Advances in the assessment and rehabilitation of older adult fallers

Student thesis: Doctoral ThesisDoctor of Philosophy


This thesis attempts to answer a number of questions regarding falls in older adults, both in terms of the assessment of individuals experiencing falls and their physiotherapy based rehabilitation. Firstly, an audit (Chapter 2) of a commonly used falls risk assessment tool (the Physiological Profile Assessment: PPA) was performed to determine the variability of component measures in differing age groups and to assess its clinical validity. A novel multi-task directed stepping test was designed and piloted to investigate changes in volitional directed stepping when performing complex spatial tasks (Chapter 3). Changes in prioritisation of postural tasks with older age were identified in healthy older adults compared to a healthy young cohort. A case control trial was performed to compare vestibular function in older adult fallers and age matched healthy individuals (Chapter 4). Both groups were compared to age matched patients with known peripheral vestibular dysfunction across a range of physical and questionnaire measures. It was identified that fallers have significantly higher proportions of vestibular dysfunction than age matched healthy older adults. A 2 arm RCT was performed to investigate the beneficial effects of a customised multi-sensory balance home exercise rehabilitation programme (vs. stretching) (Chapter 5). Older adult falters undertook an 8 week Otago programme combined with either a Multi-sensory or Stretching home exercise programme. Multi-sensory rehabilitation provided significant within group and larger between group changes in FGA scores and PPA falls risk. This study identifies the beneficial effects of multi-sensory rehabilitation in older adult fallers, when combined with the Otago exercise programme.
Date of Award2013
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMarousa Pavlou (Supervisor) & Sheila Kitchen (Supervisor)

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