#PhysioTalk Transcript

Healthcare social media transcript of the #PhysioTalk hashtag.
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physiotalk @physiotalk
Good evening and welcome to tonights #physiotalk with @agilecsp on Postural Stability in Practice
physiotalk @physiotalk
Taking part tonight are @agilecsp of course but also look out for tweets from the team behind tonights chat @sarahdebiase @ListonMatt @sarahphysiomom @MarousaPavlou – welcome! #physiotalk
AGILE @AGILECSP
RT @physiotalk: Taking part tonight are @agilecsp of course but also look out for tweets from the team behind tonights chat @sarahdebiase @…
physiotalk @physiotalk
Before we get started with the questions – please say hello, where you are tweeting from and if you are ready for Christmas! #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
Starting now #physiotalk
AGILE @AGILECSP
RT @physiotalk: Good evening and welcome to tonights #physiotalk with @agilecsp on Postural Stability in Practice
Justine Musiime - MSc MPH MCSP @JustineMusiime
@AGILECSP @thecsp @thecspstudents
Anna Spiteri @spiteri_anna
Hello everyone. Looking forward to tonight’s chat. I’m tweeting from London. In the background supporting the @physiotalk team. #physiotalk
Janet Thomas @JanetThomas47
@physiotalk Hi I'm on the @physiotalk account tonights from a chilly Edinburgh. Cakes iced, Mince pies made and tree is purchased if not up yet! #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@physiotalk Hello! Susanne in Coventry - @AGILECSP Secretary! #physiotalk
Sarah De Biase @sarahdebiase
RT @physiotalk: Taking part tonight are @agilecsp of course but also look out for tweets from the team behind tonights chat @sarahdebiase @…
Katie Knapton @physiokatiek
@physiotalk @AGILECSP @sarahdebiase @ListonMatt @sarahphysiomom @MarousaPavlou Katie Joining from West Sussex #physiotalk
AGILE @AGILECSP
@physiotalk Hello, tweeting from my personal account too @lynseyferguson6 from Dundee. Absolutely not Christmas ready 🎄 #Physiotalk
IPTOP @IPTOPphysio
Why not take part in tonights #physiotalk tweetchat with our members @agilecsp Starting now!
Laura Cook @LauraDianeCook
RT @JustineMusiime: Starting now #physiotalk
Katie Knapton @physiokatiek
@physiotalk @AGILECSP @sarahdebiase @ListonMatt @sarahphysiomom @MarousaPavlou No Christmas happening yet just managed to get 🎄up #physiotalk
Sarah De Biase @sarahdebiase
@physiotalk Joining from rainy blustery yorkshire as @AGILECSP chair #physiotalk
AGILE @AGILECSP
RT @IPTOPphysio: Why not take part in tonights #physiotalk tweetchat with our members @agilecsp Starting now!
Catherine Bowdler @clbowdler
@physiotalk Evening! Catherine from Chester. All ready to go for Christmas here. #physiotalk
physiotalk @physiotalk
@sarahdebiase @AGILECSP Welcome! Thanks for suggesting tonights #physiotalk tweetchat
physiotalk @physiotalk
@OSlatarra Welcome! Please make sure you put #physiotalk in your tweets so we can follow them
Claire O' Connell @ClaireOCPhysio
@physiotalk Hello. Tweeting from Bristol. For the first year ever, I have bought all my Christmas presents (I am usually a Christmas Eve shopper!) #physiotalk
physiotalk @physiotalk
Don’t forget to add #physiotalk to all your comments tonight.
Laura Cook @LauraDianeCook
@physiotalk #physiotalk
physiotalk @physiotalk
A reminder to you all! Please put #physiotalk in your tweets so that we can all follow your tweets
physiotalk @physiotalk
Time to get started with our questions tonight There are quite a few tweets being sent without the #physiotalk hashtag though - PLEASE remember to put them in all of your tweets
Carmichael Clinic @CarmichaelClini
@physiotalk #physiotalk checking in from Knutsford
AGILE @AGILECSP
RT @physiotalk: Time to get started with our questions tonight There are quite a few tweets being sent without the #physiotalk hashtag th…
physiotalk @physiotalk
A reminder that to tweetchat you need to search for the hashtag #physiotalk to see all the tweets and reply using the hashtag each time (Yes – even if you are replying to one of our tweets!)
AGILE @AGILECSP
RT @physiotalk: A reminder that to tweetchat you need to search for the hashtag #physiotalk to see all the tweets and reply using the hasht…
physiotalk @physiotalk
Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your assessment and management of postural instability? #physiotalk
Anne💙Bruton @AnnieBruton
RT @physiotalk: Good evening and welcome to tonights #physiotalk with @agilecsp on Postural Stability in Practice
Laura Cook @LauraDianeCook
@physiotalk Sorry I forgot again 🤦‍♀️#physiotalk
AGILE @AGILECSP
Come on AGILE committee we are so far the worst offenders for missing the #physiotalk 😂
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk Thanks for the reminder #physiotalk
AGILE @AGILECSP
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
Joanna Cavill @JoannaCavill
@physiotalk I'm in Devon. All my Christmas shopping finished and cards written and posted! #physiotalk
physiotalk @physiotalk
Lovely to have our Irish friends joining us. Don’t forget the hashtag #Physiotalk
Sarah De Biase @sarahdebiase
@ListonMatt just in case...
