Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty member Jeff Musgrave discusses how to help older adults understand the value in practicing falling as well as tips for increasing confidence & helping older adults set positive expectations for a meaningful experience.

Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

INTRODUCTIONWelcome to the PT on Ice Daily Show. My name is Dr. Jeff Musgrave, Doctor of Physical Therapy. Proudly serving as part of the older adult division and super excited to be bringing you some more conversations, some more topics regarding older adults. In particular, I think a big swing and a miss oftentimes for older adults when we're thinking about balance and falls training. So much of our time is focused on falls prevention, preparing someone for falls prevention and trying to keep someone from having a fall, which is awesome. We need to do that. It's very important. There's a lot at stake for older adults and we want to prevent as many falls as possible. but we really should not stop our falls training there. So there is a lot of great research to show that we can help improve confidence and reduce injury risk if we can actually prepare someone to fall. And there are two big steps there. So if we're going to go beyond this falls prevention into falls preparedness, there's two pieces. One is getting someone up and down from the ground is a key thing for building confidence and something we need to do if we're planning to do any falls landing with anyone. So just so we're clear, I'm not gonna be covering floor transfers today. I am gonna be talking about strategies. If maybe you've learned how to do these things and you're not sure how to create a successful session regarding falls landing. So I did mention that there is some literature showing benefits for falls landing, because maybe that's new for you. You're like, yeah, I'm not so sure about that. There was a study that came out in 2019 by Moon et al, where they took older adults and they taught them a tuck and roll strategy. So the reality is everyone that got exposure to falls landing using a tuck and roll strategy were able to do two things. One, reduce the acceleration speed of their head hitting a cushioned mat, but also the impact force, the ground reaction force is on their hips. So when we're thinking about trying to reduce head injuries, head, neck, spine injuries, as well as reducing fracture risk. We can do that successfully with a tuck and roll strategy. They found that older adults, after only just two sessions of learning a tuck and roll strategy, were able to reduce their head acceleration speed by more than 40%. 40% slower of their head hitting the floor, or in this case, a crash pad. The other thing they were able to do was reduce that hip ground reaction force by 33%. That's huge, and I especially want you to think about, we know that 30% of adults fall each year. We don't wanna say you're older, so we know that you're going to fall, but we do want them to be aware that there are things they can do to reduce their injury risk. We can teach that, and we want to keep in mind that a lot of our older adults, because of deconditioning, have become frail. They've lost muscle mass. They don't bounce back from injuries as quickly as they should because they've lost reserve and don't have that extra beyond what they need to live daily life physically or within their balance, so they are more likely to fall, and they're more likely to get hurt when they fall, causing a catastrophic injury. So we think about the people in our caseload that are the most frail, they probably, in a lot of ways, have the most benefit from these fall landing strategies, because they're the most likely to have a life-altering fall. Because I think most of the time we think, well, this is just for the people who are super healthy, super strong already. But those people are the ones that are more likely to be okay if they have a fall. The people that really probably need this the most and need it most urgently are those who are the most frail, the most weak. They have the most to lose and are the most likely to get injured in a fall. So I really want to advocate that we find the right strategy for the right place to start these strategies for older adults. And I've got a few tips to try to create a successful session for older adults if you're teaching fall landing for the first time. So I'm not going to be going through the mechanics of how to do that. That is something we go through in depth in our in our live course and teaching that, but I do want to help you set the stage for how to make this a successful session, first time teaching fall landing strategies. VALUE IN PRACTICING FALLS So the first thing is value. Your patients are probably gonna need to be sold on the value, like why in the world would we practice falling? Because it sounds risky and you as a provider may be perceiving risk too. And there is some risk involved. We need to have a very calculated mindset of risk versus reward that's also gonna help us dictate at what place do we start these fall landing strategies. So what's the game? We can prevent head, neck, and spine injuries. We can prevent those hip fractures, likely, if we can teach an effective falls landing strategy. So I wanna let them know that they can learn they can reduce their injury risk. They need to know that it's really possible, it's been studied, people have done it, and if you've already been doing this with your clients, you