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In-Seivice Talking Points

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1. Elueily peisons with impaiiments in cognition anuoi executive function aie
at an incieaseu iisk foi falls.
a. Twice as likely to expeiience falls than auults without cognitive
impaiiment.
b. 7u-8S% of patients with cognitive impaiiment uementia will fall eveiy
yeai.
c. (Muir, Gopaul & Odasso, 2012)
u. (Shaw, 2002)
2. uait is no longei iegaiueu as an automateu motoi task. Recent stuuies show
it involves an inteiaction of executive function, the ability to inteipiet multi-
moual cues anu attention to task.
a. uait = Executive Function + }uugment + Attention
b. (Amboni, Barone & Hausdorff, 2013)
S. A combination of maintaining physical function ANB using stiategies to
hampei uecline in cognition can significantly ieuuce fall iisk among oluei
auults.
a. Reuuction in Fall Risk = Physical Rehabilitation + Cognitive-Linguistic
Stiategies
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As theiapists, oui task is twofolu: 1) Pievention & 2) Inteivention
Pievention:
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Questions to ask youiself when scieening a patient.
1. Boes this patient have a histoiy of falling.
2. Boes this patient engage in iisky behavioi. (i.e. not using walkei
oi waiting foi assistance, impulsivity etc.)
S. Boes this patient exhibit uifficulty paying attention, iecalling basic
infoimation
Intervention: The role of the Speech-Language Pathologist
1. Determine specific areas of cognitive impairment that maybe affecting safety
& Activities of Daily Living
a. Attention
b. Visuospatial Skills
c. Language
d. Memory
2. Develop and implement cognitive linguistic strategies to improve function.
a. Visual cues
b. Memory strategies (i.e. notebook, calendar etc.)
c. Environmental Modifications
d. Training activities that encourage neuroplasticity
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References
Amboni, M., Barone, P., & Hausdorff, J. (2013). Cognitive contributions to gait and falls:
Evidence and implications. Movement Disorders, 28(11), 1520-1533. doi:
10.1002/mds.25674
Guo, J.-L., Tsai, Y.-Y., Liao, J.-Y., Tu, H.-M. and Huang, C.-M. (2013), Interventions to
reduce the number of falls among older adults with/without cognitive impairment:
an exploratory meta-analysis. International Journal Geriatric Psychiatry.
doi: 10.1002/gps.4056
Makizako H, Shimada H, Doi T, Park H, Yoshida D, Uemura K, Tsutsumimoto K, Liu-
Ambrose T, Suzuki T. Poor balance and lower gray matter volume predict falls in
older adults with mild cognitive impairment. BMC Neurology. 2013;13:102-112.
Muir, S., Gopaul, K., & Odasso, M. (2012). The role of cognitive impairment in fall risk
among older adults: a systematic review and meta-analysis. Age Ageing, 41(3),
299-308.
Shaw, F. (2002). Falls in cognitive impairment. Clinics in geriatric medicine, 18(2), 159-
173.