physiotalk @physiotalk
@AGILECSP A hint - I have it copied so all I need to do is Control + V to paste it in every time! #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
Matt Liston @ListonMatt
@physiotalk Evening! Twittering from a nondescript tonbridge here, I am Christmas ready having eaten all the mince pies! #physiotalk
Sarah De Biase @sarahdebiase
@CarmichaelClini search for #physiotalk for questions and chat
AGILE @AGILECSP
RT @physiotalk: @AGILECSP A hint - I have it copied so all I need to do is Control + V to paste it in every time! #physiotalk
AGILE @AGILECSP
RT @ListonMatt: @physiotalk Evening! Twittering from a nondescript tonbridge here, I am Christmas ready having eaten all the mince pies! #p
physiotalk @physiotalk
Lovely to have you joining us! Don’t forget the hashtag #Physiotalk
physiotalk @physiotalk
Welcome! #physiotalk
physiotalk @physiotalk
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
sarah lambert @sarahphysiomom
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
Susanne Arnold (Finnegan) @FinneganSusanne
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
Grace Harrington-Lambert @GraceHL_Physio
@physiotalk Hi! I’m from Stoke & I’m almost done, I hope! #physiotalk
Sarah De Biase @sarahdebiase
@MarousaPavlou just checking you are with us and able to follow? #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk Static... Dynamic.. Seated.. Standing.. #physiotalk
physiotalk @physiotalk
@CarmichaelClini @AGILECSP @sarahdebiase @ListonMatt @sarahphysiomom @MarousaPavlou You need to search for the #physiotalk hashtag and then answer any questions There is a lot of chat about Christmas trees and mince pies at the moment :)
Catherine Bowdler @clbowdler
@physiotalk Postural stability is a crossover function of musculoskeletal, neurology (afferent pathways) and vestibular apparatus. I try to assess all three components (big focus on history) when assessing falls patients. #physiotalk
physiotalk @physiotalk
RT @clbowdler: @physiotalk Postural stability is a crossover function of musculoskeletal, neurology (afferent pathways) and vestibular appa…
Janet Thomas @JanetThomas47
@JustineMusiime @physiotalk Now that's a thing I always have a 'thing' about Are we ever truly static? #physiotalk
Anna Spiteri @spiteri_anna
This is what we are talking about right now. Pop along if you can @BEHMHTNHS #physiotalk. Relevant for older people mental and physical health wards
IPTOP @IPTOPphysio
@physiotalk Is postural stability more than balance though? So many factors to think about #physiotalk
AGILE @AGILECSP
@JanetThomas47 @JustineMusiime @physiotalk I guess not while we are living .... #physiotalk
AGILE @AGILECSP
RT @IPTOPphysio: @physiotalk Is postural stability more than balance though? So many factors to think about #physiotalk
physiotalk @physiotalk
@sarahphysiomom Can you put #physiotalk rather than @physiotalk in your tweets Its the hashtag that we need to follow Thanks!
Justine Musiime - MSc MPH MCSP @JustineMusiime
@JanetThomas47 @physiotalk ? might be a technical term. It is more like 'equilibrium'?Face with tears of joy #physiotalk
physiotalk @physiotalk
#physiotalk
Sarah De Biase @sarahdebiase
#physiotalk and person specific ie if can’t stand unsupported won’t ask to do multitasking challenge in dynamic state in initial assessment
Janet Thomas @JanetThomas47
@JustineMusiime @physiotalk So our bodies are in 'equilibrium' rather than responding to an external stimulus? #physiotalk
physiotalk @physiotalk
Great use of hashtag #physiotalk after a slow start. Thank you everyone! #physiotalk
AGILE @AGILECSP
RT @sarahdebiase: #physiotalk and person specific ie if can’t stand unsupported won’t ask to do multitasking challenge in dynamic state in…
Justine Musiime - MSc MPH MCSP @JustineMusiime
@JanetThomas47 @physiotalk True #physiotalk
Marousa @MarousaPavlou
@JanetThomas47 @JustineMusiime @physiotalk Static balance refers to maintaining an upright position without a change in base of support thus from a postural control point of view yes but even in this static position there is a small degree of sway even in healthy individuals. #physiotalk
physiotalk @physiotalk
@sarahdebiase Would you all say that you assess in this way - increasing the level of challenge if the person is able to cope ?safely / well with the previous? #physiotalk
physiotalk @physiotalk
RT @MarousaPavlou: @JanetThomas47 @JustineMusiime @physiotalk Static balance refers to maintaining an upright position without a change in…
physiotalk @physiotalk
Onto our next question #physiotalk
@UniHertsPhysio @UniHertsPhysio
RT @physiotalk: Q1) What do you understand postural stability (PS) to encompass/mean and what factors of PS do you use to guide your asse…
Justine Musiime - MSc MPH MCSP @JustineMusiime
RT @clbowdler: @physiotalk Postural stability is a crossover function of musculoskeletal, neurology (afferent pathways) and vestibular appa…
physiotalk @physiotalk
Q2) What are the barriers/ challenges to improving postural stability in older adults? #physiotalk
sarah lambert @sarahphysiomom
@lynseyferguson6 @physiotalk I like this definition. Ultimately it fulfils a functional task. It enables task fulfilment, whether through movement or providing stability for other tasks. #physiotalk
Janet Thomas @JanetThomas47
@MarousaPavlou @physiotalk @JustineMusiime I think that's where my issue is - that element of sway always present. I use the term but with that caveat! #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
#physiotalk
Katie Knapton @physiokatiek
@physiotalk @sarahdebiase Depends on level of function required but like to think push within assessed limits for optimum outcome #physiotalk
AGILE @AGILECSP
RT @physiotalk: Q2) What are the barriers/ challenges to improving postural stability in older adults? #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q2) What are the barriers/ challenges to improving postural stability in older adults? #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
RT @physiotalk: Q2) What are the barriers/ challenges to improving postural stability in older adults? #physiotalk
Katie Knapton @physiokatiek
@physiotalk @AGILECSP Fear #physiotalk
physiotalk @physiotalk
RT @sarahphysiomom: @lynseyferguson6 @physiotalk I like this definition. Ultimately it fulfils a functional task. It enables task fulfilmen…
Janet Thomas @JanetThomas47
@physiokatiek @physiotalk @AGILECSP You best me to it! Just about to answer fear... #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@physiotalk Safety concerns/confidence/fear #physiotalk
physiotalk @physiotalk
@MarousaPavlou @IPTOPphysio Lovely to have you joining us! Don’t forget the hashtag #Physiotalk not the @Physiotalk. This is so your comments are captured on the chat and included in the transcript. #physiotalk
Marousa @MarousaPavlou
