GERIATRIC

REHABILITATION
 Ageing factors
Ageing:

• process of growing old – physiological changes in the

body
• Common to all members of species
• Progressive with time
• Evidence: 1.decline in homeostatic
efficiency
2.Increasing probability – reaction to
injury will not be successful
• Varies among individuals
 Mortality & Morbidity

• In 2030 – 22 % of population expected

• Increased Life Expectancy:
1. Advances in health care, improved
infectious disease control
2. Advances in infant / child care,
decreased mortality rates
3. Improvements in nutrition & sanitation
Demographics, Mortality & Morbidity

• Leading Causes of death in persons over 65

• CHD – 31%
• Cancer – 20%
• Cerebrovascular disease ( stroke )
• COPD
• Pneumonia
Demographics, Mortality & Morbidity

• Leading causes of disability/chronic conditions

( Morbidity ) in persons over 65, in order of
frequency
• Arthritis 49%
• Hypertension 37%
• Hearing impairment 32%
• Cataracts 17%
• Orthopedic impairments 16%
• Diabetes & Visual impairments 9%
 Theories of Aging
Aging changes:
• Cellular Changes
1. Increase in size, fragmentation of golgi
apparatus & mitochondria
2. Decrease in cell capacity to divide &
reproduce
3. Arrest of DNA Synthesis & cell division
 Theories of Aging
• Tissue Changes:
1. Accumulation of pigmented materials,
lipofuscins
2. Accumulation of lipids & fats
3. Connective tissue changes: decreased
elastic content, degradation of collagen
• Organ Changes
1. Decrease in functional capacity
2. Decrease in homeostatic efficiency
 Theories of Aging
• Biological theories:
a. Genetic: aging is intrinsic to the
organisms, genes are programmed to
modulate aging changes
1. Vary among the individuals to express

aging e.g. graying of hair, wrinkle

2. Progeria – defective genetic
programming
 Theories of Aging

• Increases in stress hormones – cortisol – damage

brain’s memory center & immune cells
• Immunity theory:
1. Immune cells, T- cells become less able to
fight foreign organisms, B – cells become less
able to make antibodies
2. Autoimmune diseases increases with age
 Theories of Aging
• Environmental theories:

Aging is caused by an accumulation of insults from the

environment .Environmental toxins include: UV, toxic
chemicals ( metal ions, Mg,Zn), radiations

• Psychological theories

Stress theory: homeostatic imbalances result in changes in

structural & chemical composition

Physiologic Changes & Adaptation
in the older adult
Muscular
Age-related changes
a. Decreased activity levels ( hypo kinesis) & disuse
b. Loss of Muscle strength: Peak at age 30, remains fairly
constant until age 50, after which there is an accelerating
loss, 20-40% loss by age 65 in the non-exercising adult
c. Loss of power: Due to losses in speed of contraction,
changes in nerve conduction & synaptic transmission
d. Loss of skeletal Muscle mass( atrophy ): both size & no of
fibers decrease, by age 70 lose 33% of skeletal muscle mass
Physiologic Changes & Adaptation
in the older adult
e. Changes in muscle fiber composition: selective loss of Type
II, fast twitch fibers, with increase in proportion of Type I
fibers
f. Changes in muscular endurance:
1. Decreased muscle tissue oxidative capacity
2. Decreased peripheral blood flow, oxygen delivery to
muscles
3. Altered chemical composition of muscle: decreased
myosin ATPase activity & contractile proteins
4. Collagen changes: denser, irregular due to cross linkages,
loss of water content & elasticity, affects tendons, bone &
cartilage
 Clinical Implications
a. Movements become slower
b. Movements fatigue easier, increased complaints of fatigue
c. Connective tissue becomes denser & stiffer

