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Interactive Metronome Fall Risk Reduction Program
Designing an Exercise Program, Module 3
Patient Name: _________________________________________________ Da Treating Diagnosis: ___________________________________________________________________ Balance Deficits, Decreased Cognition, Frequent Falls Multifactorial Risk Assessment
Focused History
3 Falls in the last 2 months; 1st fall with change of surface; 2nd fall while walking to mailbox and wasn’t paying attention; 3rd fall Detailed description of fall (circumstances, in a parking lot and was distracted by another person Describes his falls as “stupid” and “exasperating” Was participating in regular exercise program until back problems worsened. Lives alone in 2 story home with 4 steps to enter and 14 steps inside home.
Plavix; Lopressor; Nitroglycerin; Vasotec; Lipitor; Celexa; Xanax Medical history that could be correlated L2-5 Laminectomy and fusion (July 2011); CABG x 4 (2010) with documented anoxic event during surgery; pt. and family report cognitive changes after CABG; pt. self reports he is still “not quite right”.
Physical Exam
Equal step length and weight bearing. Initial contact is flat footed, lacking heel strike secondary to short step length. Slightly forward flexed posture, forward head. Decreased arm swing (secondary to slow walking speed). balance with eyes open and eyes closed – TUG Manual Ross Information Processing Assessment (RIPA) Predominantly uses hip and stepping strategy, even for small balance perturbations. Minimal use of ankle strategy, and only requires a small stepping strategy? Is reaction appropriate balance perturbation to take a step forward or backwards. Intact. No sensory or reflex impairments noted. Light touch, deep pressure, proprioception intact is involved in falling (heart rate, blood pressure, postural pulse, diastolic blood Within normal limits as reported by patient. Does wear prescription glasses and has seen physician in last year.
Does not report vertigo Unable to perform horizontal or vertical head turns with gait – results in significant loss of balance requiring moderate assistance to correct Visual saccades where inconsistent – had difficulty tracking object. Reported mild nausea with this activity. Exam feet and footwear (range of motion Dorsiflexion limited to neutral (0 degrees). Typically wears athletic of feet, evidence of neuropathy, appropri- shoes or lace up shoes that fit well. Not an area of concern. Range of Motion
Strength (list manual
muscle test results)
Functional Assessment
Light housekeeping (dishes, making beds, laundry) Gets in his own What ADL’s is the patient having difficulty mail Managing medications once caregiver fills pill box Pt. verbalizes a significant fear of falling and has begun to self-limit activity due to this fear. Family substantiates this behavior. Pt. is now beginning to limit his “outings” with the family by saying he doesn’t feel well, but family feels that his fear of falling is restricting his activity level.
Environmental Assessment
Has not had falls inside home. Reports this environment is “under control”. May benefit from home evaluation to determine if home safety could be increased. Create a patient problem list and assign problems to a system of balance. Each problem may belong to multiple Musculoskeletal
Proprioceptive
Oculomotor
Vestibular
Cognition
Poor visual saccades/weak vestibular system Decreased motor planning with dual tasking perturbation/excess hip and strepping strategy Delayed problem solving/mental processing Using the exercise guide located on the materials page, identify exercises that target problem areas.
Exercise Name
Check Exercises to Put in Treatment Plan
Exercise Name
Check Exercises to Put in Treatment Plan
Head Movements in SittingHead Turns with Reaching Across Using the In-Motion TriggersSeated, Reaching Across and Behind In Module 4, intensity and frequency of treatment and exercise modification will be discussed.
Keep this information as it will be used in the next module. Questions? Please email dara.coburn@interactivemetronome.com.

Source: http://interactivemetronome.com/imw/coaching/fall_risk/mod_6/Mod_6_Worksheet_Exercise_Program.pdf