presented by Michelle M. Lusardi & Mariana Wingood
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:
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 provides a foundation for understanding of postural control by presenting conceptual models used to define fall events, and to understand relationships of an individual's health status, body structure/function, and functional activity. This chapter also discusses factors involved in patients’ ability to participate in social roles understand current models of postural control.
Using a data-driven model, this chapter will review how the visual system, proprioceptive system, vestibular system and their interpreting structures influence effective motor response to postural control. Understanding the underlying mechanisms of postural control will help clinicians prioritize assessment and recognize when risk factors can be modified or require compensatory strategies.
This chapter considers how “typical” anatomical and functional changes related to aging sensory, musculoskeletal, and neuromuscular systems impact the efficiency and efficacy of postural responses, as well as how commonly occurring pathologies influence an older adult’s ability to “data collect,” ‘integrate," and respond to challenges to balance.
Postural Control is a multifactorial process, emerging from the interaction of one’s personal resources/characteristics, the task that is being performed, and conditions within the environment in which the person is moving. In this chapter, clinicians will gain facility with task and movement analysis strategies that include consideration of all three contributors to postural control, and will explore how principles of motor learning and of facilitating neuroplasticity form the foundation for any interventions aimed at improving postural control.
Now that clinicians understand the underlying mechanisms of postural control, they can begin to consider what additional intrinsic or extrinsic risk factors contribute to an older adult's vulnerability to fall. Such risk factors can be considered “yellow” or “red” flags indicating which older adults are most in need of full risk assessment/evaluation.