Fall prevention through Halliwick ® : practical implementations

7/31/2019 Fall prevention through Halliwick : practical implementations

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Fall prevention throughHalliwick: practical

implementationsJohan Lambeck PT

www.halliwick.net


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Contents Reasons for loosing balance / falling

Human balancing strategies Fall prevention programmes

Aquatic therapy: its role in fall prevention Halliwick and applications: Halliwick

Ai Chi The obstacle course


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Epidemiology 1.1 million osteoporotic fractures annually in the

US, 70% spine and 20% hips (USA 2001) 12.000 femoral neck fractures annually inSwitzerland. Costs: 600 Mio CHF per year(2004)

Falls account for 90% of hip and 50% ofvertebral fractures 30 % of persons older than 65 fall at least once

a year; in the 80 90 year old category, fallsincrease to 45 % once a year. Rubinstein cs, 1988


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Falling

Represents a failure to meet intrinsic and

extrinsic demands of mobility in a specificenvironment 45% fall because of dizziness, muscle

weakness, confusion, stiffness, etc 39% fall because of slippery surface, poor

lighting, loose objects and other extrinsicfactors Rijken H, 2003


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Intrinsic factors

Falls are correlated with:

Muscle strength of the legs, e.g.: Tibialis Anterior, Soleus and Gastrocnemius,Quadriceps Vastus Medialis

Range of Motion legs and lumbar spine 70% has ROM limitations lumbar spine

Walking, turning, walking stairs: unipedalactivities

Rising from chairs

Lord 1994


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Quadriceps and falling Cent & Visser, 2003

N=16, mean age = 74 y, 2 random groups Experimental group: quadriceps exercises

8 weeks, 3 times/week Test: Tinetti/POMA, Holten diagram

> increase in strength coincided withincrease in Tinetti/POMA score


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Prevent this!

Simmons & Hansen, 1997


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Balance strategies

non-intentional movements Reactive/correction

unexpected lossAnkle/hip strategies

Insecurity strategy

Stumble strategies Sideways, backward

Forward

= Supporting and balancereactions

Predictive/preparation

expected prevention,static mechanisms.

- static mechanisms:- stiffening joints

- increase base of sup.

Counter-weight, dynamicreactions that accompany

intentional movements

Guccione cs 2001, Bronstein cs 2004, Pijnappels 2005


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Intentional movements- initiation (go/stop)

- maintain weight-b during a task- limits of reaching with concentric/ecc

activity- unipedal weight (= stance on 1 leg)


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FICSIT land program Interventions that include balance

training significantly reduces falls

Balance training is also importantto become aware of the limits ofstability

Frailty and Injuries: Cooperative Studies of Intervention Techniques,Province, 1995 and Takazawa 2003


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Training programme Balance incl single

stance activities Isokinetic muscle

strengthening for hip

knee and ankle

Tai Chi

Obstacle course Flexibility/strength

exercises on a mat

Standing up from amat

Judge 1993 K. Mead 1996, H.Rijken 2004


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Tai Chi TC is performed with varying degrees of

concentric and eccentriccontractions. TC does not improve measures of postural

stability in older objects, it promotes confidence (fear of falling questionnaire)

Fall risk is reduced by 47.5%

Wolf SL et al. J Am Geriatric Soc, 1996 and Physical Therapy, 1997 Lan C, et al. Med Sci Sports Exerc, 1997.


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Aquatic Therapy Can aquatic therapy be used in a fall

prevention programme?


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Balance outcomesadapted from Geytenbeek, 2002

BergElderlyPositive ssDouris, 2003

Berg, TUGElderlypositiveMaginnis, 1999

F. ReachCVAPositiveMorris, 1996

Functional reachCP casePositive ssThorpe, 2000

POMAElderlyPositive ssMuhlenkamp,2000

ABCElderlyPositive ssSmulders, 2005

BergParkinsonPositiveJohnston, 2002

F. reachElderlyPositive ssSimmons, 1996

Body swayElderlyPositive ssLord, 1993

Postural swayRA and OAPositive ssSuomi, 2000

testpatientseffectAuthor


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Research example 1 Lord et al, 1993

older people with mild disabilities, n = 13

9 weeks, 1/wk aquatic therapy, 1 hour Outcome:

ss decrease of postural sway compared tocontrols, and Quad strength increased


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Lord: program Various arm/leg movements: stance 1 leg

Reachingactivities to limit of single legstance in various directions

Marching, side stepping, walk backward Arm exercises with metacentric effects

Arm exercises with floaters

Games: jumping, hopping, ball relays


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Research example 2 Simmons & Hansen, 1996

4 groups of well elderly 1. exercise in water, - 2. sitting in water 3. exercise on land, - 4. sitting on land

5 weeks, 2/wk, 45 minutes Functional reach mainly improved in 1.

