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Specialist PSI Exercise Module
EXERCISE FOR THE PREVENTION OF FALLS
AND INJURIES IN FRAILER OLDER PEOPLE
‘PSI’ INSTRUCTOR COURSE
A SPECIALIST NATIONAL TRAINING INITIATIVE
Specialist PSI Exercise Module
WHY?• Need for training to:
– Support national accident prevention targets
– Ensure greater consistency of provision– Ensure best practice
• Need for training that is:– Specialist– Evidence-based– Practical– Interdisciplinary– Recognised
Specialist PSI Exercise Module
WHO?
• Department of Health
• Merton, Sutton & Wandsworth Health Authority
• Advisory Group of National Experts
• 1999 first pilot run
• To date over 1000 PSI instructors have qualified
Specialist PSI Exercise Module
Interested Co-workers
Specialist PSI Exercise Module
WHAT?
• First Recognised National Qualification
• Postural Stability Instructors (PSIs)
• Register of Exercise Professionals (REPS) at Level 4
– CPD at Level 3
• Chartered Society of Physiotherapy Endorsed
training
• Accredited by University of Derby
• Guidelines and Consensus Recommendations
Specialist PSI Exercise Module
HOW?
• Underpinning Knowledge• Application to Practice• Practical• Case Study• C.P.D.
Specialist PSI Exercise Module
AN INTERPROFESSIONAL NETWORK
District Nurse Family/Carers General Practitioner Health Visitor Chiropodist A & E
Hospital Doctors Hospital Therapists Ambulance Services Social Services Community therapy services Pharmacist Leisure Services
• Multifactorial Nature of Falls
• Multiprofessional Skills
• Professional Liaison• Respecting Boundaries/Building Trust• Patient Centred
Specialist PSI Exercise Module
ACCIDENT &EMERGENCY
AMBULANCESERVICES
PRIMARY CARE
GP
VERY SHELTERED/RESIDENTIAL HOME/
NURSING HOME
SECONDARYCARE
SELF REFERRAL
PRE-EXERCISE ASSESSMENT
‘PREHAB’ PREVENTATIVEEXERCISE
REHABILITATIONEXERCISE
CHAIR BASEDEXERCISE
SOCIAL SERVICES
ROUTES
INTO THE
FALLS
EXERCISE
PATHWAY
Specialist PSI Exercise Module
FALLS REHABILITATION GROUP
‘PREHAB’ PREVENTATIVE
EXERCISE
CHAIR BASED EXERCISE GROUP
REFERRAL
Exercise for the Older Person Sessions
THE THREE EXERCISE GROUPS
Specialist PSI Exercise Module
Independently mobile older people
Independent with assistance/aids
Independent with assistance/aids/carer
Physically frail housebound/outpatient
Exercise Instructor NVQ2
OTAGO Exercise Leader Chair-based Exercise LeaderNVQ2/3
Dinan, 1999
Advanced Exercise InstructorExercise for the Older PersonNVQ3
Advanced Exercise InstructorExercise ReferralNVQ4
Specialist Exercise InstructorPostural StabilityNVQ4
Specialist Exercise InstructorClinical Exercise MSc
General PopulationsGeneral Populations
Special PopulationsSpecial Populations
Low RiskLow Risk
Patient Patient
PopulationsPopulations
Medium RiskMedium Risk
HighRisk
THE EXERCISE REGISTER UK
Specialist PSI Exercise Module
While I have been talking…..
• 4 older people will have been seriously injured...
• 6 older people will have had a minor injury..
…..as a result of a fall at home
Specialist PSI Exercise Module
While we are here today...
• 900 older people will have had a minor injury..
• 122 older people will have been seriously injured..
• 33 older people will never return home…
….as a result of a fall at home
Specialist PSI Exercise Module
A Four Point Plan to:
Improve Balance and co-ordination
Increase Functional Capacity
Increase Bone and Muscle Mass
Increase Confidence (reduce fear of falling)
Includes:
7 Evidence Based Activities
FaME into practice
Specialist PSI Exercise Module
1. Dynamic endurance training for balance
Specialist PSI Exercise Module
2. Dynamic balance training
Specialist PSI Exercise Module
Specialist PSI Exercise Module
3. Targeted resistance training (weights, bands and body weight) including targeted bone loading
- for leg and ankle strength
- for arm and back
- open & closed chain
Specialist PSI Exercise Module
4. Backward chaining
Specialist PSI Exercise Module
5. Functional floor activities
Specialist PSI Exercise Module
6. Flexibility training for leg and ankle, chest, spine
Specialist PSI Exercise Module
7. Sustained, three dimensional adapted Tai Chi training