Further resources

To be supplemented

The patient below is 78 years old. About a month ago, he fell on the street, he did not break. 

In his findings, dexa T-score result: AP spine L1-L4 -2.6; Femur left: -1.9; Femur right: – 1.7 

The total height reduction is 3 cm. 

His blood pressure is stable, he does not tend to feel dizzy. 

Watch the videos and assess the patient’s status regarding balance and fall risk. 

In the case of static balance, it is clear that narrower support and standing on one leg cause difficulty for the patient. 

He carries out the dynamic tests and solves them within the time limits, but in several tests the continuity of movement and the need for equilibrium reactions can be seen. 

The patient does not have secure balance in all situations, so there is a risk of falling, and improvement can be recommended. 

The patient needs balance-building and muscle-strengthening exercises. 

Therapy I. – Educational program: everything related to falls. 

Do not jump out of bed or chair, do not turn suddenly. 

Don’t let footwear, clothing, or environmental factors get in the way. 

Walk, move, do crosswords. 

Measure your blood pressure, height, communicate with other specialists, go to the ophthalmologist and for current medical examinations. 

Therapy II. Movement program: 

Physical development should always begin with a warm-up so that all organ systems of the body can prepare for safe execution. 

Perform mobilization exercises to ensure sufficient range of motion. 

The central goal is to develop coordination and balance, which must always be done in a safe environment. Progress from simple exercises to complex exercises so that the patient can adapt. Consider biomechanical features such as: the size and hardness of the support surface; the relationship between the center of gravity and the support surface (closer to and as much as possible in the middle); the relationship between the weight line and the support surface (the more perpendicular, the more secure the balance); in order to increase bone mass and slow down the decomposing processes, using the compression effect, depending on the condition, with weight load / own body weight load / partial body weight 

Always consider the contraindicated condition (OP stage III, IV). 

The development of balance cannot be achieved without adequate muscle strength, so special attention must be paid to the muscles of the lower limb (e.g.: quadriceps, glutes, tibialis anterior, triceps surae) and the muscles of the trunk (core). In addition to analytical strengthening, exercises with a closed kinematic chain and a functional approach should also be incorporated into the therapy, using both static and dynamic forms. By all means, strive for the appearance of the axial compressive force and approximation. It is also necessary to introduce exercises necessary for everyday forms of activity, such as: lifting from the ground, high up. 

During the therapy, it is worth using different types of support surfaces, try to imitate the sudden effects of the external environment in the gym with unstable devices, different directions and rhythms. 

The development of endurance can also be supported by a conscious increase in the daily activity level and an increasingly extended training program over time. 

At the end of the treatment, stretching and relaxing exercises and relaxation should also be performed.  Overall, therefore, try to apply the methods of complex mobility, endurance and strength development in a variety of ways, adapted to the individual, in order to achieve the best possible results.