1. Increased risk of muscle sprains, strains, tendon tears

2. Loss of range of motion
3. Increased tendency of fibrinous adhesions,
contractures
d. Decreased functional mobility, limitations to movement
 Clinical Implications
• Gait Changes:
1. Stiffer
2. Decreased amplitude & speed, slower
cadence
3. Shorter steps, wider stride, increased double
support to ensure safety, compensate for
decreased balance
4. Decreased trunk rotations, arm swing
5. Gait may become unsteady due to changes in
balance, strength, increased need for assistive
devices
 Intervention to slow or reverse
changes
b. Increase levels of physical activity, stress
functional activities & activity programs
1. Gradual increase in intensity of activity to
avoid injury
2. Adequate warm ups & cool downs,
appropriate pacing & rest periods
 Intervention to slow or reverse
changes
C. Provide strength training:
1. Significant increases in strength noted in older
adults with isometric & PRE regimes
2. High- intensity training programs ( 70-80% of
one repetition max ) produce quicker & more
predictable results than moderate intensity
programs, both have been successfully used with
the elderly
3. Improvement in strength correlate to improved
functional abilities
 Intervention to slow or
reverse changes
D. Provide flexibility, ROM
exercises
1. Utilize slow, prolonged
stretching, maintained for 20-30
sec
2. Tissues heated prior to
stretching are more distensible,
e.g. Warm Pool
3. Maintained newly gained
range, incorporate into functional
activities
4. Mobility gains are slower
with older adults
 Age related changes in Skeletal
System
1. Cartilage changes
2. Loss of bone mass & density
3. Intervertebral disc:
Flatten
Less resilient
Loss of collagen elasticity
trunk length
Overall height decreases

4. Senile postural changes

 Clinical implications
• Maintenance of weight bearing is
important for cartilaginous / joint health
• Clinical risk of fractures
 Intervention to slow or reverse
changes
• Postural exercises
• Weight bearing exercise to decrease bone loss
• Nutritional, hormonal & medical therapies
 Neurological System
• Age related changes in neurological
system
1. Atrophy of nerve cells
2. Changes in brain morphology
Generalized cell loss in cerebral
cortex – particularly in frontal &
temporal lobes
 Age related changes in neurological system

• Presence of lipofuscins, senile or neuritic

plaques, & neurofibrillary tangles
• Significant accumulations associated with
pathology e.g. Alzheimer’s dementia
• Selective cell loss in basal ganglia
( substantia nigra & putamen), cerebellum,
hippocampus, brain stem minimally
affected
C. Decreased blood flow & energy
metabolism
neuritic plaques, & neurofibrillary
tangles
 Age related changes in neurological
system
D. Changes in synaptic transmission
1. Decreased synthesis &
metabolism of major
neurotransmitters, e.g.
acetycholine, dopamine
2. Slowing of many neural process,
especially in polysynaptic
pathways
 Age related changes in neurological
system
E. Changes in spinal cord / peripheral nerves
1. Neural loss & atrophy: 30-50% loss of
AHC, 30% loss in PHC by age 90.
2. Loss of motoneurons results in increase in
size of remaining motor units
3. Slowed nerve conduction velocity: sensory
greater than motor
 Age related changes in neurological
system
D. Age related tremors
1. Occurs as an isolated symptoms,
particularly in hands, head & voice
2. Characterized as postural or kinetic,
rarely resting
3. Benign, slowly progressive, in late stages
may limit function
4. Exaggerated by movement & emotion
 Clinical implications
A. Effects on movement
1. Overall speed & coordination are decreased,
increased difficulties with fine motor control
2. Slowed recruitment of motoneurons contributes to
loss of strength
3. Both reaction time & movement time are
increased
4. Demonstrate increased cautionary behaviors, an
indirect effect of decreased capacity
B. Slowing of neural processing
C. Problems in homeostatic regulation
 Intervention to slow or reverse changes
• Correction of medical problems:
improve cerebral blood flow
• Improve health: diet, smoking
cessation
• Increase levels of physical
activity; may encourage neuronal
branching, slow rate of neural
decline, improve cerebral
circulation
 Intervention to slow or reverse changes

