| Subject: Falls Assessment |
Grade: Home care |
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1. Topic-
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| Fall Risk and Falls Prevention |
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2. Content-
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| Balance, coordination, visual impairment, impulsivity, depression |
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3. Goals: Aims/Outcomes-
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1. No falls with injury
2. Decrease number of falls
3. Consistent use of assistive gait device |
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4. Objectives-
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1. Remove trip-hazards.
2. Pt demonstrates safe sit-stand transfers, including stand, and
then turn.
3. Barriers to pt use of gait device are removed; pt accepts gait
device at least for high risk times. |
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5. Materials and Aids-
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| 2 books with lots of pictures on falls prevention in general, and
home modifications in particular. Paper for individualized HEP. |
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6. Procedures/Methods-
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A. Introduction-
1. Congratulations! You have had more falls than anyone else in
the program.
2. Your luck is going to run out for falling without serious injury.
3. Seriously, we don't want you to get hurt, even though you don't
think it is a big deal, because we want you to live at home as long
as possible. |
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B. Development-
1. Site visit with patient and wife to places in the home where
falls have occurred in order of frequency.
2. Problem solve with patient and wife how to prevent a fall from
occurring there again.
3. Demonstrate how adaptive equipment would be useful.
4. Work with patient and wife around cuing strategies that will minimize
bickering and increase desired behaviors.
5. Walking and turning, and walking and talking are high risk activities
for the patient. PT role-models how to follow him without distractions. |
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C. Practice-
1. Have patient plan and sequence the transfers in a consistent
manner in each location. Have wife write out the sequence for follow-up
cuing.
2. Teach balance exercises done at center to be done at home, modified
as needed for the setting. Write instructions, including stick-figure
drawings.
3. Include use of RW or 3ww or 4ww, patient choice of 1, to be used
for walking in the home.
4. Assist wife to make list of high risk areas, and plans for modification.
5. Don't walk and talk, then walk and talk, to demonstrate to wife
the difference as a fall risk factor. |
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D. Independent Practice-
1. Use of assist device, especially during high risk times, e.g.,
morning routine and bedtime routine. Wife to report to PT if pt refuses
x3.
2. HEP may be done by patient and wife.
3. Wife makes home modifications with assist as needed. |
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E. Accommodations (Differentiated Instruction)-
1. Wife is very verbal but a selective listener. Write down key
points to review.
2. Patient is aware enough of his neurological deficits to be depressed.
Reaffirm his successes in the past (no falls in a 3 month period the
end of last year).
3. Build HEP from his memory, explicit or procedural, of the center
based exercises. |
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F. Checking for understanding-
1. Ask wife to tell me what is on her "To-do" list of home modifications,
and any anticipated barriers.
2. Ask patient when he plans to do HEP, when will it fit into his
day.
3. Observe patient in sit-to-stand activities in various locations
in the home.
4. Ask them if they have any questions about what I have presented.
5. Ask if they have any other questions related to falls.
6. Ask them how I might teach the subject "better" next time. |
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G. Closure-
1. Review goal of decreased falls, home modifications and transfer
sequence, use of gait device.
2. Plan f/u home visit to assist with modifications, and review HEP
as needed.
3. Regular phone contact. |
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7. Evaluation-
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1. Wife report of patient using gait device, doing HEP, not falling.
2. PT observation of pt gait and balance in general at the center,
and during PT sessions. |
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8. Teacher Reflection-
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| Teacher hopes to make more of an impact than during the last home
visit, when wife was planning for joint replacement surgery, ie, preoccupied
with her own health. |
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