@JanetThomas47 @JustineMusiime @physiotalk Yes. Even when responding to small degree perturbations we will normally use an ankle or hip strategy and this will still be considered static balance as there is no change in base of support #physiotalk
IPTOP @IPTOPphysio
@MarousaPavlou @physiotalk Would you use the terms interchangeably? #physiotalk
Matt Liston @ListonMatt
@clbowdler @physiotalk Indeed, but don’t forget the efferents! #physiotalk
Chloe Dooley @chloedooley99
@physiotalk Compliance with exercise programmes, fear of falling and belief that it can’t be improved as it’s ‘normal when you get older’ #physiotalk
Katie Knapton @physiokatiek
@physiotalk @AGILECSP Adherence to programme Accessibility to treatment Coordinated care with drug and other condition management #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk that’s why we are here tonight - trying to find out how #physios understand, assess and treat postural stability (or instability)... @AGILECSP @ListonMatt @MarousaPavlou eager to know the approaches taken abs baseline level of knowledge /skill in ax/rx older people
sarah lambert @sarahphysiomom
@physiotalk I assess muscle power and co-ordination, vestibular function, proprioception, and if indicated cognition #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
RT @physiotalk: Q2) What are the barriers/ challenges to improving postural stability in older adults? #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@lynseyferguson6 @physiotalk Totally agree @lynseyferguson6 #physiotalk
physiotalk @physiotalk
RT @chloedooley99: @physiotalk Compliance with exercise programmes, fear of falling and belief that it can’t be improved as it’s ‘normal wh…
physiotalk @physiotalk
#physiotalk
physiotalk @physiotalk
#physiotalk
Susanne Syme @SusanneSyme
@physiotalk #physiotalk
physiotalk @physiotalk
@lynseyferguson6 How much is fear from the clinician I wonder? #physiotalk
AGILE @AGILECSP
RT @sarahdebiase: #physiotalk that’s why we are here tonight - trying to find out how #physios understand, assess and treat postural stabil…
physiotalk @physiotalk
RT @sarahdebiase: #physiotalk that’s why we are here tonight - trying to find out how #physios understand, assess and treat postural stabil…
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk Pathophysiology #Physiotalk
IPTOP @IPTOPphysio
RT @sarahdebiase: #physiotalk that’s why we are here tonight - trying to find out how #physios understand, assess and treat postural stabil…
ElaineEphysio @eephysio1
@physiotalk Patient fear, engagement, challenging the perception that changes in balance/ mobility/ falls risk are normal parts of the ageing process #physiotalk
Matt Liston @ListonMatt
@physiotalk @lynseyferguson6 i think that's a very good point. You need to feel comfortable and confident making people feel a little unsteady... but keep an eye on what you are challenging and what their response to that challenge is #physiotalk
Claire O' Connell @ClaireOCPhysio
@physiotalk Trying to teach patients that it can be improved.. Most refer to it as a symptom of ageing.. Need time to educate and teach. #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@lynseyferguson6 @physiotalk Agree again - as your clinical experience increases and you get to know your patient/client you get a feel for when to try a bit more #physiotalk
physiotalk @physiotalk
RT @ListonMatt: @physiotalk @lynseyferguson6 i think that's a very good point. You need to feel comfortable and confident making people fee…
physiotalk @physiotalk
Time for our next question #physiotalk
Claire O' Connell @ClaireOCPhysio
@physiotalk @lynseyferguson6 I think fear from the clinician will occur with limited experience in the area. Fear will reduce with experience #physiotalk
sarah lambert @sarahphysiomom
@physiotalk @sarahdebiase Yes, gradually increase the challenge. But I do find it hard to identify sensitive enough tests with my higher functioning patients #physiotalk
physiotalk @physiotalk
Q3) How do you measure the effectiveness of your postural instability intervention? #physiotalk
Catherine Bowdler @clbowdler
@physiotalk Two main challenges: comprehensive assessment of all systems contributing to postural stability, and person centred functional strength and balance exercise programmes. #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q3) How do you measure the effectiveness of your postural instability intervention? #physiotalk
@UniHertsPhysio @UniHertsPhysio
RT @physiotalk: Q3) How do you measure the effectiveness of your postural instability intervention? #physiotalk
AGILE @AGILECSP
RT @physiotalk: Q3) How do you measure the effectiveness of your postural instability intervention? #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @FinneganSusanne @physiotalk And I think how much you see them in their own environment as well. (This can be a good or bad thing!) #physiotalk
Claire O' Connell @ClaireOCPhysio
@physiotalk @sarahdebiase Yes I will always challenge, find what starts to challenge them and then work from there #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@physiotalk I am planning to update our @AGILECSP outcome measure resource very soon so am very keen to hear what outcome measures people are using in the real world #physiotalk
Laura Cook @LauraDianeCook
@physiotalk Clinicians feeling confident when patients feel unsteady #physiotalk
physiotalk @physiotalk
RT @FinneganSusanne: @physiotalk I am planning to update our @AGILECSP outcome measure resource very soon so am very keen to hear what outc…
Marousa @MarousaPavlou
@ClaireOCPhysio @physiotalk Completely agree. Many patients will say normal to stand on their heels and sway but when you retrain CoG and postural alignment and their sway decreases they can see it is not a normal function of age. Real feedback = important enemy of education #physiotalk
physiotalk @physiotalk
@FinneganSusanne @AGILECSP So would you like people to tweet out what measures they are using? #physiotalk
sarah lambert @sarahphysiomom
@physiotalk Using outcome measures are vital, in this domain I find subjective measures as useful as objective markers because fear of falling is such an influential factor. #physiotalk
IPTOP @IPTOPphysio
What outcome measures are you using for postural instability? #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@physiotalk @AGILECSP Yes please 👌👌 #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk #physiotalk Outcome measures at baseline and at the end of the intervention e.g OTAGO, Berg Balance scale, Elderly mobility scale etc
IPTOP @IPTOPphysio
@sarahphysiomom @physiotalk What do you use for this - FES-I or something else? #physiotalk
physiotalk @physiotalk
RT @FinneganSusanne: @physiotalk @AGILECSP Yes please 👌👌 #physiotalk
The WeStretch App @We_Stretch
What do you notice the most? We found it is the fear of starting it- they don't know what will happen, even if it's for the better, so they don't start.
