more used to the exercises.
 If you’re very sore the day after exercising, the exercise intensity needs to be . You shouldn’t feel joint pain with the exercises. “No pain, no gain” is not true.
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Balance exercises
 STS
 Lat stepping
 Tandem stance
 Tandem amb
Strengthening
 Standing hip AB
 Standing HR/TR
 Seated LAQ
Effects of aging:
  thoracic kyphosis
  lumbar lordosis
  hip ext
  knee ext
Geriatric Interventions Clinical Considerations:
 Slow mvnt &  fatigue
  amb speed, shorter steps,  arm swing
  reliance on vision for mvnt & balance
 Visual & hearing deficits
 Sensory losses: touch, taste, smell
 Various strategies for memory & learning
 SOB or difficulty breathing
 Effects of meds, nutrition, & family
Basic Balance Progressions
Proactive Balance: Anticipatory balance – knowing what you’re going to have to do before u do it (ex. jumping over puddle)
Reactive Balance: Responding to an unknown situation
 Not knowing what you’re going to have to do before it happens (ex. balloon taps w partner)
 Ball in tube, Ball on plate (F/R/L/circles, keep ball in middle), Balloon vball, Scarf toss/catch, Bat/Dowel balance, Ball catch (wall vs partner)
Progressions - Sitting, Kneeling, Standing
Static:
 EO  HM w eyes stationary (gaze stability)  HM w eyes moving  EC  EC w HM  The add unstable surface (gym mat, foam, air-disc 
Dynamic:
 Forward reach, Lat reach (same side), Lat reach (across)
 Rotational reach (same side w torso turn), Rotational reach (across w torso turn)
 Running man: “move arms like you’re running.. hip to chin”
 Elevated reach (overhead)
 Sunrise/Sunset (hip – overhead – opposite hip) OH with rotational component
 FA  FT  Staggered  Tandem
 Unstable surface (foam, air-disc)
 Progress reaching by adding squat
SLS Balance Progressions
 SLS w Leg Swing (A/P, M/L)  SLS w leg ER/IR  SLS w clock dial  SLS w RDL  SLS w RDL & UE reach
BOSU flat side up  flat side down  BAPS)
Retraining Balance & Fall Prevention in Seniors
We hear this all this time… “I used to have such great balance.” Here’s the hard truth. When is the last time you actually worked on your balance?
Balance is a skill. It’s one of the first things that you lose when you stop doing it, but it’s one of the quickest things that returns when you start practicing.
 I think it has less to do with strength than coordination – muscles firing at the right time doing the right thing.
 Falls are NEVER normal at ANY age.
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Fall Statistics
 33% of all ppl over age 65 will fall. 75% will get better. 25% will require hospitalization. >25% of those ppl will never recover.
 55% of seniors who have fallen fell inside the house, 23% fell outside but rear the house, 22% occurred away from home.
 Typical place for a fall: living room (31%), bedroom (30%), kitchen (19%), bathroom (13%), hallway (10%)
What are the effects of a fall? devastating consequences
 Leading cause for older adults in terms of mortality & morbidity (illness, disease, impairment)
 Falls & Fall-related injuries have been the leading cause of injury deaths among older adults
 Fall-related hip fx’s account for ~25% of injury deaths among older adults
 34% of injury deaths among those age 85 & older
Major Risk Factors
Intrinsic factors:
 Age-related physiological changes
 Gender: Men fall mortality rate 46% higher than women
 Race: Caucasian 2.5X more likely to fall than non-white ppl
 Impairments to sensory-nervous system
 Disorders of musculoskeletal system
 Specific acute & chronic diseases
Extrinsic factors:
 Environmental hazards & obstacles interfering with safe mobility
 Medication side effects
Best Strategies for Fall Prevention
Multi-factorial
Environmental modifications
 Risk assessment (including medication management)
 Physical activity (exercise)
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Fall Guidelines
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 your risk factors will  likelihood of falls
 fall risk:
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Fall in last 6 months
Fear of falling
>4 meds (diuretics, psychotropic meds, anti-arrhythmic meds, digoxin.. slows HR)
Medical condition: Syncope (heart problems), Postural hypotension
Visual problems (acuity, depth perception, contrast sensitivity)
Envt (no grab bars or non-slip mats, poor lighting, loose rugs)
Physical problems (slow gait speed,  step length,  step width, step variability,  ankle/foot strength & mobility)
I’ve had a fall… now what?
My life is over attitude
Most don’t require hospitalization or surgery
 Most will  their standing activity level d/t fear of falling. This is a downward spiral of less & less activity.
 “One who fears failure limits his activities. Failure is only the opportunity to more intelligently begin again.” – Henry Ford
 To work on Fall Prevention you have to get someone standing
 A pt needs strength, balance, and confidence
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