Falls & Gait Evaluation

Question 1

Ask ALL pt:

Answer 1

Have you had any falls in the last year?

Question 2

Example of a gait assessment tool

Answer 2

Get up & go

Question 3

Most gait disorders ARE or AREN’T associated with underlying disease

Answer 3

ARE

Question 4

Important component of neurological exam

Answer 4

Describing pt. gait

Question 5

How to perform the get up & go test

Answer 5

Risk from a chair w/ arms, walk 10 feet, turn, return to chair & sit down

Question 6

Most adults can complete the get up & go in ____ seconds

Answer 6

10-12

Question 7

A get up & go test of ___ seconds indicates increasing risk for falls

Answer 7

> 14

Question 8

A get up & go test of ___ seconds indicates HIGH risk for falls (more comprehensive eval indicated)

Answer 8

> 20

Question 9

Results of the get up & go are strongly associated with……

Answer 9

Functional independence of ADLs

Question 10

Reduction in gait speed is ass. w/

Answer 10

Poorer health status, poorer physical functioning, more disabilities, additional rehab visits, longer hospital stays, high costs
*Increase in speed has the opposite effects!!

Question 11

How do we measure comfortable gait speed?

Answer 11

Timed walk

Question 12

Conditions that contribute to gait disorder

Answer 12

• DJD
• Acquired MSK deformities (e.g. RA, gout)
• Intermittent claudication
• Impairments following ortho surgery, stroke
• Postural hypotension
• Dementia
• Fear of falling

USUALLY MULTIFACTORIAL (e.g. dementia + antalgic gait s/p failed hip surgery)

Question 13

________ is not a common cause of falls

Answer 13

Syncope (own entity, NOT a multifactorial event -> what we’re worried about)

Question 14

Antalgic gait

Answer 14

Shortened phase of gait on painful side; pain-induced

Question 15

Circumduction gait

Answer 15

Outward swing of leg ass. w/ neurologic disorder

Question 16

Festination gait

Answer 16

Acceleration of gait; PD pt.

Question 17

Foot drop

Answer 17

Loss of ankle dorsiflexion; indication for orthotic evaluation

Question 18

Trendelenburg gait

Answer 18

Weakness in pelvic stabilizing muscles -> affected hip drops w/ step (supposed to lift); r/t myopathy

Question 19

Fall definition

Answer 19

Coming to rest inadvertently on the ground or at a lower level

Question 20

___ of older adults reported a fall (2014)

Answer 20

A quarter

Question 21

Leading cause of death from injury in persons aged >65

Answer 21

Falls

Question 22

Annual incidence of falls is _____ among those who have fallen before

Answer 22

Over half

Question 23

___% of falls by older adults result in fx or other serious injury

Answer 23

20

Question 24

Most (95%) of ___ fractures are caused by falls

Answer 24

Hip (“widow maker”)

Question 25

Falls are the most common cause of ____

Answer 25

TBI

Question 26

The death rate attributable to falls ________ w/ age

Answer 26

increases

Question 27

Mortality is highest in this population

Answer 27

White men aged >85

Question 28

Sequelae of falls

Answer 28

- Decline in functional status - NH placement - Increased use of medical services - Fear of falling (leading to isolation)

Question 29

____ of those who fall are unable to get up without help

Answer 29

Half

Question 30

What is a "long lie"?

Answer 30

When older adult is found down

Question 31

What lab test do we do in pt. who are found down?

Answer 31

CK - looking for rhabdo!

Question 32

A "long lie" predicts

Answer 32

Lasting functional decline

Question 33

Balance control requires input from these systems:

Answer 33

Visual, vestibular, proprioceptive, tactile & kinesthetic sensation, CNS processing, and execution of motor output

Question 34

Intrinsic RF r/t falls:

Answer 34

- POLYPHARMACY - Dizziness - Muscle weakness - Gait abnormalities - MSK, motor control problems - Peripheral neuropathy - PD, CVA - Vestibular disorders - Nocturnal urination - Decreased vision - Previous falls

Question 35

Common clinical problems identified in fall pt.

Answer 35

Top three: - Neuropathy - DJD - Pain syndromes

Question 36

List of inappropriate medications in older adults

Answer 36

Beer's list

Question 37

Examples of medications that pose significant risk

Answer 37

BZDs, AD's, AP's, Anti-HTN, Anti-histamines (esp. diphenhydramine, don't forget H2 blockers)

Question 38

In regards to medications, the highest risk of falls is r/t

Answer 38

of medications pt. is on (regardless of type)

Question 39

Extrinsic RF r/t falls:

Answer 39

- Stairs - Poor lighting - Clutter - Loose throw rugs, slippery surfaces - Ill-fitting close, footwear - Pets

Question 40

Situational RF r/t falls:

Answer 40

- Rushing - Inattention - Poor safety awareness - Unfamiliarity or hazards - Risk-taking behavior (usually r/t cognitive impairment)

Question 41

Fall assessment: history

Answer 41

- Meds - Vision - Gait & balance - Lower limb joint issues - Neuro - CV

Question 42

Fall assessment: physical exam

Answer 42

- Orthostatics - Visual acuity screening - MENTAL STATUS (MINI-COG) - Cranial nerves - Romberg - Cerebellar function - QUALITATIVE GAIT ASSESSMENT

Question 43

If single fall, check.....

Answer 43

For balance or gait disturbance

Question 44

If recurrent fall or (+) gait/balance disturbance, perform.....

Answer 44

Complete fall evaluation

Question 45

Routine lab testing in fall pt.:

Answer 45

CBC & BMP (exclude anemia, dehydration, hyperglycemia, electrolyte abnormality)

Question 46

Lab test dependent on H&P in fall pt.:

Answer 46

ECG, echo, brain imaging (if delirium present), radiographic studies, UA, CXR, TSR, RPR

Question 47

Goals of treatment for falls:

Answer 47

Reduce intrinsic & environmental risk factors

Question 48

__________ approach to fall prevention is the most efficacious

Answer 48

Interdisciplinary

Question 49

Fall interventions:

Answer 49

- Revise meds - Assistive devices (walker, cane, orthotics) - Energy conservation - Home safety equipment - Pt. + caregiver education - Alarms - Transfer & functional training - Therapeutic exercises - Behavioral programs

Question 50

What is the stay independent questionnaire?

Answer 50

A self-assessment tool for those who are cognitively intact that assesses risk of falls (can be filled out by caregivers if necessary)