ElaineEphysio @eephysio1
@LauraDianeCook @physiotalk And seeking to gain patient trust and build their confidence so they can see that this can be a modifiable and improvable thing! #physiotalk
Catherine Bowdler @clbowdler
@physiotalk In my last job I used Tinetti and the FES-1 #physiotalk
Sarah De Biase @sarahdebiase
#phyiotalk clinician fear needs to be understood - is this indicative of confidence & competence issues in assessing & treating? Even newly qualified #ohysios need to assess PS effectively- its a skill set needed in daily practice w older people irrespective of years experience.
physiotalk @physiotalk
RT @sarahphysiomom: @physiotalk Using outcome measures are vital, in this domain I find subjective measures as useful as objective markers…
Marousa @MarousaPavlou
@sarahphysiomom @physiotalk @sarahdebiase Mini-best is the strongest one available currently. Sensor based systems are gaining momentum but mini-best is free to download, has clear instructions for use and validated in older adults. Particularly good for higher level individual. #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
#physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
RT @IPTOPphysio: What outcome measures are you using for postural instability? #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk What do we need to do to support #physios to not approach postural stability assessments with fear? Tell us @AGILECSP
physiotalk @physiotalk
RT @JustineMusiime: @physiotalk #physiotalk Outcome measures at baseline and at the end of the intervention e.g OTAGO, Berg Balance scale,…
Sarah De Biase @sarahdebiase
RT @physiotalk: Q3) How do you measure the effectiveness of your postural instability intervention? #physiotalk
Matt Liston @ListonMatt
@sarahdebiase @AGILECSP @MarousaPavlou #physiotalk
Janet Thomas @JanetThomas47
@physiotalk @FinneganSusanne @AGILECSP Berg mainly but also individual elements of it and Turn 180 Not used Best or MiniBest and would like to know if others are #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@lynseyferguson6 @physiotalk @AGILECSP I wish 🤪🤪🤪#physiotalk
physiotalk @physiotalk
#physiotalk
Marousa @MarousaPavlou
@sarahphysiomom @physiotalk Absolutely! Recent data we are currently writing up shows balance confidence or lack of it to be a significant contributor to functional gait assessment and mini best performance. #physiotalk
sarah lambert @sarahphysiomom
@IPTOPphysio @physiotalk Yes, FES-1 , Dynamic gait index and Tinetti for lower level patients. Just been introduced to the mini besTest. Haven’t had a chance to use this but cover more domains than the others #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
RT @MarousaPavlou: @sarahphysiomom @physiotalk @sarahdebiase Mini-best is the strongest one available currently. Sensor based systems are g…
physiotalk @physiotalk
@MarousaPavlou @sarahphysiomom @sarahdebiase What would you define as a high level? I think choosing for different people is always a challenge? #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@FinneganSusanne @physiotalk @AGILECSP Berg Otago TUSS TUSS Tog Rhombergs #physiotalk
physiotalk @physiotalk
RT @MarousaPavlou: @sarahphysiomom @physiotalk @sarahdebiase Mini-best is the strongest one available currently. Sensor based systems are g…
Claire O' Connell @ClaireOCPhysio
@physiotalk Im in the acute so will focus on 180 turn/TUS for quick Ax. If able, would use tinetti. Use FES-1 if appropriate #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk Woaw @lynseyferguson6 I’d like to understand more about this suspicion. Linked to protectionism around roles ie vestibular versus neuro versus older people specialism? Or absence of role modelling /readership in this area historically in teams?
