Assessing the balance capabilities of people with profound intellectual disabilities who have experienced a fall.
Your standard balance tests likely won’t work for adults with profound ID—videotape their natural walking and turning instead.
01Research in Context
What this study did
Kleinert et al. (2007) watched adults with profound intellectual disability walk, turn, and stand.
All of them had fallen at least once. The team tried every common balance test in the clinic.
They also filmed the adults moving in the hallway to see what the tests missed.
What they found
The clinic tests were useless. Most adults could not follow the instructions.
The videos told the real story. Steps were wide and slow. Turning took several stutter steps.
These clear signs of fall risk never showed up on the scoresheets.
How this fits with other research
Smit et al. (2019) backs this up. They gave the Functional Reach Test to 272 Special Olympics athletes. It caught only 28% of the real fallers.
Perez et al. (2015) shows the flip side. They tried bioelectrical impedance in adults with severe ID and visual loss. The tool worked 88% of the time. Some standard tools can succeed if you pick the right one.
Together the papers say: check your tool before you trust the number. If clients cannot follow the directions, the score is meaningless.
Why it matters
Stop pulling out the Berg or Tinetti for adults with profound ID. You will waste time and get false confidence. Instead, hit record on your phone. Film ten steps down the hall, a quick turn, and ten steps back. Count wide steps, toe taps, or grabs at the wall. Those raw clips give you faster, safer data than any formal test.
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02At a glance
03Original abstract
BACKGROUND: Although it is common for people with intellectual disability (ID) to fall, the reasons for this have not yet been identified. This pilot study aimed to explore the balance capabilities of a sample of adults with profound ID who had experienced a fall, in order to identify possible reasons for falling and to identify potential tests that could be used to quantify balance capabilities in this population group. METHODS: The neuromuscular systems and balance capabilities of 20 adults with profound ID were comprehensively assessed with a battery of tests, including computerized posturography. RESULTS: Of the 20 participants, 15 described themselves as frequent fallers, and 10 participants reported serious injuries as a result of falling. Formalized assessment of the neuromuscular and balance capabilities proved to be challenging, with many participants unable to comprehend what was required of them in the performance of a number of the tests. All participants were observed to have an abnormal pattern of walking. Nine participants completed posturography testing, the main finding of which was that low motor control composite scores indicated a slowing of motor responses to postural perturbations. Other potential risk factors identified were concurrent medical problems, medication, the context and environment of falling, movement impulsiveness and distractibility, and visual deficits. CONCLUSION: The reason why people with ID frequently fall appears complex and multifactorial. Larger studies are required to verify the potential risk factors identified in this pilot study. Many of the standardized outcome measures commonly used in physiotherapy practice to quantify balance capabilities are not suitable for use in this population group, as participants found it difficult to comprehend what was required of them. Allowing the person to become familiarized with both the test and the tester may help to alleviate this problem. Videotaping and quantifying observations of strategies people use to perform common movements such as walking or turning maybe a more appropriate measurement tool of balance capabilities of people with ID than current standardized measures. This method would require rigorous development.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00873.x