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    Careplan

    Balance Impairment, Adult

    Dec.13.2021

    Balance Impairment (Adult Inpatient)

    Clinical Description

    • Care of the hospitalized patient experiencing an inability to safely or comfortably maintain upright control of the body’s center of gravity relative to the base of support in the given environment.

    Key Information

    • Balance is a complex process involving interactions between multiple body systems, including musculoskeletal, neurologic and sensory systems, such as vestibular, visual and somatosensory systems. Assessment and treatment should address the multifactorial components of balance.
    • Poor balance confidence may lead to reduced participation in functional activities. This reduced participation and sedentary behavior may lead to decreased strength, range of motion and endurance, which can further impair balance. It is important to address limitations in balance confidence.
    • Deficits in attention, judgment, memory and cognition directly influence balance abilities, as well as hinder motor learning processes needed to relearn balance skills.
    • High-risk medications related to balance problems include antidepressant, antianxiety, antihistamine, antiepileptic, narcotic, sedative, insulin or oral hypoglycemic, hypnotic and cardiovascular agents, as well as polypharmacy.

    Clinical Goals

    By transition of care

    A. The patient will achieve the following goals:

    • Improved Balance and Postural Control

    B. Patient, family or significant other will teach back or demonstrate education topics and points:
    • Education: Overview
    • Education: Self-Management
    • Education: When to Seek Medical Attention

    Correlate Health Status

    • Correlate health status to:

      • history, comorbidity
      • age, developmental level
      • sex, gender identity
      • baseline assessment data
      • physiologic status
      • response to medication and interventions
      • psychosocial status, social determinants of health
      • barriers to accessing care and services
      • health literacy
      • cultural and spiritual preferences
      • safety risks
      • family interaction
      • plan for transition of care

    Balance Impairment

    Signs/Symptoms/Presentation

    • dizziness
    • fear of falling
    • hearing impairment
    • history of fall
    • postural control impaired
    • reliance on arms and hands for support
    • restricts movement to avoid threats to balance
    • unsteady gait
    • vertigo
    • visual impairment
    • wide base of support

    Problem Intervention

    Optimize Balance and Safe Activity

    • Evaluate balance skills using a validated tool.
    • Screen for, and address, underlying impairments, such as muscle weakness, sensorimotor, cognitive and postural control deficits.
    • Promote participation in regular daily and physical activity to minimize decline associated with inactivity; provide adaptations as needed.
    • Recommend and facilitate environmental modifications to promote independence and safety, such as grab bars or bath seat; consider a home assessment.
    • Facilitate safe surroundings; keep needed items within reach, such as call light and personal belongings.
    • Provide a safe, barrier-free, uncluttered environment that promotes optimal level of function; ensure adequate lighting, especially at night.
    • Train in and reinforce use of appropriate orthoses, adaptive equipment or assistive devices (e.g., ankle foot orthosis, rolling walker, long-handled adaptive equipment).
    • Facilitate therapeutic interventions, such as balance training, muscle strengthening, trunk training, virtual reality and tai chi, yoga or Pilates exercise.
    • Address sitting balance impairments with interventions, such as supportive seating, positioning devices and therapeutic exercise.

    Associated Documentation

    • Activity Management
    • Adaptive Equipment Use
    • Safety Promotion/Fall Prevention
    • Self-Care Promotion

    Education

    CPG-Specific Education Topics

    Overview

    • description

    • signs/symptoms

    Self-Management

    • activity

    • assistive/adaptive devices

    • home safety

    • medication management

    • provider follow-up

    • rehabilitation therapy

    When to Seek Medical Attention

    • unresolved/worsening symptoms

    General Education Topics

    General Education

    • admission, transition of care

    • orientation to care setting, routine

    • advance care planning

    • diagnostic tests/procedures

    • diet modification

    • opioid medication management

    • oral health

    • medication management

    • pain assessment process

    • safe medication disposal

    • tobacco use, smoke exposure

    • treatment plan

    Safety Education

    • call light use

    • equipment/home supplies

    • fall prevention

    • harm prevention

    • infection prevention

    • MDRO (multidrug-resistant organism) care

    • personal health information

    • resources for support

    Population-Specific Considerations

    Geriatric

    • Balance disorders are a common cause of falls in older adults and can lead to injury, as well as loss of function, independence and quality of life.
    • Gradual decline of vestibular and sensory function with normal aging, sarcopenia and slowing of motor responses contribute to balance impairments. Treatment to improve balance in older adults is imperative to address these declines.

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    Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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