Sarah De Biase @sarahdebiase
RT @MarousaPavlou: @ClaireOCPhysio @physiotalk Completely agree. Many patients will say normal to stand on their heels and sway but when yo…
Claire O' Connell @ClaireOCPhysio
@lynseyferguson6 @sarahphysiomom @IPTOPphysio @physiotalk Think tinetti works for the patients I see. Most struggle with the 2nd half of Berg #physiotalk
Laura Cook @LauraDianeCook
@physiotalk Outcome measures I used Berg, Tinetti and FES-I. Also fear of falling hierarchy linked to goal setting #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @sarahphysiomom @IPTOPphysio @physiotalk And we like a Berg in Fife! I do wonder why we veer to particular measures? Familiarity? I used Tinetti in my research though :) #physiotalk
Matt Liston @ListonMatt
@lynseyferguson6 @LauraDianeCook @physiotalk Totally! Always start easy and gradually increase challenge.... If they can't do the simpler things then there isn't really a need to go further than that in the assessment. You have stuff to get working on...#physiotalk
Katie Knapton @physiokatiek
@MarousaPavlou @sarahphysiomom @physiotalk @sarahdebiase Will look into this I am outpatient MSK so would like a good measure for my elderly patients #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@Physiomark2 @MarousaPavlou @physiotalk @JanetThomas47 Too right🤣🤣🤣 #physiotalk
Claire O' Connell @ClaireOCPhysio
@IPTOPphysio @sarahphysiomom @physiotalk Yes we use FES-1 when appropriate. Unfortunately not always seen as a vital part of an assessment in the acute but would plan to use it for whoever sees the patient next #physiotalk
physiotalk @physiotalk
Time for the next question #physiotalk
physiotalk @physiotalk
Q4) What are the gaps in your knowledge, skills and/ or services in terms of postural instability management in older adults? #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q4) What are the gaps in your knowledge, skills and/ or services in terms of postural instability management in older adu…
Justine Musiime - MSc MPH MCSP @JustineMusiime
RT @sarahphysiomom: @physiotalk Using outcome measures are vital, in this domain I find subjective measures as useful as objective markers…
Susanne Arnold (Finnegan) @FinneganSusanne
RT @physiotalk: Q4) What are the gaps in your knowledge, skills and/ or services in terms of postural instability management in older adu…
Susanne Syme @SusanneSyme
@physiotalk Is there an outcome measure that captures the fear of someone having a fall in care providers ( carers, family, ward staff) Improved PS only results in improved outcomes if their carers believe it has happened #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @sarahdebiase But they have to wobble to improve! #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk Anyone using miniBestest? Likely need a suite of tools &/- agree need narrative of what observe when assessing or what person feels when doing to draw on wider domains of postural stability
Marousa @MarousaPavlou
@ClaireOCPhysio @IPTOPphysio @sarahphysiomom @physiotalk ABC also a valid tool to use and highly correlated with FES-I #physiotalk
physiotalk @physiotalk
RT @SusanneSyme: @physiotalk Is there an outcome measure that captures the fear of someone having a fall in care providers ( carers, family…
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk How strong is gait as a predictor for falls? #physiotalk
sarah lambert @sarahphysiomom
@MarousaPavlou @physiotalk @sarahdebiase Yes, I’m looking forward to using it #physiotalk
physiotalk @physiotalk
Based on previous #physiotalk I suspect the vestibular system might be a gap in knowledge
Susanne Arnold (Finnegan) @FinneganSusanne
@physiotalk Vestibular for me #physiotalk
Katie Knapton @physiokatiek
@physiotalk Other underlying issues that maybe contributing especially drugs. Hard to gather all relevant info as patient "normalises" it down to old age #physiotalk
Christine @CKelly193
@lynseyferguson6 @JanetThomas47 @sarahdebiase True, or offer a walking aid which can *sometimes* actually be worse! #physiotalk
Marousa @MarousaPavlou
@JanetThomas47 @lynseyferguson6 @sarahphysiomom @IPTOPphysio @physiotalk No ideal outcome measure exists but if issues observed with standing and basic gait, Tinetti a better tool and FGA or Mini Best can be assessed with progress as appropriate. #physiotalk
Katie Knapton @physiokatiek
@FinneganSusanne @physiotalk That too #physiotalk
Matt Liston @ListonMatt
@JanetThomas47 @lynseyferguson6 @sarahdebiase Bingo! It's about getting the right 'level of wobble'.... #physiotalk
Catherine Bowdler @clbowdler
@physiotalk Management of B12 deficiency. #physiotalk
physiotalk @physiotalk
RT @ListonMatt: @JanetThomas47 @lynseyferguson6 @sarahdebiase Bingo! It's about getting the right 'level of wobble'.... #physiotalk
sarah lambert @sarahphysiomom
@physiotalk Being given the time to do a thorough and comprehensive assessment! #physiotalk
Ieuan Ellis 🎓🏃🏴󠁧󠁢󠁷󠁬󠁳󠁿 🌍 💙 @Prof_IeuanEllis
On balance you are probably correct 🙂 ! #physiotalk
physiotalk @physiotalk
@clbowdler Do we consider medical and medication issues enough I wonder? #physiotalk
Anna Spiteri @spiteri_anna
RT @ListonMatt: @JanetThomas47 @lynseyferguson6 @sarahdebiase Bingo! It's about getting the right 'level of wobble'.... #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
@ListonMatt @physiotalk @JanetThomas47 @lynseyferguson6 @sarahdebiase I always found trying to find the right environment on an acute medical ward to assess and work on the wobble a bit tricky #physiotalk
Assistant Practs UK @WeAPS_NHS
RT @physiotalk: Q4) What are the gaps in your knowledge, skills and/ or services in terms of postural instability management in older adu…
physiotalk @physiotalk
RT @Prof_IeuanEllis: On balance you are probably correct 🙂 ! #physiotalk https://t.co/c4eq0uRo3T
Oisín Ó Slatarra @OSlatarra
@physiotalk What outcome measures for postural stability are commonly used over telehealth/telerehabilitaton? #physiotalk
Anna Spiteri @spiteri_anna
RT @MarousaPavlou: @sarahphysiomom @physiotalk @sarahdebiase Mini-best is the strongest one available currently. Sensor based systems are g…