• Provide effective strategies to improve motor learning

& control
1. Allow for increased reaction & movement times,
will improve motivation, accuracy of movements
2. Allow for limitations of memory, avoid long
sequences of movements
3. Allow for increased cautionary behaviors, provide
adequate explanation, demonstration when teaching
new movement skills
4. Stress familiar, well learned skills, repetitive
movements
 Sensory System
• Age related changes: Older adult
experiences loss of function of the
senses, alters quality of life, ability
to interact socially & with the
environment
1. May lead to sensory deprivation,
isolation, disorientation, confusion,
appearance of senility
2. May strain social interactions
3. May lead to decreased functional
mobility, risk of injury
 Age related changes in sensory
system
• Aging changes in vision: decline in visual acuity,
rapid decline between ages 60 & 90, visual loss
may be as much as 80% by age 90.
1. Presbyopia: Visual loss in middle & older ages
characterized by inability to focus properly &
blurred images, due to loss of accommodation,
elasticity of lens
2. Decreased ability to adapt to dark & light
3. Increased sensitivity to light & glare
 Age related changes in sensory
system
• Additional vision loss with pathology:
1. Cataracts – Clouding of lens due to
changes in lens proteins, results in gradual
loss of vision, central first, then peripheral,
glare, darkening of vision, loss of acuity,
distortion
 Age related changes in sensory
system
Glaucoma –
Increased intraocular pressure, degeneration of
optic disc, atrophy of optic nerve, results in
early loss of peripheral vision, progressing to
total blindness.
 Age related changes in sensory
system
Senile macular degeneration – loss of central
vision – age related degeneration of the
macula compromised by decreased blood
supply or abnormal growth of blood vessels
under the retina, initially patients retain
peripheral vision, may progress to total
blindness
 Age related changes in sensory
system
4.Diabetic retinopathy – damage to retinal
capillaries, growth of abnormal blood
vessels & hemorrhage leads to retinal
scarring & finally retinal detachment,
central vision impairment, complete
blindness is rare
 Clinical Implications
• Decreased peripheral vision may limit social
interactions, physical function: Stand directly in front
of patient at eye level when communicating with
patient
• Provide sensory cues when vision is limited: verbal
descriptions to new environments, touching to
communicate you are listening
• Provide safety education
 Hearing – Aging changes
• 23% of individuals aged 65-74 have hearing
impairments
• 40% over age 75 have hearing loss, rate of loss in
men is twice the rate of women
• Outer ear: buildup of cerumen ( ear wax ) may
result in conductive hearing loss, common in older
men
• Middle ear: minimal degenerative changes of bony
joints
 Hearing – Aging changes
• Additional hearing loss with
pathology
• Otosclerosis: immobility of
stapes, results in profound
conductive hearing loss
 Clinical implication
• Examine hearing: acuity, speech discrimination,
tinnitus, dizziness, vertigo, pain
• Measure air & bone conduction: weber test
• Determine use of hearing aids: check for proper
functioning
• Minimize auditory distractions: work in quiet
environment
• Speak slowly & clearly, directly in front of patient at
eye level
 weber test
• Weber's test uses a vibrating tuning
fork to determine hearing loss. The
fork is struck and held against either
the forehead or teeth (in my
experience, the latter is much more
audible, but also gives you a
headache).
• The patient is asked where the
sound is loudest. A normal result is
where the sound is heard in the
middle of the head.
• If the sound is louder in one ear than
the other, it shows unilateral
conductive loss of hearing.
• A sound in only one ear shows
sensorineural hearing loss.
 Clinical implication
• Use nonverbal communication to reinforce
your message, e.g. gesture, demonstration
• Orient persons to topics of conversation
they cannot hear to reduce
paranoia,isolation
 Vestibular / balance control –
aging changes
• Degenerative changes in otoconia of utricle &
saccule: loss of vestibular hair-cell receptors,
decreased no. of vestibular neurons, VOR gain
decreases, begins at age 30, accelerating decline at
ages 55-60 resulting in diminished vestibular
sensation
• Diminished acuity, delayed reaction times, longer
response times
• Reduced function of VOR, affects retinal image
stability with head movements, produces blurred
vision
 Vestibular / balance control –
aging changes
• Altered sensory organization; older adults more
dependent upon somatosensory inputs for balance
• Less able to resolve sensory conflicts when
presented with inappropriate visual or
proprioceptive inputs due to vestibular losses
• Postural response patterns for balance are
disorganized, characterized by diminished ankle
torque, increased hip torque, increased postural
sway
 Somatosensory – Aging changes
• Decreased sensitivity to touch associated with
decline of peripheral receptors, atrophy of
afferent fibers – lower extremities more
affected than upper
• Proprioceptive losses
• Cutaneous pain threshold increased
 Somatosensory – Aging changes
• Additional loss of sensation with pathology
• Diabetes ,peripheral neuropathy
• Peripheral vascular disease, peripheral
ischemia
 Clinical Implications / compensatory
strategies
• Examine Sensation:
• Allow extra time for responses with increased
thresholds
• Use touch to communicate
• Highlight, enhance naturally occurring
intrinsic feedback during movements, e.g.
stretch, tapping
• Provide assistive devices
 Cognition – age related changes
• No uniform decline in intellectual abilities throughout
childhood
Changes do not typically show up until mid 60s,
significant declines affecting everyday life do not
show up until early 80s
Most significant decline in measures of intelligence
occur in the years immediately preceding death
( terminal drop )
 Cognition – age related changes
• Tasks involving perceptual speed – show
early declines ( by age 39 ), require
longer times to complete tasks
• Numeric abilities ( tests of adding,
subtracting, multiplying ) – abilities peak
in mid – 40s, well maintained until 60s
• Verbal ability - abilities peak in mid –
30s, well maintained until 60s
 Cognition – age related
changes
• Memory
Impairments are typically noted in short-term memory, long
term memory retained
Impairments are task dependent, e.g. deficits primarily with
novel conditions, new learning

