Anticipatory guidance for injury prevention is the systematic and intentional providing of information to patients and caregivers as a tool to reduce likelihood of future harm from injury. This guidance assists patients and caregivers to better anticipate unwanted conditions or events, being more able to prevent adverse outcomes. In pediatric and adolescent medicine, anticipatory guidance typically involves guidance based on the age and developmental stage of the patient (e.g., at age 6 months/crawling – install gates near stairs).  In the adult population, because the heterogeneity of aging and disease makes anticipatory guidance by age alone less helpful, recommendations should be based on disease or medical condition.  Disease/condition-based anticipatory guidance items may overlap if multiple conditions are present. 

Movement disorders may result from an acute injury or illness (e.g., fall, gout, infection), but are frequently due to chronic and progressive conditions.  Longstanding movement disorders may stem from:

• Musculoskeletal conditions (e.g., arthritis, muscle atrophy, kyphosis due to osteoporosis)
• Neurological conditions (e.g., dementia, Parkinson’s disease, strokes, normal pressure hydrocephalus, neuropathy)
• Sensory loss (e.g., macular degeneration, cataracts)
• Other contributing factors

The many and varied contributing factors to movement disorders require tailoring guidance to each individual patient.  The following anticipatory guidance categories encompass generalized fall, pressure injury, and burn prevention, as well as specific considerations for travel. The categories below contain specific items of safety guidance for injury prevention.  This listing may be printed and given to patients and their caregivers at clinical visits, or the clinician and health care team members may choose to focus on a pertinent area of concern.

1. Fall prevention

• Consider a home safety evaluation by an Occupational Therapist to identify hazards unique to the individual’s home.
• Remove area rugs or secured them to the floor using double-sided tape.  Pile height should be low to medium to avoid tripping. Avoid carpet protectors as these tend to bunch up.
• Cords should be secured or wrapped to prevent snagging or catching.
• Adaptive equipment should be evaluated for the environment used. Unwheeled walkers may be hazardous in high traction or irregular surface areas (e.g. multiple door thresholds, area rugs, split level environments), or where movement paths are cluttered.
• Limit stair access. Ideally, doors to stairways should be locked, not simply closed. If using child gates, these need to be set at chest/torso level to prevent falling over the top. 
• Increase lighting to avoid hazards.
• Use an automatic fall alert system in case the individual cannot press the alert due to either injury or poor cognition.  Do not rely on cell phones or cordless phones as alternative alarm systems.
• Depending on the municipality, door key boxes may be available that are installed, and used by, first responder personnel to expedite home entry in an emergency. 

2. Pressure injury prevention:

• If there is a mobility problem or sensory problem, ensure that appropriate pressure relieving cushions are used. Avoid increased or persistent pressure over ischial tuberosities and on the heels.
• If there are upper body strength limitations, assistance may be required in pressure relieving methods (e.g. lifting body weight from a wheelchair or transport chair to relieve pressure areas).  Impairments in mobility that prevent pressure relieving methods warrant a consultation to physical therapy or Physical Medicine and Rehabilitation.
• Avoid clothing that exerts pressure on bony prominences (e.g. shoes with a narrow toe box, clothing folds that create pressure points).
• Avoid use of foam sitting “rings” as they increase pressure across portions of the upper thighs.
• Use caution with the duration of time spent on toilets, or surfaces that concentrate weight in one area.

3. Travel

• Keep emergency contacts, medications, allergy, and medical problems lists in a prominent place with the individual when traveling (e.g. in a document envelope on a lanyard).
• Longer distances can be prohibitive for individuals with movement disorders. Many travel venues (e.g. airports, larger intermodal hubs) have customer services that assist mobility impaired travelers but require advanced arrangements.
• Non-stop flights may help with the difficulty of making connecting flights.
• If a deep brain stimulator (DBS) is used, check if it is x-ray and security compatible.
• Travel with a companion if possible.
• Use travel chairs or wheelchairs with a footrest to avoid dragging limbs, particularly if another person is pushing the chair or if the individual usually removes footrests to facilitate scooting.
• Inquire at hotels for handicap accessible accommodations to allow easier navigation.

4. Burn prevention

• Set water temperature at 120˚ F / 49˚ C or to low setting. Use thermometers in full immersion baths – safe bath temperature is 95 to 100˚ F/ 35-38˚ C.
• Avoid unsupervised use of heating devices such as electric blankets or pads. 
• Avoid heating devices such as stoves, space heaters, or fireplaces. Unplug heat sources when needed.
• Quit smoking. If this is not possible, avoid unsupervised smoking or smoking in areas with fire hazards (e.g., bed, upholstered furniture, near oxygen) or during use of sedative medications.