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk Duration &frequency of input! In some community therapy services, a patient is seen only once a week. Some of the balance re-training exercises are not always appropriate for patients to practice on their own, so, less progress is achieved. #physiotalk
physiotalk @physiotalk
RT @OSlatarra: @physiotalk What outcome measures for postural stability are commonly used over telehealth/telerehabilitaton? #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk might just have been the attendance on the night... I am not sure our participants tonight are fully representative of the #physio workforce with roles in PS ax/mx... Need to consider how we upskill across all levels to support improvement in PS management
Justine Musiime - MSc MPH MCSP @JustineMusiime
@FinneganSusanne @physiotalk Same here. #physiotalk
Susanne Syme @SusanneSyme
@physiotalk I would like to know more about the evidence base around provision of equipment when working with someone with postural instability #physiotalk
Marousa @MarousaPavlou
@CKelly193 @lynseyferguson6 @JanetThomas47 @sarahdebiase Medication, poor seep quality or duration, psychological state,, sedentary behaviour all contribute to increased falls risk. Challenging to assess all in one session and may require >1 Ax session or ask patients to complete self report forms before appointment. #physiotalk
physiotalk @physiotalk
RT @SusanneSyme: @physiotalk I would like to know more about the evidence base around provision of equipment when working with someone wit…
physiotalk @physiotalk
@JustineMusiime And wondering if this is more of a problem with the changes in our services? #physiotalk
Claire O' Connell @ClaireOCPhysio
@physiotalk Time to spend doing a full assessment, our service is focused more on patients function/discharge.. Limited staff with vestibular training. #physiotalk
Catherine Bowdler @clbowdler
@physiotalk Probably not. I think peripheral neuropathy and B12 deficiency were on my radar in my previous role but I’m getting better at having these as a focused element as part of my assessment now. #physiotalk
Claire O' Connell @ClaireOCPhysio
@lynseyferguson6 @FinneganSusanne @ListonMatt @physiotalk @JanetThomas47 @sarahdebiase @lastenhouse And the other staff who interrupt sessions! #physiotalk
Katie Knapton @physiokatiek
@sarahdebiase Upskilling vital with an ageing population we all need to be involved #physiotalk
physiotalk @physiotalk
And heading toward our next (and penultimate question) #physiotalk
AGILE @AGILECSP
RT @SusanneSyme: @physiotalk I would like to know more about the evidence base around provision of equipment when working with someone wit…
sarah lambert @sarahphysiomom
@JanetThomas47 @lynseyferguson6 @IPTOPphysio @physiotalk I think familiarity has a lot to do with it #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk Services & commissioning. In some places, there are community exercise classes for onward referrals, but in others, there aren't. #physiotalk
physiotalk @physiotalk
Q5) What training would help you improve assessment and rehabilitation pathways for patients with postural instability? #physiotalk
Janet Thomas @JanetThomas47
@sarahphysiomom @lynseyferguson6 @IPTOPphysio @physiotalk I think probably the main thing is to make sure that we DO measure it using a validated test suitable for the people we are seeing #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q5) What training would help you improve assessment and rehabilitation pathways for patients with postural instability?…
physiotalk @physiotalk
@clbowdler What do you normally advise to increase B12? #physiotalk
Christine @CKelly193
@OSlatarra @physiotalk Perhaps questions addressing function? Eg can both arms be used when sitting, or can certain tasks be done in standing? #physiotalk
Marousa @MarousaPavlou
@JustineMusiime @physiotalk Exercises should be specific to each patient’s abilities; there are basic exercises to start with even in set programmes like OTAGO or FaME. #physiotalk
Susanne Arnold (Finnegan) @FinneganSusanne
RT @physiotalk: Q5) What training would help you improve assessment and rehabilitation pathways for patients with postural instability?…
Matt Liston @ListonMatt
@JustineMusiime @physiotalk In some cases giving them a week to practise gives you a chance to see if they've improved... There are lots of ways to get people doing exercises, the corner of the room with a chair in front of them is a great place for static exercises. #physiotalk
Katie Knapton @physiokatiek
@physiotalk Increase awareness of specific assessment tools including intro to vestibular retraining. Tips from experts, best outcome measures What to look out for.... So much feeling slightly scared 🙄#physiotalk
Sarah De Biase @sarahdebiase
#physiotalk it reads to me we need to not only upskill in terms of what domains to assess and how; but also how to empower to adapt assessment and treatment to different clinical contexts #challengethestatusquo (pardon the pun)
physiotalk @physiotalk
RT @ListonMatt: @JustineMusiime @physiotalk In some cases giving them a week to practise gives you a chance to see if they've improved... T…
Marousa @MarousaPavlou
@OSlatarra @physiotalk Questions, questionnaire/a sent out prior to appointment, specific instructions prior to the appointment for patient to set up at home to Ax standing and even gait, as appropriate. #physiotalk
Katie Knapton @physiokatiek
@physiotalk I think there would be a good demand for a virtual training course #physiotalk
physiotalk @physiotalk
RT @physiokatiek: @physiotalk I think there would be a good demand for a virtual training course #physiotalk
Claire O' Connell @ClaireOCPhysio
@physiotalk @clbowdler Our consultants/pharmacists/psych team are fantastic at reviewing meds and deprescribing as required. I probably don't think of it as frequently, as I know they will look at this #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@SusanneSyme @physiotalk I think it provides a foundation for the patient to start their rehab, & as they progress, some are able to get rid of it (the equipment). Yet if they didn't have it, they might be unsafe to do certain activities let alone be able to progress/improve. #physiotalk
