Everything Flashcards by Wayne Smith

What is the role of a physio with regards to falls?

Fall prevention
Harm prevention
Risk identification and assessment
Falls plan develop
Intervention strategies
Equipment

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Falls and its effects on hips?

20% mortality rate at 12 months
<50% will return to pre-# function

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What percentage of falls in older people cause neck of femur #?

25%

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Financial burden of Falls- Cost of Falls?

Roughly $4000 per stay, exceeds road trauma

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What does a fear of falling do?

Leads to decreased activity, which decreases balance, increases weakness and risk of falls.

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Fall Assessment Algorithm. What does it include?

If only 0-1 falls, check for balance and vision. If recurrent, then do full assessment which includes
- History
- Vision
- Gait and balance
- Lower limb joints

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Taking a history of falls. What is the acronym?

SPLATT
Symptoms of time at all
Previous number of falls
Location of falls
Activity engaging in at time of fall
Time of day of falls
Trauma sustained during fall

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Falls Assessments- Neurological. When looking for UMN or LMN pathologies, what do you assess?

Tone
Reflexes
Proprioception
Sensation
Coordination
Vision

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Fall Assessment- Vision. What do you check for?

Visual acuity
Depth perception
Contrast sensivity
Multifocal lens can cause falls

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Fall Assessment- Lower limb joint. What do you test for?

Range of motion
Strength
- Weak tib ant implicated in falls
- MMT vs Functional assessment
Muscle length

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Fall Assessment- Cardiovascular. What do you measure?

Blood pressure- Done both supine and standing after 2 minutes
Pulse- rate and rhythm.

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Fall Assessment- Gait and analysis. What does it include?

Gait- General observation. Initiation, foot clearance, step symmetry, dual tasking.

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Fall Assessment- Gait and analysis. Whats an objective measure for gait?

DGI- Dynamic Gait Index. <19 out of 24, indicative of high falls risk

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Falls Assessment- Balance. What tests to use?

TUG- Timed up and go >13.5 second = 90 accurate in predicting falls
BBS- Berg Balance Scale.
Step Test

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Falls Prevention and Management- Low Risk Fallers. What is this stage called and what do you promote?

‘Immunisation stage’
Promote weight bearing, balancing challegning or strengthening exercise.
Promote nutrition- Calcium, Vitamin D or diabetes management

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Falls Risk. What dose of exercise?

2 x weekly for 6 months.

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Falls Prevention- What exercises to improve?

Pilates
Tai Chi
Otago

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Dementia- Definition

A syndrome that causes a progressive decline in a persons functioning, including loss of memory and the ability to reason and learn. Loss of four things
- Personality
- Loss of intellectual capacity
- Memory
- Perform ADL’s

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Dementia- Diagnosis.

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Detailed history
Cognitive testing- MMSE
Functional assessment
Exclusion of other issues
Cerebral imaging MRI

Dementia- Risk factors?

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Mental activity
Physical activity
Diet- High cholesterol, saturated fat
Diabetes

Dementia- What are the four main types?

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Alzheimers Disease
Vascular Dementia
Frontotemporal Dementa
Diffuse Lewy Body Dementia

What is the most common form of Dementia?

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Alzheimers Disease (50-75%)

Alzheimers Disease is characterised by?

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Short term memory loss, apathy and depressin in early stages

Alzheimers Disease- What parts of the brain affected most?

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Cerebral atrophy of the cortex and especially in the hippocampus- Formation of new memories.

How common is Vascular Dementia? (VaD)

Second most common dementia 20-30%

How is Vascular Dementia (VaD) caused?

White matter infarcts- Can begin with gait abnormality

Difference between Vascular Dementia and Alzheimers?

Alzheimers is gradual progression while VaD is step wise, sudden drops.

Frontotemporal Dementia. Prevalence and when does it occur?

5-10 % and happens in younger people 45-65 years old

Frontotemporal Dementia- What is it characterised by?

Personality changes Dysfunctional social behaviour and excutive dysfunction (Planning)

Frontotemporal Demention- How do they perform on the Mini Mental State Examination?

Usually perform well. Too basic as personality changes aren't the focus of MMSE

Diffuse Lewy Body Dementia- What is it caused by and prevalence?

Accounts for 20-30 percent of dementia. Caused by denergative death of nerve cells in the brain and the presence of spherical bodies called Lewy Bodies.

Diffuse Lewy Body Dementia- Characterised by?

- Flunctating levels of consciousness - Hallucinations - Parkinsonian symptoms- Gait and Bradykenesia - Rapid onset - Poor response to antipsychotics and L-Dopa

Stages of Dementia?

Early- First year or two Middle- Second to 4th or 5th year Late- 5th year and after

Dementia and Physiotherapy Implications. How do you help with sequencing of tasks?

Part practice with one stage instructions.

Dementia- What are some medications used to moderate symptoms?

Cholinesterase inhibitors (ChEls). Reduce rate of cognitive decline

Dementia- Non-pharmacological management of BPSD?

Based on 3 theories of BPSD - Unmet needs - Learned behaviours - Environmental vulnerability and low stress threshold.

Dizziness- How common is it?

15-20% of adults yearly reported

Dizziness- Why is it important to physios?

Dizzy people fall over, functional limitations, reduced quality of life, limiting of activities and associated deconditioning

Dizziness- Subjective assessment. What do you ask about?

Cardiac history Drug interactions- Coinciding with new medication Orthostatic hypotension Anxiety disorders VBI- Cervical rotational issues Somatosensory loss- Peripheral neuropathy and diabetes Central problems- Basal artery area- Ischemia (Potential stroke or tia) Cervical vertigo-

Dizziness- Common symptoms of vesitbular deficiets?

Nausea, vertigo, visual impairrments, gait and balance disorders, nystagmus

Dizziness- Nystagmus. How does it occur and how is it defined?

Stimulation of the semi-circular canals (SSC) when the head isn't in motion. Direction of nystagmus is defined as the direction of the quick phase.

VOR- Stands for?

Vesitbular occular reflex.

Two types of physiological nystagmus

Opticokitentic- Induced by looking at moving visual stimuli Postratory- Induced by spinning around then stopping

Functions of the Vestibular System

Sensing and percieving self motion Orientation to vertical Controlling the centre of mass (balance) Stabilising the head

Central processing of the vestibular system- What is primary processor? And Secondary processor?

Vestibular nuclei complex in the brainstem- Pons in particular. Process sensory input concurrently. Cerebellum is adaptive processor, readjusts output. (Tends to be inhibitive effect) Both help maintain and calibrate VOR and posture

Everything Flashcards

(45 cards)