About the Fallproof! Program
Maintaining balance and mobility is essential to successful aging. In addition to making it possible to perform basic activities of daily living, such as rising from a chair or climbing a ﬂight of stairs, good balance forms the foundation on which a healthy and active lifestyle is built. Impairments in any of the multiple systems that contribute to postural stability not only limit the extend and type of physical activities we pursue as we grow older but also may result in
falls, leading to further restrictions in activity and profound psychological consequences. The strong association between impaired balance and mobility and greater risk of falling suggests the need for activity-based programs that speciﬁcally and systematically focus on improving the multiple dimensions of the balance system, particularly among the aging population.
The Fallproof! Program provides a structured approach to the design and implementation of a balance and mobility program that reduces many of the risk factors that contribute to falling. This program remains the ﬁrst published balance and mobility program to provide the fundamental concepts and practical skills needed to assess and design eﬀective activity programs for older adults. Participating in this program, with its balance speciﬁc exercises for the elderly, can facilitate the successful aging of the older adult.
The innovative balance and mobility program described here was developed at the Center for Successful Aging at California State University at Fullerton and is currently being implemented in numerous community-based and residential care settings with considerable success.
About the Author:
Debbie Rose, Professor in the Department of Kinesiology at California State University, Fullerton, Director of the Center for Successful Aging and Co-Director of the Fall Prevention Center of Excellence. She teaches and conducts research in the area of motor control and learning, and balance and mobility disorders, in particular. Dr. Rose is nationally and internationally recognized for her work in the area of fall risk reduction programming and has served as a research consultant to a number of different organizations and companies over the course of the previous 10 years. Her research in the area of fall risk reduction in the elderly has been published innumerous peer-reviewed publications. Her work in this area is also well supported by a number of research grants (exceeding $1.5 million). The innovative fall risk reduction program she developed was recently recognized by the National Council on Aging as one of seven programs nationwide that promotes a healthy, active lifestyle. She is a fellow of the Research Consortium of AAPHERD and past Executive Board Member of the North American Society for the Psychology of Sport and Physical Activity.
- 12 and 36 inch rulers
- 6 inch high bench (18’X18’ stepping surface)
- Masking tape
- 2 Airex® pads
- Length of non-slip material between pads if floor is not carpeted
Stand with feet together and eyes closed
Purpose: Assess ability to use somatosensory* cues to maintain upright balance while standing in a reduced base of support and vision unavailable. *The somatosensory system provides us with information about our spatial location and the movement of the body relative to the support surface (ground).
Safety Procedures: Position person being tested n a corner (If available) or close to a wall. Stand close to participant In case of loss of balance. Hold watch at eye level so participant and time can be monitored simultaneously.
Testing procedures: Demonstrate the correct test position and then instruct the participants to move the feet independently until they are together. If some participants are unable to achieve the correct position due to lower extremity joint problems, encourage them to bring their heels together even though the front of the feet are not touching. Have participants adopt a position that will ensure their safety as the arms are folded across the chest and they prepare to close the eyes. Begin timing as soon as the participant closes the eyes. (Instruct participants to open the eyes if they feel so unsteady that a loss of balance is imminent.)
Verbal instructions: “Bring your feet together, fold your arms across your chest, close your eyes when you are ready, and remain as steady as possible until I instruct you to open your eyes.”
Reach forward to retrieve an object (pencil) held at shoulder height with outstretched arm
Purpose: Assess ability to lean forward to retrieve an object without altering the base of support; measure of stability limits in a forward direction.
Equipment: Pencil and 12-inch ruler
Safety Procedures: Position person facing out from corner (If available) or close to wall. Position self to side of participant’s outstretched hand. Use arm holding pencil In horizontal position to manually assist client If a loss of balance occurs.
Testing procedures: Provide participant with sagittal view of desired movement. Instruct the participant to raise the preferred arm to 90o and extend it with fingers outstretched. Use the ruler to measure a distance of 10 inches from the end of the fingers of the outstretched arm. Hold the object (pencil) horizontally and level with the height of the participant’s shoulder. Be sure not to move the pencil once the Instructions are provided. Instruct the participant to reach forward, grasp the pencil, and return to the initial starting position without moving the feet, if possible. (It is acceptable to raise the heels as long as the feet do not move while reaching for the pencil.) If the participant is unable to reach the pencil within 2-3 seconds of initiating the forward lean, indicate to the participant that it is okay to move the feet in order to reach the pencil. Record the number of steps taken by the participant in order to retrieve the pencil.
Verbal instructions: “Try to lean forward to take the pencil from my hand and return to your starting position without moving your feet.” After allowing 2-3 seconds of lean time: “You can move your feet in order to reach the pencil.”
