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Improving Balance and Reducing Fall Risk

presented by Michelle M. Lusardi and Mariana Wingood

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Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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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:

Meet Your Instructors

Michelle M. Lusardi, PT, DPT, PhD, FAPTA

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…

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Mariana Wingood, PT, DPT, GCS, CEEA

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,…

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Chapters & Learning Objectives

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1. Developing a Problem List and Delineating Measurable Goals

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.

2. Where do You Start?

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).

3. Determining Prognosis and Developing a Plan of Care

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.

4. Individualized Interventions

This chapter provides a brief review of motor learning, as well as the person/task/environment model that forms the basis of Gentiles Taxonomy.

5. Plan and Justify Intervention

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.

6. Documenting Efficacy of Intervention/Outcome Measures

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.

7. Planning for Discharge

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.

More Courses in this Series

The Impact of Aging on Functional Mobility and Gait: Introduction

Presented by Julie Ries, PT, PhD

The Impact of Aging on Functional Mobility and Gait: Introduction

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This course is part of our GCS Prep-Program. Learn more about the full prep-program here: MedBridge GCS Prep-Program.

The motor task of walking is ultimately a product of the characteristics of the individual, the environment in which one is immersed, and the task(s) performed while walking. As physical therapists we must be mindful of all components and strategically integrate appropriate challenges when targeting gait interventions. This course is designed to present the predictable set of age related changes of temporal & spatial gait characteristics and review the environmental & task demands of community ambulation. The value of collecting gait speed data, and its relationship to health, function, and mortality are emphasized.

View full course details

Interventions for Aging Gait: Understanding Cognition & Frailty

Presented by Julie Ries, PT, PhD

Interventions for Aging Gait: Understanding Cognition & Frailty

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
In formulating optimal interventions, there may be special considerations within the context of assessing and treating gait dysfunction in older adults. The slippery slope of aging describes a progressive decline of function over time, and we know that 6-7% of older adults meet the definition of frailty. With behavioral “buy-in” and appropriate level of challenge, we can impact gait and function in frail and pre-frail individuals, perhaps even reversing the direction they are traveling on the slope. The inter-relatedness of gait and cognition is well represented in the research literature and holds important implications for our assessment and treatment of older adults. Recent literature in both of these areas is presented in this course.

View full course details

Understanding Postural Control and Risk of Falling

Presented by Michelle M. Lusardi, PT, DPT, PhD, FAPTA and Mariana Wingood, PT, DPT, GCS, CEEA

Understanding Postural Control and Risk of Falling

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
Falls are a major concern for older adults, their families, and the health professionals who care for them. Falls have many contributing factors, some of which are modifiable. Why should clinicians be concerned about falls in later life? What is the underlying neurophysiological mechanism of postural control, and how does postural control change over the lifespan? This course will seek to answer these key questions and more related to falling risk in geriatric patients. In particular, consideration of the physiological and practical aspects of postural control and risk assessment will provide participants with an improved understanding of balance and fall risk. This first course in a three course series provides a foundation for clinicians’ ability to critically reason through potential contributors to risk of falling, plan their screening/assessment and select interventions for older adults with balance impairment and risk of falling.

After completing this course, continue to the next two courses in the series for more detail on assessment and intervention for impaired balance and risk of falls:

View full course details

Assessing Risk of Falls: Too Many Choices!

Presented by Michelle M. Lusardi, PT, DPT, PhD, FAPTA and Mariana Wingood, PT, DPT, GCS, CEEA

Assessing Risk of Falls: Too Many Choices!

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
How do we screen and assess balance and fall risk? There are many screening and assessment tools to choose from. By completing this course participants will know how to choose a screening tool and/or assessment tool for their patient. The course begins by setting the stage and discussing what clinicians should be looking for, how to screen for it, and how to select the risk factors to further evaluate patients in order to prescribe an appropriate intervention or refer out. Depending on the patient’s screening results, a clinician will be able to use the appropriate assessment tool and document a good clinical assessment.

Be sure to view the other two courses in the series for more detail on assessment and intervention for impaired balance and risk of falls:

View full course details

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