ImplementationImplementation

Remember the overall Remember the overall goals!goals!Strength & Balance Strength & Balance

exercises:exercises:3 x week 3 x week (rest days between),(rest days between), 30 30 mins mins

PLUS PLUS

Walking:Walking:If safe, 2 x week, 30 mins If safe, 2 x week, 30 mins (or “snacks”) (or “snacks”)

Client AssessmentClient Assessment

Health Health ANDAND Function: Function:

1. chair stand test 1. chair stand test 2. four-test balance scale2. four-test balance scale

(original Otago assessments)(original Otago assessments) p.25p.25

WHY?WHY?

ASSESSMENT TOOLSASSESSMENT TOOLS

Examples/to be agreed locally with Examples/to be agreed locally with falls services, and physiotherapists;falls services, and physiotherapists;

Tinetti – Gait & BalanceTinetti – Gait & BalanceConfidence in maintaining balance Confidence in maintaining balance scale (ConfBal)scale (ConfBal)Visual analogueVisual analogueTimed up & Go (3 meter) (TuG)Timed up & Go (3 meter) (TuG)

Original Research OEP Original Research OEP Inclusion criteriaInclusion criteria

– Inclusion:Inclusion: Living at homeLiving at home 65+65+ (most effective - (most effective - >80, previous fall in >80, previous fall in

past year)past year)– Exclusion:Exclusion:

Unable to walk around own homeUnable to walk around own home Unable to understandUnable to understand Currently receiving physioCurrently receiving physio

LLT Implementation LLT Implementation Guidelines for Inclusion Guidelines for Inclusion

Suitability for inclusion assessed and confirmed by appropriate health professional. (Local protocols as agreed depending on leader/instructor skill sets);Suitability for inclusion assessed and confirmed by appropriate health professional. (Local protocols as agreed depending on leader/instructor skill sets);

Living at homeLiving at homeAble to walk/mobilise indoors without aidAble to walk/mobilise indoors without aidAble to independently walk outdoors (or with 1 stick) Able to independently walk outdoors (or with 1 stick) 65+ (most effective 65+ (most effective >80, previous fall in past year)>80, previous fall in past year)Able to rise from chair without assistance Able to rise from chair without assistance No contraindications to exerciseNo contraindications to exerciseNo co-morbidities (unless L3/L4 qualified instructor)No co-morbidities (unless L3/L4 qualified instructor)

LLT Implementation LLT Implementation Guidelines for Guidelines for ExclusionExclusion

Unable to walk around own homeUnable to walk around own home Unable to understandUnable to understand Currently receiving physiotherapyCurrently receiving physiotherapy 2 or more falls in past 6 months2 or more falls in past 6 months Medical investigations pendingMedical investigations pending Client has not been assessed as part Client has not been assessed as part

of an agreed falls prevention serviceof an agreed falls prevention service

Outcome measure(s)Outcome measure(s)

Falls:Falls:– Stamped, addressed, Stamped, addressed,

monthly calendars filled in monthly calendars filled in dailydaily

Compliance:Compliance:– Diary/calendarDiary/calendar

Home visitsHome visits

Weeks 1,2,4,8 Month 6,12Weeks 1,2,4,8 Month 6,12 30mins each 30mins each

except week 1 = 1 hourexcept week 1 = 1 hour What happens at each?What happens at each?

Progression Progression

Strength:Strength:– How?How? Increase ankle weight resistance Increase ankle weight resistance– When?When? 2 sets of 10 reps (with sound 2 sets of 10 reps (with sound

technique) before progressing to next technique) before progressing to next weightweight

Balance:Balance:– How?How? Reduce support (recommended Reduce support (recommended

steps?)steps?)– When?When? Client can recover with legs not Client can recover with legs not

grab with armsgrab with arms

EquipmentEquipment

Instructor:Instructor:– StopwatchStopwatch– Table 4 (p.19) Reps/ProgressionsTable 4 (p.19) Reps/Progressions– Copies of exercise booklet (fill in reps)Copies of exercise booklet (fill in reps)– Chart to record exercise prescriptionChart to record exercise prescription

Client:Client:– Exercise bookletExercise booklet– Ankle cuff weights (1/2kg to start?)Ankle cuff weights (1/2kg to start?)– Falls/Exercise calendar(s)Falls/Exercise calendar(s)– Sturdy, armless chair Sturdy, armless chair

Health & Safety 1Health & Safety 1

1. Venue (home and/or community venue)1. Venue (home and/or community venue)

2. Equipment2. Equipment

3. Service structure/OEP Leader support3. Service structure/OEP Leader support

4. Qualifications, and insurance4. Qualifications, and insurance

Important considerations for delivering the OEP;

Health & Safety 2Health & Safety 2

1&2. Venue & Equipment – OEP Leaders should 1&2. Venue & Equipment – OEP Leaders should work with their line managers to ensure risk work with their line managers to ensure risk assessment of appropriate venues and equipmentassessment of appropriate venues and equipment

3. Service structure – OEP Leaders should be 3. Service structure – OEP Leaders should be working as part of a broader falls service whereby working as part of a broader falls service whereby frailer and more complex patients can be referred frailer and more complex patients can be referred to health professionals for inputto health professionals for input

4. Qualifications, and insurance – OEP Leaders 4. Qualifications, and insurance – OEP Leaders should understand their parameters of practice should understand their parameters of practice and what populations they are able to lead and what populations they are able to lead exercise toexercise to

Telephone supportTelephone support

Between home visits; Between home visits; months 3,4,5,7,8,9,10,11 months 3,4,5,7,8,9,10,11

OROR

Contact if no show at group Contact if no show at group sessionssessions

OEP Leader OEP Leader AssessmentAssessment Complete TWO worksheetsComplete TWO worksheets Practically lead FOUR of the OEP Practically lead FOUR of the OEP

exercises in a role play situationexercises in a role play situation Complete a self evaluation of Complete a self evaluation of

leading skills with peer feedbackleading skills with peer feedback Submit a full session plan detailing Submit a full session plan detailing

ALL 24 of the OEP exercisesALL 24 of the OEP exercises

OEP SESSION PLAN

EXERCISEEXERCISENo.No.

EXERCISE EXERCISE NAMENAME

REPETITIONREPETITIONSSAND/OR AND/OR TIMETIME

KEY SAFETY POINTS for KEY SAFETY POINTS for effectivenesseffectiveness(NOT INSTRUCTIONS)(NOT INSTRUCTIONS)

PURPOSE E.G.PURPOSE E.G.ACTIVITIES OF ACTIVITIES OF DAILYDAILY LIVING LIVING (ADL)(ADL)

Front Knee Front Knee StrengtheneStrengthenerr

Build up Build up to 10 to 10 repsreps

- Sit back in chair so that - Sit back in chair so that back is supportedback is supported*Posture (See above) *Posture (See above) –– Reinforce - sit tallReinforce - sit tall- Hands on Chair- Hands on Chair- Slow & Controlled move- Slow & Controlled move- Breathing- Breathing- Full ROM but don- Full ROM but don’’t lock t lock kneeknee

Strengthen Strengthen muscles at muscles at front of thigh front of thigh and helps to and helps to improve improve balance.balance.

HelpsHelps: : walking, walking, getting up getting up from a chair, from a chair, stepping up or stepping up or down, down, dressing.dressing.