Making and correcting movement errors in asafe environment + variability of practice


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Simmons V, Hansen PD: J Gerontol A Biol Sci Med Sci1996

34.0*28.7*24.423.6

Water

exercise

Land exerciseWater sittingLand sitting

5 weeks 2 times per week, 45 minutes. Ntotal = 52

Elderly subjects: 80 +/- 5.8 years

Measurement: Functional Reach

Initially: each group at risk, FR < 25 cm

Effectiveness of water exercise on postural mobility in the well elderly: anexperimental study on balance enhancement


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Simmons/Hansen: program Walking forward, backward high stepping

Marching for/backward with extendedknees

Sidestepping with/without crossing legs Balance on the spot: toe/heel raises etc

Kicking in diagonals

twisting


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In water: Halliwick, Ai Chi balance and the

obstacle course focused on intentional andnon-intentional balance strategies at theICF levels of body function and activity

ICF: International Classification of Function, Disabilityand Health (WHO, 2001)


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ICF and aquatic therapy

Fitness

Ai Chi

Watsu

BRRM

Obstacles

Halliwick

ParticipationActivityBody function


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HalliwickTen-Point-Program and Water Specific Therapy

Be dynamic: in the middle of the pool

Use hands-free Halliwick Teach falling and standing up with the Halliwickpoints

Work from simple to complex: disengage inevery point Apply functionally and repeat on land

Facilitation: Trial and Error, Guiding, Automatic activity


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The Ten-Point-Program Mental Adjustment/Dis Sagittal Rotation Control/Dis Transversal Rot Control/Dis Longitudinal Rot Control/Dis Combined Rotation Contr/Dis

Upthrust/Dis Balance in Stillness/Dis Turbulent Gliding/Dis

Simple Progression/Dis Basic Movement/Dis

Dynamic

Static

Dynamic


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Principles of Disengagement Change supports

Change fluidmechanical principles Change general mechanics

Change exercise physiology parameters In order to:

Progress and vary at random


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The Ten Point Program in fall

prevention Breath control

Transversal Rotation Control Upthrust / Mental Inversion

Combined Rotation Control Sagittal Rotation Control

Balance in Stillness


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Breath control A part of mental adjustment

Oral and nasal Some 5 seconds of expiration

Timing and quick reaction is important To be combined with movement = falling


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Transversal Rotation Control A control around a transversal axis of the

body From stand / sit to supine, stand up again

falling backward as a tree Also a basis for local endurance of e.g. hipextensors


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Upthrust / Mental Inversion To realize that its difficult to stay at the

bottom of a pool One always comes to the surface again

Head should be put forward during thefloatation time

Ps: Mental Inversion is 1 step more


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Combined Rotation ControlThe combination of all rotations:

TRC and LRCSRC and LRC

preventing the prone position

Preparation for functional movements

Eg: falling and standing up


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Sagittal Rotation ControlTo go to the limits of reaching

To transfer weightWith differing bases of support

Include reaching activities


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Balance in Stillness To be able to keep a position during different

balancing tasks No peripheral movements, good alignment and

no attempts to enlarge radius, use metacentric

effects or close chains Disturbing factors are: turbulence, waves and

metacentric effects + others

Focus: control of head and trunk around all axes


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Applications In Halliwick, swimming is applied in

activities as Competition High-low / waterbasketball

In Halliwick, balance in posture and gait isapplied in: Ai Chi

The obstacle course


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Ai Chi and balance All intentional strategies

Maintain weight during a task shift weight and reach to the limits with

concentric and eccentric components,

unipedal stance, at least 10 sec initiation (go / stop)

Non-intentional strategies

Ankle / hip / sideward stumble strategies Counter weight strategies


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The obstacle course is designed to

train balance strategiesFormalized equipment:

-Wiggle board

-Balance beams

-Hurdles-Reaching pole

With cognitive double tasks, dimmed light, a tray in

front, passing each other etcK. Mead 1996, H.Rijken 2004


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Task-Type training In all of the stations of the obstacle course,

functional tasks should be included Throw a ball in a basketball bucket Wheel someone on a ball through the pool

Fill a basket with water, using bags

A tower of boards, push up/down Step/jump over a rope

Collect material, sitting on a mat

Transport bottles across the pool

Fall prevention through Halliwick ® : practical implementations

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