Postural Stability in Practice #physiotalk 14th Dec 8pm

Our next #physiotalk tweetchat is on Monday 14th December at 8pm GMT It is being hosted by @AGILECSP

One in three people over the age of 65 fall annually, with the majority of these being caused by balance disorders. These have wide-ranging physical and psychological consequences and increase the likelihood of frailty, cognitive decline, sedentary behaviour, social exclusion, falls and injury related death. Postural deficits are a very frequent and detrimental problem for older adults and can be explored within established models for postural control.

Postural control is complex and depends on visual, proprioceptive and vestibular input, their processing (including reweighting of information according to cue availability and task demands), and sophisticated mechanisms to support reactive and anticipatory postural adjustments. In addition, age-related decline in all these sensory inputs and functions is well documented and leads to impaired postural and ambulation control, increased falls risk and injury. Additionally, age related deficits in executive function and attention are common and are, associated with impairments in postural control, dual-tasking balance ability (i.e. walk and talk at the same time), reduced gait speed and increased falls risk and strongly predict impairment in activities of daily living and functional independence, with road crossing a typical cognitively complex balance task in which older adults show impairments.

The National Institute of Clinical Excellence (NICE) UK Falls in Older People Guidelines recommend early detailed individualised assessment and treatment interventions for older adults at risk of falls, but provide limited guidance on how postural control rehabilitation strategies should be conceptualised, designed and implemented within these treatment interventions, specifically strength and balance training interventions. Physiotherapy to improve balance and postural control consists of personalised sets of exercises, defined by an appropriately trained healthcare professional. Rehabilitation programmes may either be delivered in group settings or as individualised interventions, with participants performing supplementary exercises daily in the home environment.

These interventions are supported by numerous guidelines and systematic reviews. Many established programmes have been shown to be effective in reducing falls rates in older adults, reducing falls by 30-40% (dependant on target population). However, many programmes may not be optimised as they are not developed using an established model for postural control. For example, numerous studies have identified that inner ear balance (vestibular) dysfunction is common in older adults who fall, with studies highlighting that up to 80% of older people who fall suffer from vestibular dysfunction. The majority of falls rehabilitation programmes do not address this or they do not address it until very late in the programme. Greater awareness of postural control models and its relevance to falls assessment and rehabilitation will be useful for clinicians and service leads to ensure optimal exercise programme design, content and effectiveness.

Chat questions

Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your assessment and management of postural instability ?

Q2) What are the barriers/ challenges to improving postural stability in older adults ?

Q3) How do you measure the effectiveness of your postural instability intervention ?

Q4) What are the gaps in your knowledge, skills and/ or services in terms of postural instability management in older adults ?

Q5) What training would help you improve assessment and rehabilitation pathways for patients with postural instability ?

Q6) What examples of digital rehabilitation for postural instability do you have ?


Multi- sensory Training

Balance and Falls

NICE Guidelines Falls

Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?

Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review

Chat transcript

Missed the chat? Then catch up with the transcript

Your hosts

The people behind this chat are:

Dr Marousa Pavlou, Centre for Human and Applied Physiological Sciences, King’s College London.

Dr Matthew Liston, Head of Research & Development Chartered Society of Physiotherapy

Mrs Sarah Lambert Education Officer (AGILE) / Team Lead Physiotherapist- Balance and Bone Health Team. BSUH NHS Trust

Ms Sarah De Biase, AGILE Chair | AHP Lead Older People’s Mental Health Service AGILE | Bradford District Care NHS Foundation Trust

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