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
Objectives
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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.
Developmental Disability
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Developmental disability (DD) is a term used to describe
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severe
life-long disabilities
attributable to mental and/or physical impairments
before the age of 22.
Common developmental disabilities:
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Cerebral Palsy
Down Syndrome
Mental Retardation
Autism
More Information
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http://en.wikipedia.org/wiki/Developmental_disability
Developmental Disability Can
Result in…
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substantial functional limitations in two or more of the
following areas of major life activities:
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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
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)
Who Falls
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1/3 of older adults living in the
community (>65 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).
Consequences of Falls
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Death
Injuries
• i.e. hip fractures
Hospitalization
Traumatic Brain Injury
What about falls and
developmental disabilities?
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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).
So….
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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!
Common Risk Factors
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Seizures, behavior and medications
History of Falls
Muscle Weakness
Gait Deficit
Balance Deficit
Use of Assistive Device
Visual Deficit
1. Research focusing on people
with developmental disabilities
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Seizures
• i.e. seizures on a monthly basis→4x at risk for
falls
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Destructive behavior
Antipsychotic medications
2. History of Falls
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There are two important things to consider
when someone previously suffered a fall:
1. Predisposition
2. Previous Fall
Therefore, we need…
1.
Documentation
2.
Tracking method
3.
Periodical check-up
Signs of a Fall
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Fracture
Bruising
Soreness
Limping
Inactivity
Any others?
3. Muscle Weakness
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Decrease strength can lead to inability to
support ones self when changing positions.
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Going to the bathroom
Getting out of bed
Signs of muscle weakness
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Unable to stand without help
Noticeable muscle atrophy and/or wasting
Poor breathing
Poor body posture
Pressure ulcers
4. Walking Difficulties
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Compromises stability and balance and
leads to increase risk for falls.
Common developmental disabilities that
affect walking:
• Cerebral Palsy
• Down’s Syndrome
• Mental Retardation
• Autism
Common Walking Problems
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Scissoring gait
Walking on toes
Inability for leg to clear the floor
Hip drop
Shuffling
Dynamic Gait Index Profile
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Clinical measurement of walking function
in people with balance and vestibular
disorders.
8 item or 4 item (short form) test
Gait Video Assessment
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Profile: 25 y.o. male with autism
Walking Assessment:
• What do you see?
• What do you think are his impairments and
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functional limitations?
Compare his walking on the track vs. the pool
deck?
5. Balance Deficit
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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
Balance Assessments
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Balance Berg Scale
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Tinetti
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Timed Up and Go (TUG)
Balance Berg Scale
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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 <45 was predictive of
multiple falls.
Estimated time to complete: 15-20
Tinetti
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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:
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< 19 high risk
19-24 at risk for falls.
The Timed Up & Go Test (TUG)
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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.
6. Use of Assistive Device
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Assistive Devices become a risk factor
for falls when there is:
• Improper use
• Faulty mechanics
• Household obstacles and floor coverings
• Broken or faulty equipment
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Solutions: proper equipment, education
and home modifications
7. Visual Deficit
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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
Signs of Visual Deficits
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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
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http://www.aoa.org/documents/QRG-20.pdf
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Breakout Session
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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:
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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?
Test and Measure Table (Give
Handouts)
Gait
Balance
Muscle
Strength
Dynamic Gait
Index
Balance Berg
Scale
Tinetti
Informal
Assessment
Timed Up and
Go
Interventions
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Interventions should be:
• Comprehensive
• Performed by trained individuals
• Accessible to those who need it
Comprehensive Interventions
1.
2.
Home modification
Exercise
a. Balance
b. Strength
c. Aerobics
3.
4.
Education
Medical Intervention
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
2. Exercise
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Have been shown to improve function
Target:
• Balance
• Strength
• Aerobic endurance
Exercise Cont’d.
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Balance training produced functional
improvement for older adults with ID
(Carmeli et al, 2004).
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Participation in low-impact aerobic dance
program increased the cardiovascular
endurance of adults with ID.
3. Education
Should include education on the following:
• Proper use of assistive device
• Falls prevention
• What to do in the event of a fall
Who could be involved?
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Physicians
Nurses
Physical Therapists
Occupational
Therapists
Psychologists
Family
Caregivers
Transferring Tips
Transfers
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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
Key Tips
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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 person’s clothing and do
NOT have them grab onto your clothes as
leverage.
Key Tips Cont’d.
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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!
Let’s Practice!
What IF Someone Falls?
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Asses the environment
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If a person has suffered a serious fall,
DO NOT MOVE THEM, CALL 911.
• Make sure it’s safe to help
Getting Up From a Fall
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Can be done:
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Let’s practice:
• Independently
• With the assistance of 1 or more persons
• With the assistance of sturdy support
• Safe ways to get up from a fall
• How 1 or more people can safely and properly
provide assistance.
Coming Soon
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DC HRP Falls Risk Algorithm
DC HRP Transfer Video
American Physical Therapy Association
(APTA) pocket guide to falls risks
assessment, intervention and
prevention.
Additional Resources
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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.h
tm
http://www.aoa.org/documents/QRG-20.pdf
THANK YOU!
Contact Info:
www.dchrp.info
VRL2@DUKE.EDU