can share success stories of how you've done this with other people, that it went fine, but you also need to keep in mind the individual characteristics of the person in front of you. I'm not saying carte blanche, like take these people, drop it like it's hot, hit the mat, hit the floor with everyone. If you have taken our live course, you know that there are lots of ways to scale this to make it really easy and very non-intimidating, very low risk. And I'll share a couple of those at the end. So first thing you've got to do is you've got, they've got to know the value. Why would I want to learn this? What could be made better? Reducing their injury risk is the biggest sell here. And even if they're not having lots of falls at this point, we do want to keep in mind with populations that have degenerative neurological conditions that we know are progressive in nature, whether it be MS or Parkinson's disease, falls are frequent. They happen very often. And if they've got the motor control and the ability to learn and do those things now, we want to teach them early rather than later. And get those grooves nice and deep. Get those motor patterns. so that they can access them when they need to. So value is the first thing. What's the value to the patient? You're gonna have to sell them on this. Should be a pretty easy sale because our older adults are thinking about falls and the consequences all the time, whether they've had a catastrophic fall or they've had a friend or family member that's had a catastrophic fall. So that should help set the stage. SET POSITIVE EXPECTATIONS FOR A MEANINGFUL EXPERIENCE The second thing is you wanna set positive expectations. They're gonna need to borrow some confidence from you. You have got to come in confident. You've got to know where you're going to start with the person you're planning to teach fall landing. What is going to be a positive experience for them? Where is it reasonable for them to do this? How many reps? How irritable are their symptoms? We gotta think about those things, but we also wanna share the positive experiences we've already had with others. Hey, I've done this with lots of people. I know it sounds scary. Meet them where they are. They probably wanna hear that you know that they're scared. Or they may be a little concerned. Maybe we don't want to say fearful or scared. But, hey, I realize this could sound scary, but I want you to give this a shot. I'm confident you can do this. We can do this without irritating your symptoms. It's not going to be as exciting as you're imagining. I know what you're imagining in your head. We're not going to be just dropping it like it's hot. We're not going to be hitting the floor. We're not going to hit a hard surface. We're going to teach you all the mechanics. We're going to do it nice and slow, and we'll progress as you're ready. So set those positive expectations, let them know kinda how the progression's gonna go, and that you're gonna be starting very simple, very easy, with just learning the positions, and then from there, you can scale it up and make it more challenging. So value first, positive expectations, and then the last piece, which if you've been following the older adult crew for a while, you've probably heard, but is a huge key with older adults for building their confidence, and that is intentional under dosage. You may have someone who's super active. independent, relatively robust, but you still wanna start fall's landing in a scenario that's gonna set them up for success. We want those successful reps early on to build their confidence so we can invite them along on this journey towards more challenge and more challenging options for fall landing. So we can add complexity, we can add more height to these fall landings so that they can really build their confidence, and take this journey with us. So to give you, I think it's gonna make more sense to give you some examples of how to do this. So intentionally underdosing for something like a backwards fall could simply be done from a recliner. You're a home health clinician, you've got a patient who tends towards backwards falling. You can get them at the edge of the recliner and you can have them tuck their chin and then fall back into the recliner. With the recliner up maybe. Maybe it's completely upright, They are seated, chins tucked, and we're gonna have them slowly work on landing from there. From the recliner, you could tilt it back a little bit and do the same thing. You could progress it all the way from an upright position, slowly falling backwards, to 45 degrees, to all the way flat. You could do this in home health in their favorite spot, which for a lot of our clients in the home health setting is in their recliner. Maybe you're in a clinic setting and you want to introduce a backwards fall landing. You can do that from a seated position with a big wedge. So you imagine that 45 degree wedge, their butt is sitting at the edge of it. You're going to have them tuck their chin and then work on landing backwards, sending the arms out. But they're only doing a very small range of motion. They're not in the floor. They're not Worried about being in the floor, you're not having to teach that getting up and getting down, you can do that from a seated position, which is beautiful. I don't know too many of our clients that would not be successful from a seated position, even our older adults who are pretty frail and are medically complex. If they can go from a seated