• Learning
Increased cautiousness
Anxiety
Fast learning is problematic
Interference from prior learning
 Intervention to slow or reverse
changes
• Improve health
• Correction of medical problems, imbalances between oxygen
supply & demand to CNS, e.g. Cardiovascular disease, HT,
diabetes.
• Pharmacological changes: drug re – evaluation, decreased use
of multiple drugs, monitor closely for drug toxicity
• Reduction in chronic use of tobacco & alcohol
• Correction of nutritional deficiencies
 Intervention to slow or
reverse changes
• Increase physical activity
• Increase mental activity
e.g. chess, crossword puzzle, high level
of reading
• Engaged life style: Socially active
• Cognitive training activities
• Auditory processing may be decreased
– provide written instructions
 Intervention to slow or reverse
changes
• Provide stimulating, enriching environment
avoid environmental dislocation
e.g. hospitalization or institutionalization may
produce dis-orientation & agitation in some
elderly
• Reduction of stress: counseling & family
support
 Cardiovascular system – aging
changes
• Changes due more to inactivity & disease than aging
• Degeneration of heart muscle with accumulation of
lipofuscins ( characteristic brown heart), mild cardiac
hypertrophy left ventricular wall
• Decreased coronary blood flow
• Cardiac valves thicken & stiffen
• Changes in conduction system: loss of pace maker
cells in SA node
 Cardiovascular system – aging
changes
• Systolic function is preserved but diastolic function
declines
• Reason: reduction in rate of calcium reuptake after
depolarization in the sacroplasmic reticulum –
necessary for relaxation of the myocardium
• Structural changes – increased fibrosis of the
pericardium & myocardium – leads to stiffness –
affects diastolic function
• Reduced sympathoadrenergic responsiveness in the
aged to the need for increased CO
 Clinical Implications
• Changes at rest are minor: resting heart
rate & CO relatively unchanged, resting
BP increase
• Cardiovascular response to exercise:
blunted, decrease in heart rate
acceleration, decrease maximal oxygen
uptake & heart rate, reduced exercise
capacity, increased recovery time
• Decreased stroke volume due to
decreased myocardial contractility
• Maximum heart rate declines with age
Pulmonary System – aging changes
• Chest wall stiffness, declining strength of
respiratory muscles results in increased work
of breathing
• Loss of elastic recoil, decreased lung
compliance
• Decline in TLC: residual volume increases,
vital capacity decreases
Pulmonary System – aging changes
• Forced expiratory volume decreases
• Altered pulmonary gas exchange
• Blunted ventilatory responses of chemoreceptor
chemoreceptor in response to respiratory acidosis,
decreased homeostatic responses
• Blunted defence/immune responses: decreased ciliary
action to clear secretions, decreased secretory
immunoglobulin, alveolar phagocytic function
Interventions to slow or reverse changes
in Cardiopulmonary system
• Complete cardiopulmonary examination prior
to commencing an exercise program is
essential in older adults due to the high
incidence of cardiopulmonary pathologies
• Selection of appropriate exercise tolerance
testing protocol (ETT) is important
• Many elderly cannot tolerate maximal testing;
sub maximal testing commonly used
• Testing & training modes should be similar
 Individualized exercise prescription
essential

