Balance and Falling
Impairments and Functional Limitations:
Muscle weakness (specifically quadriceps, ankle dorsiflexors, ankle plantarflexors)
Limited range of motion
Cognitive impairment especially attention and executive function
Slowed reaction time
Reduced processing of sensory information
Disequilibrium
Vestibular impairment
Sometimes if someone has had a previous fall or an injury, they become very afraid of falling again or believe that they are not capable of doing the activity again. For some people, they become so afraid of falling, and failing at that activity, that they place limitations on their movements and activities. Limiting your participation in activities puts people at an increased risk for falling because they are not using their muscles as much and they become weak. As therapists, we need to encourage our patients to continue to engage in activities they were doing before their injury or fall as best, and as safe, as they can!
Falls Efficacy Scale
The Falls Efficacy Scale is an assessment that is used for the therapist to understand the patients fear of having a fall. A higher score indicates a higher fear of falling. This is good for the therapist to know what areas of life are concerning to the patient, what areas to work on, and let’s the therapist know to educate and provide extra encouragement to the patient. If someone had a previous fall, and/or other tests and observations are showing difficulties with balance then you will want to focus your treatments in improving the patient’s balance through strengthening exercises and tasks that involve reaching in different planes. After treating the patient for a few weeks or a month of working with the patient, it is good to provide the same Falls Efficacy Scale assessment to the patient to understand if the total number is decreasing or not. The goal over the course of treatment is to decrease the total score, which means that the patient’s fear of falling is decreasing.
Assessing Standing Balance
To assess standing balance, you may use either the Berg Balance Test or the 4-stage Balance Test. Both assessments are attached below.
The 4-stage Balance test only measures static standing balance, and shows pictorial representations of how the feet should be positioned.
The Berg Balance Test also measures static standing balance, but also involves higher level standing balance tasks and dynamic standing balance, including reaching outside the base of support and turning around.
Functional Sitting Balance Rating Scale
This scale is used to determine a person’s sitting balance and allows us to understand how their balance may impact their ability to perform everyday, functional tasks. It is good to complete this rating scale and add up the total score in the beginning stages of treatment to have a baseline of where the patient is performing. The assessment should be completed and scored again after several weeks or sessions to determine if there has been any significant improvements or changes to the person’s safety and balance during functional tasks.
The Timed Up and Go Test
The Timed Up and Go Test is primarily used to assess mobility and screen for balance problems. If someone takes 30 seconds or more to complete this task, then they are more likely to need an assistive device, such as a cane, walker or wheelchair. To make this assessment more functional for everyday life, you could modify the assessment and have the person carry a cup or other item during the test. As a general rule, if someone takes 12 seconds or longer to complete this assessment, they are at risk for falling. It is very important to prevent falls to avoid further injury to patients you are working with.
For this assessment, it is important for the patient to be wearing their regular footwear/shoes, and use any assistive device they are currently using to walk if any at all. The therapist should not give the patient any assistance so that you can see what they are able to do for themselves.