Turn 360 degrees in right and left directions
Purpose: Assess ability to turn in a full circle in both directions in the fewest number of steps without loss of balance
Safety Procedures: Position person being tested about one foot In front of a wall and facing you. Stand close enough during test to provide manual assistance If a loss of balance occurs.
Testing procedures: Verbally explain and then demonstrate the task to be performed, making sure to complete each circle in four steps or less and pause briefly between turns. Instruct the participant (who is facing you) to turn in a complete circle in one direction, pause, and then turn in a complete circle in the opposite direction. Count the number of full steps taken to complete each circle. Stop counting steps as soon as the participant is facing you after completing each turn. Allow for a small correction in foot position before a turn in the opposite direction is initiated.
Verbal instructions: “In place, turn around in a full circle, pause, and then turn in a second full circle in the opposite direction. Do not begin the full circle in the opposite direction until you are facing me.”
Step up onto and over a 6-inch bench
Purpose: Assess ability to control body in dynamic task situations; also a measure of lower body strength and bilateral motor coordination.
Equipment: 6-inch-high bench (18- by 18-inch stepping surface)
Safety Procedures: Position bench close to a wall and self on opposite side of bench. Adopt close supervisory position and move with participant as she/he steps up and over the bench In each direction.
Testing procedures: Verbally explain the movement to be performed before demonstrating the step up onto and over the bench (at normal speed) in both directions. Instruct the participant to step onto the bench with the right foot, swing the left leg directly up and over the bench, and step off the other side, then repeat the movement in the opposite direction with the left leg leading the action. Encourage the participant not to touch the wall or you to maintain balance during the test. During performance of the test item, watch to see that the participant’s trailing leg (a) does not make contact with the bench, or (b) swing around, as opposed to directly up and over, the bench. Verbally cue which leg should be leading the action just prior to the start of the movement In each direction.
Verbal instructions: “Step up onto the bench with your right leg, swing your left leg directly up and over the bench, and step off the other side. Repeat the movement in the opposite direction with your left leg as the leading leg.”
Purpose: Assess ability to dynamically control center of mass with an altered base of support
Equipment: Masking tape
Safety Procedures: Set the tandem walk line approximately 12 Inches away from a wall. Monitor the participant closely during performance of the test Item and walk forward with the client as he/she completes the test Item. Be ready to provide manual assist If a loss of balance occurs.
Testing procedures: Verbally explain and demonstrate how to perform the test item correctly before the participant attempts to perform it. Instruct the participant to walk on the line in a tandem position (heel-to-toe) until you tell him/her to stop. Allow the participant to repeat the test item one time if unable to achieve a tandem stance position within the first two steps. The participant may elect to step forward with the opposite foot on the second attempt. Score as interruptions any instances where the participant (a) takes one or more steps away from the line when performing the tandem walk or (b) is unable to achieve correct heel-to-toe position during any step taken along the course. Do not ask the participant to stop until 10 steps have been completed.
Verbal instructions: “Walk forward along the line, placing one foot directly in front of the other such that the heel and toe are in contact on each step forward. I will tell you when to stop.”
Stand on one leg
Purpose: Assess ability to maintain upright balance with a reduced base of support.
Safety Procedures: Position the person being tested In a corner (If one Is available) or close to a wall. Stand In a close supervisory position and on the side of the raised leg.
Testing procedures: Instruct the participant to fold the arms across the chest, lift one leg off the floor, and maintain balance until instructed to return the foot to the floor. Begin timing as soon as the participant lifts the foot from the floor. Stop timing if the legs touch, the raised leg contacts the floor, or the participant lifts the arms off the chest before the 20 seconds has elapsed. Allow the participant to perform the test a second time with the other leg raised if they touch down quickly on the first attempt or are unsure as to which leg should be raised.
Verbal instructions: “Fold your arms across your chest, lift one leg off the floor (without touching your other leg), and stand with your eyes open until I ask you to put your foot down.”
Stand on foam with eyes closed
Purpose: Assess ability to maintain upright balance while standing on a compliant surface with eyes closed
Equipment: Stopwatch; two Airex® pads, with a length of nonslip material placed between the two pads and an additional length of nonslip material between the floor and first pad if the test is being performed on an uncarpeted surface.
Safety Procedures: Position person to be tested In a corner (If one Is available) or close to a wall. After demonstrating the test Item, place the Airex® pads In front of the person If standing In a corner. Adopt a close supervisory position and hold watch at a height that allows for simultaneous monitoring of the participant’s arm position and eyes as well as the time. Instruct the participant to open the eyes if she/he feels so unsteady that a loss of balance is imminent. Manually assist the client off the foam pads if he/she appears unsteady.