• Choice of training program is based on: fitness level,

presence or absence of cardio-vascular disease,
musculoskeletal limitations, individual’s goals &
interests
• Walking, chair & floor exercises, modified strength /
flexibility well tolerated by most elderly
• Pool programs with bone & jt impairments
• Consider multiple modes of exercise ( circuit
training ) on alternate days to reduce likelihood of
muscle injury, joint overuse, pain & fatigue
 Aerobic training
• Increases maximum ventilatory capacity: vital capacity
• Reduce breathlessness, lowers perceived exertion
• Psychological gains, improved sense of well – being, self
image
• Improves functional capacity
• Improves overall daily activity levels for independent
living
Lack of exercise is an important risk factor in the
development of CP diseases
Lack of exercise contributes to problems of immobility &
disability in the elderly
 Pathological conditions associated
with the elderly
• Musculoskeletal disorders &
diseases
• Osteoporosis: disease process
that results in reduction of bone
mass,
• Etiologic factors:
1. Hormonal deficiency
2. Nutritional deficiency
 Musculoskeletal disorders &
diseases
• High risk of fractures
• Trabecular bone more involved than
cortical bone; common areas affected
Vertebral column
Femoral neck
Distal radius/wrist, humerus
 Musculoskeletal disorders &
diseases
Examination
• Medical record review
1. History, physical exam, nutritional history.
2. Bone density tests
3. X-rays for known or suspected fractures
• Physical activity / fall history
• Assess dizziness; Dizziness handicap inventory
• Sensory integrity; vision, hearing, somato-sensory,
vestibular, sensory integration
• Motor function; strength, endurance, motor control
 Musculoskeletal disorders &
diseases
• ROM / Flexibility
• Postural deformity
Postural kyphosis, forward head position
Hip / knee flexion contractures
• Postural hypotension
• Gait & balance assessment
 Musculoskeletal disorders &
diseases
Goals, Outcomes, & interventions
• Medications: Evista, Fosamax, Calcitonin
• Promote health, provide counseling

Daily calcium intake

1. 1000mg premenopause
2. 1500mg after age 50 years of age

Daily vitamin D intake

1. 200IU premenopause
2. 400IU after menopause
3. 600IU after age 75
Diet; low in salt, avoid excess protein; inhibits body’s
ability to absorb calcium
 Musculoskeletal disorders &
diseases
• Maintain bone mass; exercise
• Weight bearing (gravity-loading)
exercises, walking (30 min/day)
• Resistance exercises, e.g. hip & knee
extensors, triceps.
 Musculoskeletal disorders & diseases
Postural / balance training
• Postural reduction, postural exercises to
reduce kyphosis, forward head position
• Flexibility exercises
• Functional balance exercises, e.g. chair rises,
standing/kitchen sink exercises ( e.g. toe
raises, unilateral stance, hip extension, hip
abduction, partial squats )
• Gait training
 Musculoskeletal disorders &
diseases
Safety education / fall prevention
• Proper shoes; thin soles, flat shoes
enhance balance abilities ( no heels)
• Assistive devices; cane, walker as
needed
• Fracture prevention; counseling on safe
activities, avoid sudden forceful
movements, twisting, standing, bending,
over lifting, supine sit-ups
 Fractures
• High risk of fractures in the elderly;
associated with low bone density & multiple
risk factors
e.g. age, co-morbid diseases, dementia,
psychotropic medications
• Hip fracture; common orthopedic problem or
older adults with more than 270,000 hip
fractures annually in U.S; rate doubles each
decade after 50; by age 90 affects 32% of
women & 17% of men
 Fractures
• Mortality rate; 20% associated with complications
• About 50% will not resume their premorbid level of
function e.g. walk independently
• May result in dependency; continued
institutionalization occurs in as many as 1/3 of
patients with hip fractures
• Majority of hip fractures are treated surgically; 95%
are femoral neck or intertrochanteric fractures;
remaining 5% are subtrochanteric fractures
 Fractures
• Intensive interdisciplinary rehabilitation
program with early mobilization may
improve outcome
• Treatment protocols are based on the
type of fracture & surgical procedure
used; internal fixation versus prosthetic
replacement
 Fractures
Vertebral compression fractures
• Usually occur in lower thoracic, lumbar regions
(T8 – L3)
• Typically result from routine activity; bending,
lifting, rising from chair
• Chief complaints; immediate, severe local spinal
pain, increased with trunk flexion
• Lead to shortening of spine, progressive loss of
height, spinal deformity (kyphosis), can progress
to respiratory compromise
 Fractures
Goals, outcomes, & interventions; acute phase
• Horizontal bed rest, out of bed 10 min every hr
• Emphasis on proper posture, extension in
sleeping, sitting, & standing
• Isometric extension exercises in bed
 Fractures
Goals, outcomes, & interventions;
chronic phase
• Teach patient extension exercises;
avoid flexion activities
• Postural training
• Modalities for relief of pain
• Safety education / modify environment
• Decrease vertebral loading, e.g. use soft
soled shoes
 Arthritis
• Characteristics
• Pain, swelling, & stiffness, worse early
morning or with over use, e.g. knee pain,
hip pain
• Muscle spasm
• Loss of ROM & mobility, crepitus
• Bony deformity
• Muscle weakness secondary to disuse
 Arthritis
• Goals, outcomes, & interventions
• Medical Management; ( NSAIDS),
corticosteroid injections, topical
analgesics, joint replacements
• Reduction of pain & muscle spasm;
modalities, relaxation training
 Arthritis
Exercises;
• Maintain or improve ROM
• Correct muscle imbalances;
strengthening exercises to support
joints, improve balance & ambulation
• Aerobic conditioning
• Aquatic programs
Causes of falls
 Intrinsic factors
Cardio- Vascular
Neurological
Musculo-Skeletal
Sensory
Cognitive, e.g. Mental problems, fear of fall,
multi drugs
 Extrinsic factors

