The Backward Chaining MethodBackward chaining techniques in preventing falls are used to teach the older adult a task and to actively involve the older adult in the task. In this case, this is getting onto the floor safely and more importantly getting off the floor. They begin with the first step of the task sequence, then the second step and continue learning steps of the task in a sequential order until they can perform all steps in the task. In the knowledge that falls are the leading cause of deaths in over 75 year olds I know there are simple fitness solutions to create physical strength and power for a potential faller. After the first fall there is a 60% chance of falling again.
On and Off the FloorLets face it, if I tell Joan, my 88 year old that she will in fact exercise on a mat on the floor she will probably say no and not attend my sessions. Joan will automatically become fearful and the fear will stop her from participating in a strength and balance class for falls prevention.
What does getting on the floor look like?Look at rising out of a chair, turning around and stepping forward to kneel on the floor, both knees down, walk into a box position, turn on your side and sit on your hip and then slide to lie down. Easy!
Break it downLook at the biomechanics. Look how you can work around each of the moves and build strength.
- Sit to stand challenges vestibular, co-ordination, postural hypotension. It addresses thigh power and lateral thoracic breathing (breathing through the ribs).
- Stepping forward and slowly stepping on the spot addresses cardiovascular fitness and proprioception. In other words all of it is strong and designed for the body to make improvements.
- Lunge with strongest leg forward towards chair. LUNGE! Where do we begin or the importance of lunges?
- Knees to floor and knee walk into a box position targeting balance and bone loading, leg power.
- Side sitting position bringing in obliques, balance, co-ordination and shoulder stabilisation.
- Hold this to avoid postural blood pressure changes, then slide into a side lying position ready for floor exercise (but that’s another blog).
Then simply reverse the whole process.The method reinforces all the components so that the older adult doesn’t feel out of control. It may take a while, it may needs more hands at first, or it may change, if not save a life. The entire component may take your client weeks or even months to successfully complete this. Your client will thank you for it. When they say never, it may actually mean they do not know what they do not know yet. I have experienced a few challenges with this over the years probably 3 clients’ fear took over their capability, as for the rest?…. They are still steady on their feet and not many recordings of falls. We can not prove that by working on solutions like backward chaining, stops people f falling. No-one has a crystal ball. We can say that hundreds of clients have had life changing experiences working through this method. Take a look at some of our films and hear it straight from them.
Working with the older population is rewarding and challenging but always completely wonderful.