Validation of Evidence-Based Fall Prevention Programs for Adults with Intellectual and/or Developmental Disorders: A Modified Otago Exercise Program

Abstract

IntroductionEvidence-based fall prevention (EBFP) programs significantly decrease fall risk, falls, and fall-related injuries in community-dwelling older adults. To date, EBFP programs are only validated for use among people with normal cognition and, therefore, are not evidence-based for adults with intellectual and/or developmental disorders (IDD) such as Alzheimer’s disease and related dementias, cerebral vascular accident, or traumatic brain injury.BackgroundAdults with IDD experience not only a higher rate of falls than their community-dwelling, cognitively intact peers but also higher rates and earlier onset of chronic diseases, also known to increase fall risk. Adults with IDD experience many barriers to health care and health promotion programs. As the lifespan for people with IDD continues to increase, issues of aging (including falls with associated injury) are on the rise and require effective and efficient prevention.MethodsA modified group-based version of the Otago Exercise Program (OEP) was developed and implemented at a worksite employing adults with IDD in Montana. Participants were tested pre- and post-intervention using the Center for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents Deaths and Injuries (STEADI) tool kit. Participants participated in progressive once weekly, 1-h group exercise classes and home programs over a 7-week period. Discharge planning with consumers and caregivers included home exercise, walking, and an optional home assessment.ResultsDespite the limited number of participants (n = 15) and short length of participation, improvements were observed in the 30-s Chair Stand Test, 4-Stage Balance Test, and 2-Minute Walk Test. Additionally, three individuals experienced an improvement in ambulation independence. Participants reported no falls during the study period.DiscussionPromising results of this preliminary project underline the need for further study of this modified OEP among adults with IDD. Future multicenter study should include more participants in diverse geographic regions with longer lengths of participation and follow-up.

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

“…There was no predefined duration for each item of the set of exercises, but all patients underwent an overall 45 min period training per day according to the same schedule. This schedule (see Table 2 ) was based on the Otago Exercise Program [ 34 ] and practice guidelines for the treatment of Parkinson's disease [ 39 , 40 ]. Patients did not wear shoes during the balance training.…”

“…This protocol was based on a simpler moving-platform protocol that had been previously exploited for testing and enhancing balance capacities in patients with PD and with vestibular deficit [ 31 – 33 ]. The outcome of the platform treatment was compared to that obtained in another group of matched PD patients by standardised and validated exercises aimed at training balance and dynamic balance [ 34 ]. Of note, these exercises contained no dynamic component (i.e., gait-related exercises) of balance training, contrary to [ 35 ].…”

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

“…This information is necessary to develop evidence-based geriatric TBI treatments and consensus management guidelines, including targeted fall prevention strategies. 225 Current TBI CDEs, such as the GCS or GOSE, may need to be modified (as has already been done for pediatric TBI [226][227][228] ); existing validated measures may be borrowed from other disciplines such as geriatric medicine, trauma surgery, or neurology; and some measures may need to be developed and validated de novo.…”

Bridging Aging and Intellectual/Developmental Disabilities in Research, Policy, and Practice

“…These include practices that increase safety, make environmental accommodations, and ensure a more positive quality of life (Jokinen et al, 2013). Other health-related adaptations include fall prevention programs, such as the modified Otago program, which show promise as a method of falls prevention for adults with I/DD (Renfro, Bainbridge, & Smith, 2016).…”