Backward-chaining

Original Editor - Lauren Lopez Top Contributors - Lauren Lopez, Lucinda hampton, Kim Jackson, Rachael Lowe and Shreya Pavaskar

Introduction

Older adults are at risk of falls and subsequent significant injuries. After a fall, the older adult is at risk of experiencing a long lie. As part of falls management, physiotherapists can teach older adults to get up from the floor in the instance of a fall. Backward-chaining is an effective method to do this.

Description

Backward-chaining involves breaking a particular task down into steps. Then, the whole task is taught starting with the last task and working your way backwards to the first task. If one step proves challenging, it can be broken down into smaller steps. Progress from one step to the next is only made when the individual can successfully complete all prior steps.

In the case of falls, this means you start with the older adult on the floor and then teach them to work their way back up into standing or sitting on a chair. Getting up from the floor using backward-chaining means the older adult starts in the most stable position and only progresses to more unstable positions (on knees, sitting or lying on floor) as they are able.

Sequence of steps

See here for photos.

The following is from Reece and Simpson.

1. Start by having the older adult sitting on a chair or plinth, slightly turned to one side. Or stride standing next to a plinth or chair. The older adult then kneels one knee down onto a foam wedge or similar. Next the older adult pushing back up into standing then sitting.

2. Instead of using a wedge, the older adult lowers one knee to the floor and bears weight through it. Next the older adult pushing back up into standing.

3. As per step 2, then the older adult lowers both knees to the floor into a high kneeling position. Once achieved, the older adult pushes up onto one knee, then back up into standing.

4. As per step 3 and then the older adult lowers both hands to the floor, one at a time, to come to a prone kneeling position. Once achieved, the older adult returns to the positions of steps 3, 2 and 1.

5. As per step 4, then the older adult lowers body to half sitting. This can be uncomfortable on the hips so cushions may be needed to soften the floor surface. Once this position is achieved, the older adult then pushes back up into prone kneeling and back through the steps above until they are standing.

6. As per step 5, then the older lowers the body to side lying. Again, once achieved, the older adult then returns through the previous steps until they are back in the starting position.

7. As per step 6, then the older adult turns from side-lying to supine. Once this is achieved the older adult then cycles back through the previous steps i.e. supine to side-lying, side-lying to half-sitting, half-sitting to prone kneeling, prone kneeling to high kneeling, high kneeling to one foot and one knee weight-bearing, then pushing back up into standing.