 Trip
 Slip
 Home environment
 Multi drugs
 Falls Assessment Pathway

Screen all over 75 in community and ask

annually about falls

Recurrent falls
No fall Single fall

Gait or balance
No problem ?
Yes
No action
required Needs multidisciplinary falls assessment

 Guideline for the Prevention of Falls in Older Persons AGS, BGS & American Academy of
Orthopaedic surgeons panel on falls Prevention JAGS 2001 49:664-72
Analysis of balance & Mobility
tasks
• Balanced sitting: consider the effect of the
type of chair / bed surface on sitting ability
• Observe initiated displacements in sitting
• 2. Standing up & sitting down
• Consider the following during standing up
from a chair / bed as a sole task & then while
carrying out a second task
Analysis of balance & Mobility
tasks
• Is the foot placement is appropriate with feet positioned
under / behind knee
• Is the calf / ankle flexible to enable heel contact with the
floor when feet are correctly positioned
• Is the base is too narrow / wide
• Is forward inclination of the trunk controlled with
appropriate APT
• Is anterior translation of knees , with passive dorsiflexion
of the ankle present to prepare for weight acceptance
over the base prior to buttock off
Analysis of balance & Mobility
tasks
• Balanced standing: Internal displacement
• Stand & turn head & body to the right & then to the
left. Is dizziness a problem
• Weight shift
• Ability to stand, reach outside BOS & return to the
stable position
• Ability to touch / pick up objects
• Speed of the execution of the tasks
• Balanced standing – External displacement
Baseline functional/mobility level
Previous level of independency
Role of family members
Patient’s expectation, etc

Pain:
Site, type of pain, time of pain,
Cont or interrupted,
Aggravating and easing factors,
Radiating pain etc
Pain scale:

Body chart
Pain scale:

VAS scale
Face scale
ROM:

Active and passive ROM

Goniometry
Joint laxity, Joint deformity
Muscle strength:

Oxford scale
1 - Flicker of movement

2 - Through full range but not against gravity

3 - Through full range against gravity

4 - Through full range with some resistance

5 - Through range with full resistance

Sensory/reflexes/limb length
etc

Body chart
Superficial and deep sensation
Kinaesthetic and proprioception
Two point discrimination
Graphesthesia
Stereognosis
Posture:

Sitting,
Standing,
Deviation
from
midline
Postural or
structural
 Analysis of balance & Mobility
tasks
The timed ‘Up and Go’ test:
Measure the time taken for an individual to get up from a
standard armchair, walk 3 meters, turn, walk back to the chair
and sit down again. The person should wear her/his regular
footwear. If he/she normally uses a walking aid (stick or
frame) this should be also used in the test. No physical
assistance should be given. A person should finish it in 15
seconds.

 
 Analysis of balance & Mobility
tasks
• The Functional Reach Test
is a single item test
developed as a quick
screen for balance
problems in older adults.
• Interpretation:
A score of 6 or less
indicates a significant
increased risk for falls.
A score between 6-10
inches indicates a moderate
risk for falls.
 Analysis of balance & Mobility
tasks
• Berg Balance Scale
• Tinetti (POMA)
• Dynamic gait index
Physiotherapy Input

Prevention of falls
Coping strategy in case of fall
Rehabilitation after functional
problem
 Prevention of falls

Screening of risk
patients
Home environment
assessment
Health awareness in
community
Falls education
Group exercise classes
 Coping strategy in case of
fall

First, DON’T PANIC 

If

If you are unhurt and can try to get up

from the floor then go to nearby chair
as shown
Get up from the floor by Bring your knees closer
turning onto your side so to your body
that you are resting on one
elbow

Move into a kneeling position with your arms supporting your weight and crawl
to a chair
Use a chair to rise up Bring one knee forwards
with your arms at a time

Use the chair to stand, then turn and sit on to the chair
 Rehabilitation after functional problem

Strength and ROM exercise

Balance program (Otago
home exercise program)
Walking aid and orthosis
Gait training
Stair practice
Appropriate referrals