position to a lying position safely, they can work on a backwards fall landing, and they'll be successful. For our clients who are more advanced, say that goes really well. Maybe we have them go from a standing position and just have them sit and then rock back with their chin tucked. That would be a very easy progression. Once again, not getting them in the floor. They may have had a traumatic experience in the floor. They may feel like the floor is lava, just like the game we played as kids. So we wanna keep in mind, we can scale these things and make it very easy, but you should intentionally underdose your fall landing strategy. Give them options that are super easy. I'll give you a couple examples for forward fall landing. So if you're gonna work on forward fall landing, at least the way that we teach it in the older adult division, there are lots of ways to teach fall landings. But a couple of the key things are, dispersing the load across the forearm and turning the head. You can work on just the motor control of tying these two movements together, getting onto the forearms and turning the head, or even just getting in that position from a seated position, just the mechanics. This is what we're gonna do. This is not scary, this is not hard. You can do this with someone who's super fearful, just working on the mechanics. Then from there, you could do it from a standing position to an elevated mat or some type of soft surface. So even just from a standing position, very slowly working on getting the forearms down and turning the head. It's not complicated. It's not scary. There's basically no risk there. And it could be as slow as you're ready for. After that, once you're comfortable with that, you could speed it up a little bit. Let them try to get very, a little faster down to their forearms with a head turn. From there, you could work on a quadruped position. So hands and knees, maybe on a mat table, super soft mat table, firm enough that they're not having difficulty with their wrist being in that fully extended position. But a mat table could be a great spot, or if you're in the home health setting, You could do this onto a countertop. You could put your Airex pad on top of the countertop and work on that forward fall landing. Once they're good there, you could move this to a bed. And we've not even talked about going from standing all the way down to the floor. So just keep in mind, fall landings are very scalable. Our older adults need to know how to fall, especially if they're frail. It's our job to figure out what's a correct scaling option. They need to know we need to do three things. They need to understand the value. They need to also know that this can be done successfully, that you have been successful doing this with others, that you have maybe practiced yourself based on their specific scenario. And then the third thing is you're gonna intentionally underdose this. You're gonna make sure those first reps are very easy, very easily digestible in small steps, going very slow, and you're gonna progress it gradually as they feel comfortable. And it's really that simple, team. You just have to know all the scaling options and start super simple. I hope that was helpful. I hope you didn't hop on here expecting that I was going to show you step-by-step the fall landing piece. That is something we teach in our live course. I would highly recommend if that's new for you to hop in a live course and we'd love to teach you. But that's an idea of how to set up a session for success. First time someone's learning fall landing techniques, those are the steps you want to take. If you've got experience with this, I would love to hear from you. Are there other strategies that you use that have been helpful for that day one fall landing? SUMMARY Team, if you're interested in what's going on in the older adult world, we've got our next cohort of MMOA level one, our eight-week online courses starting August 14th. We still got some seats there. So if you've not taken online level one, that will be happening soon. Level two course, just want to warn you, it does not come around as often in the last cohort sold out. So if you've taken level one, you're preparing to take level two, you're interested in our next spot, that's going to be October 17th, get your spot. They're probably going to sell out again. If you're trying to catch us on the road, maybe this fall landing thing really struck a chord with you, that's something you would like to add to your toolbox. We'd love to teach you how to do this across a continuum of the spectrum of older adults, their functional ability and whatever setting you're in. We can teach this stuff in any setting and we'll show you how to do that. The next live course is gonna be Virginia Beach. That's gonna be the 13th of this month, and then I'm gonna be in Victor, New York on the 20th, and then after that, the entire older adult team is coming together for MMOA Summit. You'll see almost our entire faculty teach this content, be together to ask us questions, pick our brains. You're gonna have tons of value there because you're gonna have so many people to help you answer your questions and go through these different techniques, and that's gonna be on the 27th in Denver, Colorado. Team, I hope this was helpful. I would love to hear your questions, comments, thoughts on this. And other than that, team, have a wonderful Wednesday and we'll see you next time.

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