Prevention assessment and intervention for falls in adults with developmental disabilities
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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. Identify 3 common risk factors for falls.

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Prevention assessment and intervention for falls in adults with developmental disabilities

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
Objectives with Developmental Disabilities

  • 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
Developmental Disability with Developmental Disabilities

  • Developmental disability (DD) is a term used to describe

    • severe

    • life-long disabilities

    • attributable to mental and/or physical impairments

    • before the age of 22.

  • Common developmental disabilities:

    • Cerebral Palsy

    • Down Syndrome

    • Mental Retardation

    • Autism

  • More Information

    • http://en.wikipedia.org/wiki/Developmental_disability


Developmental disability can result in
Developmental Disability Can Result in… with Developmental Disabilities

  • substantial functional limitations in two or more of the following areas of major life activities:

    • 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
What is a Fall? with Developmental Disabilities

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
Who Falls with Developmental Disabilities

  • 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
Consequences of Falls with Developmental Disabilities

  • Death

  • Injuries

    • i.e. hip fractures

  • Hospitalization

  • Traumatic Brain Injury


What about falls and developmental disabilities
What about falls and developmental disabilities? with Developmental Disabilities

  • 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).


Prevention assessment and intervention for falls in adults with developmental disabilities
So…. with Developmental Disabilities

  • 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
Common Risk Factors with Developmental Disabilities

  • 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
1. Research focusing on people with developmental disabilities

  • Seizures

    • i.e. seizures on a monthly basis→4x at risk for falls

  • Destructive behavior

  • Antipsychotic medications


2 history of falls
2. History of Falls disabilities

  • There are two important things to consider when someone previously suffered a fall:

    1. Predisposition

    2. Previous Fall


Therefore we need
Therefore, we need… disabilities

  • Documentation

  • Tracking method

  • Periodical check-up


Signs of a fall
Signs of a Fall disabilities

  • Fracture

  • Bruising

  • Soreness

  • Limping

  • Inactivity

    Any others?


3 muscle weakness

Decrease strength can lead to inability to support ones self when changing positions.

Going to the bathroom

Getting out of bed

Signs of muscle weakness

Unable to stand without help

Noticeable muscle atrophy and/or wasting

Poor breathing

Poor body posture

Pressure ulcers

3. Muscle Weakness


4 walking difficulties
4. Walking Difficulties when changing positions.

  • 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
Common Walking Problems when changing positions.

  • Scissoring gait

  • Walking on toes

  • Inability for leg to clear the floor

  • Hip drop

  • Shuffling


Dynamic gait index profile
Dynamic Gait Index Profile when changing positions.

  • Clinical measurement of walking function in people with balance and vestibular disorders.

  • 8 item or 4 item (short form) test


Gait video assessment
Gait Video Assessment when changing positions.

  • Profile: 25 y.o. male with autism

  • Walking Assessment:

    • What do you see?

    • What do you think are his impairments and functional limitations?

    • Compare his walking on the track vs. the pool deck?


5 balance deficit
5. Balance Deficit when changing positions.

  • 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
Balance Assessments when changing positions.

  • Balance Berg Scale

  • Tinetti

  • Timed Up and Go (TUG)


Balance berg scale
Balance Berg Scale when changing positions.

  • 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
Tinetti when changing positions.

  • 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:

    • < 19 high risk

    • 19-24 at risk for falls.


The timed up go test tug
The Timed Up & Go Test (TUG) when changing positions.

  • 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
6. Use of Assistive Device when changing positions.

  • Assistive Devices become a risk factor for falls when there is:

    • Improper use

    • Faulty mechanics

    • Household obstacles and floor coverings

    • Broken or faulty equipment

  • Solutions: proper equipment, education and home modifications


7 visual deficit
7. Visual Deficit when changing positions.

  • 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
Signs of Visual Deficits when changing positions.

  • 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

  • http://www.aoa.org/documents/QRG-20.pdf


Breakout session
Breakout Session when changing positions.

  • 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:

    • 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
Test and Measure Table (Give Handouts) when changing positions.


Interventions
Interventions when changing positions.

  • Interventions should be:

    • Comprehensive

    • Performed by trained individuals

    • Accessible to those who need it


Comprehensive interventions
Comprehensive Interventions when changing positions.

  • Home modification

  • Exercise

    • Balance

    • Strength

    • Aerobics

  • Education

  • Medical Intervention


  • 1 home modifications
    1. Home Modifications when changing positions.

    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
    2. Exercise when changing positions.

    • Have been shown to improve function

    • Target:

      • Balance

      • Strength

      • Aerobic endurance


    Exercise cont d
    Exercise Cont’d. when changing positions.

    • Balance training produced functional improvement for older adults with ID (Carmeli et al, 2004).

    • Participation in low-impact aerobic dance program increased the cardiovascular endurance of adults with ID.


    3 education
    3. Education when changing positions.

    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

    Physicians when changing positions.

    Nurses

    Physical Therapists

    Occupational Therapists

    Psychologists

    Family

    Caregivers

    Who could be involved?


    Prevention assessment and intervention for falls in adults with developmental disabilities

    Transferring Tips when changing positions.


    Transfers
    Transfers when changing positions.

    • 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
    Key Tips when changing positions.

    • 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
    Key Tips Cont’d. when changing positions.

    • 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!


    Prevention assessment and intervention for falls in adults with developmental disabilities

    Let’s Practice! when changing positions.


    What if someone falls
    What IF Someone Falls? when changing positions.

    • Asses the environment

      • Make sure it’s safe to help

    • If a person has suffered a serious fall, DO NOT MOVE THEM, CALL 911.


    Getting up from a fall
    Getting Up From a Fall when changing positions.

    • Can be done:

      • Independently

      • With the assistance of 1 or more persons

      • With the assistance of sturdy support

    • Let’s practice:

      • Safe ways to get up from a fall

      • How 1 or more people can safely and properly provide assistance.


    Coming soon
    Coming Soon when changing positions.

    • 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
    Additional Resources when changing positions.

    • 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.htm

    • http://www.aoa.org/documents/QRG-20.pdf


    Thank you
    THANK YOU! when changing positions.

    Contact Info:

    www.dchrp.info

    VRL2@DUKE.EDU