physiotalk @physiotalk
RT @MarousaPavlou: @OSlatarra @physiotalk Questions, questionnaire/a sent out prior to appointment, specific instructions prior to the appo…
Catherine Bowdler @clbowdler
@physiotalk I’ve learnt so much working alongside a consultant geriatrician in a falls clinic in these last few months and I’m still absorbing new stuff. I’ve even asked for a tuning fork from Father Christmas 😁 #physiotalk
ElaineEphysio @eephysio1
@JustineMusiime @physiotalk Huge pressure on community services at the moment and time to revisit regularly while keeping up with the rest of your caseload is a real challenge! #physiotalk
physiotalk @physiotalk
@lynseyferguson6 @clbowdler Do you have any anecdotal advice for our listeners? Would you adviise supplements? #physiotalk
Marousa @MarousaPavlou
@JustineMusiime @physiotalk Once a week in person sessions are actually very good and a home programme that is safe, viable and acceptable to the patient for practise at home on days not attending clinic. #physiotalk
physiotalk @physiotalk
RT @MarousaPavlou: @JustineMusiime @physiotalk Once a week in person sessions are actually very good and a home programme that is safe, via…
Matt Liston @ListonMatt
@sarahdebiase I think you've hit the nail on the head. It's not just about postural stability training for older adults, the theory has applications across all people with instability... and so this should be used as a framework as how we understand balance #physiotalk
Carmichael Clinic @CarmichaelClini
I’d love more knowledge on other factors affecting PS - there has been mention of B12 for example, but even Vit D deficiency which is so common can have effects on neurological function and affect balance. #physiotalk
physiotalk @physiotalk
@clbowdler So do you think its vital to expand our knowledge to be aware of all of the medical issues, so is it better to work in an MDT and focus on our individual expertise #physiotalk
Catherine Bowdler @clbowdler
@physiotalk @lynseyferguson6 I’d advise if you suspect peripheral neuropathy then do a good assessment (vibration sense, joint position testing and Romberg) and then refer back to GP suggesting B12 screening. #physiotalk
physiotalk @physiotalk
RT @ListonMatt: @sarahdebiase I think you've hit the nail on the head. It's not just about postural stability training for older adults, th…
Marousa @MarousaPavlou
@sarahdebiase Agree development of assessment tree or toolbox may be helpful in this regard.. #physiotalk
physiotalk @physiotalk
Just time for our final question - although we have touched on it already #physiotalk
physiotalk @physiotalk
RT @sarahdebiase: #physiotalk Woaw @lynseyferguson6 I’d like to understand more about this suspicion. Linked to protectionism around roles…
physiotalk @physiotalk
Q6) What examples of digital rehabilitation for postural instability do you have? #physiotalk
IPTOP @IPTOPphysio
RT @physiotalk: Q6) What examples of digital rehabilitation for postural instability do you have? #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@ListonMatt @physiotalk In the community, we meet some people whose balance is really really low. I think sometimes we can be a little risk averse in recommending what they can or can't do alone. #physiotalk
AGILE @AGILECSP
RT @physiotalk: Just time for our final question - although we have touched on it already #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk These approach can be used in acute /inpt too if we plan it well... if you think about the amount of sedentary time and opportunity to involve carers/family. Start in acute but aim closer to home. @AGILECSP will try acknowledge contexts in a training offer /resources
AGILE @AGILECSP
RT @physiotalk: Q6) What examples of digital rehabilitation for postural instability do you have? #physiotalk
physiotalk @physiotalk
RT @sarahdebiase: #physiotalk These approach can be used in acute /inpt too if we plan it well... if you think about the amount of sedentar…
Sarah De Biase @sarahdebiase
#physiotalk love it... 🎁
physiotalk @physiotalk
The hour is up - but please keep chatting! We will collect the transcript later on #physiotalk
Marousa @MarousaPavlou
@ListonMatt @sarahdebiase Absolutely. Balance is balance and studies are consistently showing similar factors affecting uptake, adherence and outcome in multiple populations with balance problems. #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@eephysio1 @physiotalk You are very right. And I find that when the patient is starting to make progress, then it is the time to discharge them, because the rest of the patients also need to be seen! Remember we are commissioned for a given number of visits! #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk foundation to holistic assessment and individually tailored treatment plans
physiotalk @physiotalk
Thanks to @AGILECSP @sarahdebiase @MarousaPavlou @ListonMatt @sarahphysiomom for tonights chat #physiotalk
Matt Liston @ListonMatt
@JustineMusiime @physiotalk It’s a tricky wicket.... but then not doing anything will not improve their balance. It all comes down to risk ax/Mx, clinical reasoning and justifying your intervention. All exercises are tailored to the need and ability of the person. #physiotalk
Marousa @MarousaPavlou
@CarmichaelClini Low BitaminD levels can also contribute to BPPV. #physiotalk
Lauren stenhouse @lastenhouse
@lynseyferguson6 @FinneganSusanne @ListonMatt @physiotalk @JanetThomas47 @sarahdebiase We did have a lovely little therapy room to carry out all our assessments. Unfortunately this has been taken off us at the moment due to covid. Other areas still have their gyms etc though #physiotalk
Laura Bunce @BunceLaura
@physiotalk I feel this is a topic area we have yet to cover specifically at uni. I have been assessing this on my current placement in early supported discharge for stroke survivors, but prior to this I would not have known where to start! #physiotalk
