By: Shelia Kries, PT
As the older adult population ages, physiological changes occur and the probability of falls increases that may result in negative outcomes. These outcomes span from pain, fear, isolation, to a decreased quality of life, high monetary costs, loss of mobility and loss of independence. The Otego fall prevention approach is an evidenced based program that has been developed to address the many variances that affect our aging population.
When it comes to falls, prevention is best. By identifying factors that contribute to falls and research based programs, we are able to develop and delay the effects of aging. We know that age associated functional declines in muscle strength and the sensory systems, in addition to several other issues, contribute to reductions in balance that may increase fall risks.
The aging population can "manage" some of the common problems that accompany age. Exercise, along with nutrition and staying educated on side effects of prescribed medications, play a crucial role in this prevention process. This article's primary focus is the rehabilitative aspect of fall prevention.
Once a risk has been identified through testing, further attention to be considered includes: range of motion, strength, proprioception, pain and posture. A licensed therapist can develop a prescribed balance and exercise training program that addresses postural stability impairments as well as training programs for performance enhancement. A good understanding of balance, postural stability and sensorimotor training (SMT) is necessary for success. Effectiveness is also dependent on the ability to identify the deficits and develop a program that addresses these deficits.
The Sensorimotor Training approach addresses both static and dynamic components of balance as well as the multitude of systems that control balance in order to train effective strategies and elicit automatic postural responses in order to promote postural stability. This program is adapted for the aging population and utilizes trained Therapy staff to provide this program.
While balance is a commonly used term to describe the ability to maintain an upright position, "postural stability" is a more specific description of the overall aging balance. Postural stability can be defined as the ability of an individual to maintain their center of gravity (COG) within the base of support (BOS). Other areas that are contributory include the many complex physiologic and neurological processes that contribute and control postural stability. This is where the sensorimotor system has an affect on balance in this population. A good understanding of both areas of the musculoskeletal system along with the input from the central nervous system is essential in development and implementation of any balance recovery program.
Normal balance requires use of righting reactions, which require normal proprioception, range of motion, strength, and use of ankle, step and hip strategies. Therefore the treatment focus is on strength, flexibility, balance and reaction times, as these are considered modifiable risk factors for fall prevention. Research has shown that adults, even in the 90's can improve in each of these areas with training.
The progression of this program has shown the best outcomes when a patient advances through three phases of SMT: Static, dynamic and functional. With in each stage individuals complete the task/exercise (1) different postures, (2) progressive BOS, (3) challenges to the center of gravity. The success of this type of training is based on several factors of addressing core areas, which includes the base of support, ankle strength, proprioception moving up to the pelvis region/posture. The main goal of SMT is to increase muscle reaction and tissue endurance rather than total joint strength. Instead of focusing on strength, the focus is placed on restoring the automatic reflexive stabilization for dynamic balance. The training outcome between normal strength training and SMT, notes that SMT showed improved objective testing scores.
We encourage you to further explore specifics of Sensorimotor training, and the Otega Exercise program to further educate and utilize these methods in reducing the falls in the aging population.