PREVENT FALLS WITH WEIGHT SHIFTING

Working with the older adult population means a lot of our clients have had falls or are at risk for falling. Most of the clients we treat have balance deficits, which potentially creates a greater falls risk.  

Balance

Standing balance is the ability to remain in an upright position without having to make significant postural adjustments or relying on external support. In order to maintain standing balance while performing functional activities, such as reaching into the cabinet, one must be able to weight shift.

Evidence-Based Practice 

We work on weight shifting activities and exercises frequently with our clients.  While using video footage in fall investigations, one group of researchers found that “results show that 41% of falls are due to incorrect weight shifting” (Woolrych, R, et al., 2015).

Weight Shifting Exercise

The goal of this exercise is for your client to keep his/her feet placed firmly in one position on...

How to Use Daily Assessments to Show Skilled Care

In your daily treatment note, you need to highlight hindrances impacting your clients progress and how you are addressing these hindrances.

And this does not have to be as hard or time consuming as you think.

To make this easy break it into 3 sections:

1. Start with what your treatment focused on that day such as:

• technique
• balance
• endurance
• vitals
• strength
• ROM
• a specific task
• ambulation technique
• transfers

2. How did your client respond that day such as:

• progression with...
• regressed with....
• modification secondary to ...
• added ...
• removed...
• facilitated ...

3. Explain your client's response to the changes that were made and how you are going to work on this in the future.

Remember as long as you can show why your treatment session required your skill and a caregiver couldn't do it you can continue to treat your client.

Do you know any other therapists that could use more ideas for client-centered treatment? Make sure to share...

Shoulder Internal Rotation

Many clients we see have a hard time reaching behind his/her back.  This can be problematic for dressing and toileting. If you find your client has a difficult time adjusting his/her clothing, you need to work on improving shoulder internal rotation.  Decreased shoulder internal rotation can potentially lead to falls if your client does not have good balance, due to increased time and effort required for self care tasks.

Treatment

In the video on our instagram page, the client was instructed to retrieve a cone from the counter top and then transfer the cone behind his back, passing cone to the other hand to bring back to the counter.  The activity is also facilitating standing balance, necessary for safety and independence with self care tasks.

In order to work on shoulder external rotation, you can do the same type of activity, modifying the movement by passing the cone behind the client’s head.

Client-Centered Treatment

Next time you...

Amplify Steps for Ambulation and Functional Mobility

If you are working on increasing step length with your client, use a colorful visual target and instruct him/her to step forward onto colored squares. Client’s who shuffle or toe walk would benefit from this exercise.  Make sure to instruct your client to step completely onto color square, instead of a simple toe tap. This activity can be modified with or without upper extremity (UE) support.

To document skilled care:

• Keep track of color marker distance and increase distance as client progresses with activity
• Include tactile or physical cues
• Verbal cues for sequencing or technique

Do you know any other therapists that could use more ideas for evidence based treatment? Make sure to share this post and follow us and tag them on Instagram www.instagram.com/thenoteninjas

And if you haven't yet make sure to download our FREE PDF with skilled care documentation tips HERE!

For Our Favorite Amazon Products to...

Ankle Strategies on Unstable Surfaces

Ankle strategies on unstable surfaces decrease fall risk more than regular balance exercises

According to a study (link found below) performing ankle strategies on an unstable surface decreases fall risk more than regular balance activities for our stroke clients.

In the study cited below, stroke patients performed 15-min sessions of ankle strategy exercises on unstable surfaces three times per week for six weeks, and the outcomes were compared with the outcomes of balance exercises.

After comparing the two it was determined that the  ankle strategy exercise was a more efficient treatment for ankle stability and balance ability in stroke patients.

What activities do you perform with your clients to improve their ankle strategies?

Link to article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792990/

Do you know any other therapists that could use more ideas for evidence based treatment? Make sure to share this post and follow us and tag...

