Effectiveness of Clock Turn Strategy On Balance And Fall In Geriatric Population

METHOD OF DATA COLLECTION

The study is planned to be conducted in  Geriatric Rehabilitation Centre -  GREAT JUBILEE MEMORIAL, ALPHONSA ABHAYA BHAVAN, ALPHONSAPURAM, ARPOOKARA EAST PO, KOTTAYAM – 686008, KERALA. After receiving ethical committee consent, consent has to be obtained from the Geriatric Rehabilitation Centre and patients by explaining the purpose and relevance of the study.

 Medical data of the patients with a risk of falls will be collected, and a detailed cross-checking of the case sheet will be done with the geriatric assessment later on. Necessary information and the benefits that they receive will be passed on to the patients regarding the study. The patients willing to participate will be provided with a consent form for the same.

After getting the consent from willing patients, a Geriatric assessment will be taken with the help of the information gathered from the case sheets and information provided and elicited from the subjects using a structured geriatric assessment form.

Subjects who satisfy the inclusion criteria will be assessed using outcome measures: Berg Balance Scale (BBS), Timed Up and Go Test (TUG),  Functional Reach Test (FRT) Falls Risk Assessment Tool (FRAT).

After this the patients are segregated as Group A (Experimental group) and Group B (Control  group) randomly. The scores of the Berg Balance scale (BBS), Timed Up and Go Test (TUG), Functional Reach Test (FRT) Falls Risk Assessment Tool (FRAT) of each patient will be entered as pre data in the data collection sheet a day before the study.

The patients of Group A (Experimental group) will be given general information about the methods and the special interventions ‘Clock Turn Strategy’ (CTS) and Balance Strength Training (BST), and Group B (control group) about Dynamic Balance Training (DBT) and Balance Strength Training  (BST) to be used for this study.

§  BBS - scoring from 0-56 with higher scores indicating better balance, 14 tasks divided into- Sitting- 4 tasks, Standing- 5 tasks, Transfers -2 tasks, Balance challenges- 3 tasks. Interpretation: 41-56-low fall risk, 21-40 – Moderate fall risk, 0-20 High fall risk.

§  TUG - scoring by time (seconds) to complete task, cut-off Scores: Normative TUG Scoring for geriatric patients with balance problems and risk of falls. Time (Seconds): Low risk -Less than or equal to 12 seconds, Moderate risk -  13-19 seconds, High risk -Greater than or equal to 20 seconds.

§FRT - Normal:> 25.4cm (10 inches), Mild impairment: 15.2-25.5cm (6-10

inches),

Moderate impairment: 10-15.1cm ( 4-6 inches), Severe impairment:< 10 cm

(4inches)

§   Falls Risk Assessment Tool (FRAT), which can be used to predict who will

fall. The

FRAT has three sections: Part 1 - falls risk status; Part 2 – risk factor

checklist; and

GROUP A (EXPERIMENTAL GROUP)

In the experimental group time of 06 minutes are for patient instruction and for explaining the drawing of the clock turn pattern on the floor and about the exercises. Balance Strength Training (BST) and Clock turn Strategy (CTS), which starts with Warm-up exercise (5minutes), BST exercises (12 minutes), Clock turn strategy training (12 minutes), Cool-down exercise (5minutes). Amounting to a total time of 40 minutes.

WARM UP EXERCISES: (5 MINUTES)

•Neck side flexion  (2 repetitions on each side within the possible range)

•

• Neck rotation       (2 repetitions each, both sides within the possible range)

 

•Arm circles            (2 times clockwise and anti-clockwise for right and left)

•Trunk twisting       (2 repetitions each, anti-clockwise and clockwise)

•Hip circles              (2 repetitions each, anti-clockwise and clockwise)

•Marching and walking for 5 seconds

BALANCE STRENGTH TRAINING (BST) (12 MINUTES)

1 BALANCE EXERCISES:

• Single-Leg Stance  (2 sets): Stand on one leg. Eye open and eye closed.

•Foam Pad                (2 sets, 30 seconds). Stand on the Foam pad with eyes open and closed.

2. STRENGTH TRAINING EXERCISES:

Upper extremity:

•Arm Raises           (2 sets)

•Shoulder Presses  (2sets)

Lower Extremity:

•Squats                     (2 sets)

•Seated Marching   (2 sets)

3. CORE:

•Bridge                        ( 2 sets)

•Seated Leg Press      (2 sets)

CLOCK TURN STRATEGY (CTS): (12 MINUTES)

The participants perform a 180-degree turn into two parts, first from 12 to 3 O’clock and then from 3 to 6 O’clock in a clockwise wise, and then back from 6 O’clock to 3  o’clock, then to 12 in an anti-clockwise direction. Anti-clockwise direction from 12 to 9 O’clock and then from 9 to 6 O’clock, from there back to 9 O’clock and then to 12 O’clock in clockwise direction.

PROCEDURE OF CLOCK TURN STRATEGY:

The patient will be asked to stand at a point, a circle will be drawn, and a reading and footprint will be calibrated on the circle, similar to a clock. The patient will be asked to stand in the circle where 12 is indicated. The reading will be 12, 3, 6, and 9, similar to a clock. The participants perform a 180-degree turn into two parts, first from 12 to 3 O’clock and then from 3 to 6 O’clock, and then back from 6 O’clock to 3 o’clock, from 3   to 12, which would take around 2 minutes to be completed. A 2-minute rest will be given to the patient, and he will be allowed to rest and take water if required. After this, the patient will have to begin again from 12 in an anti-clockwise direction, 12 to 9 o’clock, and then from 9 to 6, from there back to 9, and then to 12 O’clock, which will again take 2 minutes for the process to complete. Patient has to repeat 2 sets in a clockwise wise and 2 sets in the anti-clockwise direction. As done earlier, a cool-down period of 2 minutes will be given. The patient will be asked about any difficulties or suggestions. The total period will be for 12 minutes.

COOL-DOWN: (5 MINUTES)

1. Static stretches for core muscles, Hamstrings, and quadriceps.

2.    Deep Breathing Exercises

DYNAMIC BALANCE TRAINING: (12 MINUTES)

1. Dynamic standing    (2 sets, 30 seconds stand with feet together, shoulder width apart. Shift weight from one leg to the other.

2. Obstacles course walking       (2 sets, 10 steps, navigate through small

Obstacles, change direction slowly.

3. Balance Reaches                    (2 sets, stand with feet shoulder width

Apart, reach for objects in different directions.

COOL-DOWN: (5 MINUTES)

1. Static stretches for core muscles, Hamstrings, and quadriceps

2. Deep Breathing Exercises

The time for Experimental (group-A ) is 40 minutes, out of which 06 minutes is for patient preparation and instruction, and the remaining 32 minutes for Treatment. Amounting to a total time of 40 minutes.

The time for Control (group – B) is 40 minutes, time of 06 minutes is for patient preparation and instruction, and the remaining time. 32 minutes is for Treatment, amounting to a total time of 40 minutes.

Treatment is administered thrice a week on alternate days for 08 weeks and a total of 24 sessions, both for experimental (group A) and Control (group B).

The scores of  Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Functional Reach Test (FRT) and Falls Risk Assessment Tool (FRAT) is taken a day before the commencement of treatment and a day after the completion of the treatment and is entered as pre and post data of each individual in the data collection sheet.

Statistical analysis of this data will be done subsequently to find the effectiveness of the Clock Turn Strategy on balance and falls in the geriatric population.

Part 3 – action plan. Total scoring is 20 : (Low risk: 5-11, Medium risk:12-15,

High risk:16 - 20)