Trent Brown – The Clinician’s Guide to Reducing Falls: Evidence–Based Strategies that Work

The Clinician’s Guide to Reducing Falls: Evidence-Based Strategies that Work – Trent Brown

Reduce Falls and Increase:

• Functional and occupational performance and participation
• Visual processing and strategies during dynamic movement and ambulation
• Safety with gait, functional mobility, transfers, and sit-stand
• Patient confidence with mobility in the home and community

As a clinician who has worked in skilled nursing, home health, acute, and transitional care, I’ve seen and treated too many patients who experience falls. In the past, I focused too much of my attention on strengthening the low extremity or solely on home modification, which resulted in seeing minimal gains. What was I missing? There had to be a better way to treat this population. Finally, I discovered that by examining the myriad causes to falls – psychological, physiological, visual, and neuromuscular – I could effectively treat my patients by improving functional and occupational performance and giving them confidence with mobility in their home and community.

In this lab-intensive recording, learn and practice the evidence-based tools I use to help prevent falls. Feel confident and comfortable using these proven strategies that immediately carry over into your clinical setting.

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1. List the major contributors to falls and the most common environments where falls occur for the adult and geriatric population
2. Describe the role that medications play in falls, and what steps can be taken to reduce the likelihood of medication-related falls
3. Restate the role of clinicians in fall prevention in various rehab facilities, in the home, and in the community at large
4. Identify the common principles in a fall reduction program that lead to the best outcomes
5. Develop a practical understanding of learned exercises and assessments during labs to ensure immediate carryover into clinical settings
6. Apply documentation strategies and language based on information to justify skilled clinical services and reimbursement to all payer sources

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THE COST OF FALLS

• Frequency of falls – a breakdown in the US
• Results of falls
• Cost and future projections
• Environments where falls occur

CAUSES OF FALLS AND WAYS TO REDUCE THEM

• Specific causes
  • Medication
  • Ageism
  • Diagnosis
  • Contracture
  • Weakness
  • Compensatory gait patterns
• Common associations leading to falls
  • Fear of falling (stiffening strategy)
  • Genomic hypovitaminosis
  • Gender
  • UE weakness
• Visual space relation and fixation duration
  • Soleustretch and Visual Stance demonstration
  • LAB
• PNF functional strengthening techniques (CR vs HR vs CRAC)
  • GRAC Rowing (Modified D1, D2)
  • Gastroclock with CRAC technique
  • LAB
• Medication and mechanism
• Type I iliopsoas contracture and anterior pelvic tilt vs. posterior pelvic tilt
  • Male vs. female
  • Lengthen and shorten demonstration
  • LAB

CLINICAL AND EDUCATIONAL ROLE IN REDUCING FALLS

• Education
  • Sleep, adaptive equipment, home environment
  • Fall reduction in the home
  • Otago and other “fall reduction” programs
• 4-Test Balance Scale (LAB)
• Chair Stand Test

BEST PRACTICE: ASSESSMENTS, ACTIVITIES, AND EXERCISES

• Fall risk evaluations
  • Functional reach (FRT), TUG, Fall Algorithm
  • LAB
• Hip/frontal plane stabilizers
  • Reducing circumduction, shuffle, or Trendelenburg gait
  • Trochanter Tension
  • LAB
• Hip mobilizers
  • Seated and standing mobilization technique
  • Dynamic PNF chops
  • Quad sit-up (LAB)
  • Log roll
• Determinants of gait
• Exercise/activity dose and frequency

DOCUMENTATION AND CASE STUDY

• 5 platforms of successful documentation
• Documentation examples
• Case study

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