Halloween Meal Prep

Happy Halloween!! Today we are helping our clients with this simple meal prep activity.  This is a fun and delicious treatment idea for hard to engage clients and clients with cognitive deficits. This meal prep activity helps to facilitate following directions, standing tolerance (can be modified for sitting), functional reach and sensory integration. It also can have a positive effect on mood and promoting socialization.

Pudding Pumpkin Patch Cups

Makes 4 servings

Ingredients

• Large print directions
• Instant pudding mix
• Oreos
• Sandwich bags
• One medium or large bowl
• 2 cups milk
• Measuring cups
• Whisk
• Serving spoon
• Candy (we used pumpkin m&m’s)
• Small containers or cups for pudding

Instructions

• Whisk together 2 cups milk and pudding mix from box for 2 minutes in large or medium bowl
• Distribute pudding into cups or containers, evenly distributing pudding
• Crush five oreos in sandwich bag or on plate
• Sprinkle crushed oreos on top of pudding
• Add m&ms...

Grip Strength

Grip strength is an important indicator of your overall health. It is an indication of our muscle strength and is necessary to perform our daily activities. Opening bottles, turning handles, lifting and carrying objects, and feeding are just a few examples of what we need our grip strength for every day.  Weak grip strength not only signifies decreased muscle strength, but also can indicate higher risk of falls, stroke, heart attack, and even lung capacity.

Evidence-Based Research

"Grip strength among community-dwelling men and women is associated with risk of hospital admission over the following decade" (Simmonds, S.J., et al. (2015). Grip strength among community-dwelling older people predicts hospital admission during the following decade. Age and Ageing, 44(6), 954-959. doi: 10.1093/ageing/afv146

Evaluation

One of the first things I test in my client’s is his/her grip strength. I measure grip strength with a hand dynamometer at time of evaluation and...

How do we assess bathing?

When I assess bathing, I mainly look at three different components: environmental, physical abilities, and cognition.

Environmental

• Durable medical equipment
• Shower stall vs shower tub
• Grab bars in shower
• Bathroom set up

Physical

• Standing tolerance
• Transfer ability
• Strength (UB/LB, core)
• Balance
• Range of motion
• Cardiovascular stamina

 Cognition

• Safety
• Judgement
• Body awareness
• Sequencing

Skilled Care

Looking at the items within each component allows me to break down the actual occupation for each individual client.  Part of documenting skilled care is individualizing care plans. All clients are unique in his/her abilities and may have different set up of his/her environment.  You may devote a treatment session to educating the client or caregiver on using durable medical equipment (DME) or adaptive equipment (AE) in the shower. Another treatment session may focus on the getting in/out of shower or transferring on to shower seat.

Shower...

Resisted Theraband Ambulation

Resisted theraband ambulation is a great activity to force your clients to lean forward during gait.  Using a theraband provides you, as the clinician, more control over your client's posture and positioning to help them self-correct over time.

Technique

Have your client stand up straight with a resistance band around their waist. 

Hold the resistance band behind your client's back to maintain support and control.

Aim to keep walking at a steady pace with a normal step length.

Goals

We used this activity to force our client to shift her weight forward as she normally loses her balance posteriorly. As well as to increase core strength, which is a major goal of ours to improve balance and decrease fall risk.

Do you know any other therapists that could use more ideas for evidence based treatment? Make sure to share this post and follow us and tag them on Instagram www.instagram.com/thenoteninjas

And if you haven't yet make sure to...

Pain

Do you have a client who is fixated on their pain?  It feels like as soon as they see you, they automatically report pain.  Why does exercise and activity have to be associated with pain? We need to educate our clients on pain management in the right way.  Along with modalities and massage, mental imagery is often overlooked in treating pain.

Pain Management Goals

The general goal of treatment for individual’s with pain include improving quality of life.  In order to achieve this goal, we must teach patients how to live with symptoms and educate on pain management.  Involving family and caregivers in education and treatment is just as important to improve a patient’s overall quality of life.  

Kinesiophobia

Individuals with pain may experience kinesiophobia, which is the fear of pain due to movement.  This may lead to a hindrance in patient’s progress with therapy. It is important to build rapport with our patients early on...