Testing procedures: Following a demonstration of the task, instruct the participant to step up onto the foam pads without assistance, position the feet shoulder width apart, fold the arms across the chest, and close the eyes when ready. Begin timing as soon as the eyes close. Stop the trial if the participant (a) opens the eyes before the timing period has elapsed, (b) lifts the arms off the chest, or (c) loses balance and requires manual assistance to prevent falling. Instruct the participant to step forward off the foam at the completion of the test item. Provide manual assistance if needed.
Verbal instructions: “Step up onto the foam and stand with your feet shoulder-width apart. Fold your arms over your chest, and close your eyes when you are ready. I will tell you when to open your eyes.”
Two-footed jump for distance
(Do not Introduce this test Item if participant cannot perform test item 4 safely, has a diagnosis of osteoporosis, or complains of lower body joint pain. Score a zero on the test form and move immediately to test item #9.)
Purpose: Assess upper and lower body coordination and lower body power.
Equipment: 36-inch ruler; masking tape.
Safety Procedures: Position the person close to a wall and adopt a close supervisory position during the jump. Demonstrate the jump but do not jump more than twice the length of your own feet. Stand to the side of the participant and move forward as he or she jumps. Place your hand on the participant’s back to steady him/her as soon as the feet contact the ground following the jump.
Testing procedures: Instruct the participant to jump as far but as safely as possible while performing a two-footed jump (i.e., leave the floor with two feet and land on two feet). Demonstrate the correct movement prior to the participant performing the jump. Use the ruler to measure the length of the foot and then multiply by two to determine the ideal distance to be jumped. Observe whether the participant leaves the floor with both feet and lands with both feet. Position the ruler on the floor and on the opposite side of the participant and close to the wall so that you can glance down and see how far the participant jumped.
Verbal instructions: “Jump as far but (emphasize) as safely as you can. Try and make sure that both feet leave the floor and land at the same time.”
Walk with head turns
Purpose: Assess ability to maintain dynamic balance while walking and turning the head from side-to-side.
Equipment: Metronome set at 100 beats per minute
Safety Procedures: Position yourself directly behind the participant during the standing portion of the test Item so you can clearly see how far the head turns in either direction. Move to a position that Is behind and slightly to the side of the participant during the walking portion of this test Item. Stand close enough that you can provide manual assistance If the participant becomes unstable while walking.
Testing procedures: After first demonstrating the test item, ask the participant to practice turning the head in time with the metronome while standing in place. Watch to see that the participant Is turning the head the required distance to both sides and at the required speed. Provide verbal cueing If the participant Is not performing the head turns correctly. Once the participant appears to have the correct head turning rhythm (after no more than 4 to 6 head turns), Instruct him/her to begin walking forward. The head turns should be to the beat of the metranome. Begin counting steps as soon as the participant begins to walk forward with head turns. Observe whether the participant deviates from a straight path while walking or is unable to turn the head the required distance (In one or both directions) and/or at the required speed. If the participant Is unable to achieve the correct head turning rhythm while standing It Is highly unlikely he/she will be able to achieve It while walking (making the scoring of the test item a little easier). Also, In most cases, the steps will be synchronized with the head turns, making the counting of 10 steps easier.
Verbal instructions: “Begin turning your head to the beat of the metranome while standing In place. Start walking forward while turning your head from side-to-side with each beat of the metronome. I will tell you when to stop.”
Reactive postural control
Purpose: Assess ability to efficiently restore balance following an unexpected perturbation
Safety Procedures: Position the client approximately 3-4 feet In front of a wall. Stand Immediately behind the participant and adopt a wide base of support during the leaning portion of the test. Be ready to move your feet quickly once you release your hand and the participant begins to lose balance. Flex the elbow and release your hand as soon as you determine that the participant Is exerting sufficient pressure against your hand to require that he/she must step backwards one or more times to restore balance. This release should be unexpected, so do not prepare the participant for the moment of release or allow the participant to lean too far back onto your hand before releasing it.
Testing procedures: Instruct the participant to stand with his or her back to you. Extend your arm with the elbow locked and place the palm of your hand In the middle of the participant’s back. Instruct the participant to lean back slowly against your hand until you tell him or her to stop. Quickly flex your elbow until your hand is no longer in contact with the participant’s back at the moment you estimate that a sufficient amount of force has been applied to require a movement of the feet to restore balance. Try to quickly release your hand while you are still giving the verbal instructions. Verbal instructions: “Slowly lean back into my hand until I ask you to stop.”