Janet Thomas @JanetThomas47
@JustineMusiime @eephysio1 @physiotalk I find that incredibly hard to hear (not working in England) We need to ensure we can optimise the outcomes for everyone - and sometimes that take time! #physiotalk
Matt Liston @ListonMatt
@lynseyferguson6 @JustineMusiime @physiotalk Plan, plan and then plan some more! Love the enabling approach there Lynsey! These ex’s may make you feel wobbly, there is a slim chance you might fall (you have fallen previously), but if you do here is our support strategy! #physiotalk
AGILE @AGILECSP
RT @physiotalk: The hour is up - but please keep chatting! We will collect the transcript later on #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @JustineMusiime @ListonMatt @physiotalk and do you tell them this is in case they fall? Just wondering how this ties in with compliance if they are fearful of falling already? A tricky balance - no pun intended! #physiotalk
AGILE @AGILECSP
RT @physiotalk: Thanks to @AGILECSP @sarahdebiase @MarousaPavlou @ListonMatt @sarahphysiomom for tonights chat #physiotalk
Laura Bunce @BunceLaura
@physiotalk On my current placement it’s been assessed functionally- ie is the instability still impacting the stroke survivors .. standing, ability to climb stairs, or to wash and dress etc, and reviewing exercises. But I have also used the Berg, Dynamic Gait Index, HI-MAT #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @physiotalk I have used the Otago app with a handful of people and I suggest @clock_yourself a fair bit as well #physiotalk
physiotalk @physiotalk
RT @ListonMatt: @lynseyferguson6 @JustineMusiime @physiotalk Plan, plan and then plan some more! Love the enabling approach there Lynsey! T…
Justine Musiime - MSc MPH MCSP @JustineMusiime
@ListonMatt @physiotalk You are very right @ListonMatt. It's just the strong desire to sort everyone out and enable them all to achieve their goals before discharge that sometimes leaves one frustrated. 😊 #physiotalk
Dr Ralph Hammond 💙 @physioralph
@physiokatiek @physiotalk Check out the webinar on BPPV that @inpa hosted last week: just posted recording on website: https://t.co/gZr0Rj6DoT #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk Good to know @BunceLaura Need to differentiate btw what can realistically be taught undergraduate versus what is post graduate and experiential learning. Hopefully @AGILECSP can support the latter with @ListonMatt and @MarousaPavlou and @sarahphysiomom
Claire O' Connell @ClaireOCPhysio
@physiotalk We are still paper based, don't currently have interest from patients in anything online. #physiotalk
physiotalk @physiotalk
RT @physioralph: @physiokatiek @physiotalk Check out the webinar on BPPV that @inpa hosted last week: just posted recording on website: htt…
Katie Knapton @physiokatiek
@physioralph @physiotalk @Inpa Will do thanks so much Ralph #physiotalk
IPTOP @IPTOPphysio
Thank you for highlighting this - a great resource I'm sure #physiotalk
Justine Musiime - MSc MPH MCSP @JustineMusiime
@JanetThomas47 @lynseyferguson6 @ListonMatt @physiotalk Good question @JanetThomas47. I've practiced backward chaining with some in the past, though it is not always appropriate for others. Yet those others might be the ones that need it the most! #physiotalk
Laura Bunce @BunceLaura
@sarahdebiase @AGILECSP @ListonMatt @MarousaPavlou @sarahphysiomom Absolutely! I think placement has provided the ideal opportunity to learn this by experience 👍🏼 same with the vestibular rehab mentioned in another strand of tonight’s #physiotalk Agreed that not everything can, and should be covered in didactic lectures ☺️
Sarah De Biase @sarahdebiase
@AGILECSP #BPPV webinar @inpa
Catherine Bowdler @clbowdler
@physiotalk I think it depends on your role and how closely you work with medics. If you’re a physio specialising in falls you really need an expanded knowledge base of the medical issues that contribute to postural instability. #physiotalk
Susanne Syme @SusanneSyme
@MarousaPavlou @physiotalk @JustineMusiime People living with dementia in care who do not fear falling and do not remember they need a walking aid are often managed with better alarm systems, wall and grab rails and a clutter free environment with better line of sight by staff. Useful lessons? #physiotalk
Janet Thomas @JanetThomas47
@lynseyferguson6 @physiotalk @clock_yourself Now I'm doing home visits rather than being in a 'Day Hospital' setting I would say around 1/3 of patients seem to have smartphone or tablet from what I've seen. By the apps need to be simple and specific for their needs! #physiotalk
Janet Thomas @JanetThomas47
@JustineMusiime @lynseyferguson6 @ListonMatt @physiotalk We used to do backward chaining with everyone - but more difficult now when doing community visits. It is important to consider it though! #physiotalk
AGILE @AGILECSP
RT @sarahdebiase: #physiotalk Good to know @BunceLaura Need to differentiate btw what can realistically be taught undergraduate versus what…
Matt Liston @ListonMatt
@JanetThomas47 @lynseyferguson6 @JustineMusiime @physiotalk I think forewarned is forearmed. They've attended because they have poor balance and have fallen and / or are fearful of falling, so they have an inherent risk. We teach backward chaining as they are likely to end up on the floor at some point... #physiotalk
Sarah De Biase @sarahdebiase
#physiotalk and then it’s ‘what matters to me’ aka the other, goal setting with shared decision making in consideration of what is reversible versus irreversible in effort to reduce further fall/falls related injury
Justine Musiime - MSc MPH MCSP @JustineMusiime
@physiotalk @AGILECSP @sarahdebiase @MarousaPavlou @ListonMatt @sarahphysiomom 👏👏👏You've done a great job. #rehablegends #physiotalk
Oisín Ó Slatarra @OSlatarra
@physiotalk https://t.co/NDfMB2j3uX the @active_neuro project and @MSIRELAND have been running 'better balance' classes over Zoom @susancoote #physiotalk
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