   

4

RESEARCH ABSTRACT Training and Fall Prevention

www.drayerpt.com VOLUME 13,10, ISSUE 14 By Ashlee Jones “eyes closed”; on postural con- Falls are the leading cause trol during anterior-posterior of fatal and non-fatal and medial-lateral movements for those aged 65 and older. on the force platform; and on An estimated one in three scores on the Tinetti and Berg Delicate older adults fall every year: balance tests. 30 percent of these falls results DISCUSSION By Jessica Heath and Neal Goulet ing correct signals to the brain, in a moderate to severe , Although aging is or if the muscular system can- such as a , or even inevitable, the risk of Life, it turns out, literally is not carry out the necessary depression based on the fear can be prevented. No matter a balancing act. And the longer movements, a person may not of falling. the living situation of the older we live, the more challenged we be able to maintain or correct This fear can lead to adult, it is important to address are to stay on our feet. their balance,” according to inactivity, which further balance for improved quality of Consider that more than 30 MoveForwardPT.com. decreases an elderly individ- life. Reoccurrence of falls in percent of people aged 65 and More simply put, falls ual’s postural stability, individuals older than 65 tends older will fall this year. If you result when something, and balance. to result from the loss of agility reach age 80, your odds of falling whether health-based or Several studies and authors and dynamic control during increase to better than 50 percent. environmental (, sloping indicate that dynamic proprio- activities of daily living. And it gets worse for some. ground, poor lighting), chal- ception training is linked to Maintaining a level of In 2012-2013, according to Unstable surfaces such as a stability trainer challenge core strength lenges our balance or strength. decreasing the risk of falls. physical activity is important the Centers for Disease Control to improve postural steadiness. Proprioception is awareness for improved steadiness during and Prevention (CDC), falls SCREENING FOR RISKS of one's body position. As we walking, turning and reaching caused 55 percent of all uninten- Balance problems can age, this system decreases in METHODS A control group was asked activities. This study showed tional among adults aged manifest as tripping, swaying, function, thus increasing the 65 and older. This far outpaced stumbling, dizziness, , This study comprised 44 not to change activity levels that participation in proprio- Falls result when something health-based or environmental, such risk of falls. the number of injury deaths and, worst of all, falling. Standing subjects aged 65 and older. during the 12-week interven- ception exercises has a positive as stairs, challenges balance or strength. Dynamic proprioception Baseline characteristics were tion. The experimental group effect on gait, postural stability caused by motor vehicle acci- still or performing a single task training utilizes unstable collected on the participants participated in a propriocep- and balance in older adults. dents in that age group. may not be troublesome, but surfaces, such as an exercise through: tion intervention program for Another significant piece of Among other staggering ing or standing. Problems occur when one moving about or doing more ball or a stability trainer, to numbers about falls, which Muscle weakness, joint or more of three body systems • A self-administered question- two days per week. Each exer- fall prevention is guidance by a than one thing at a time (walk- challenge an individual’s naire (“Have you experienced cise session was 50 minutes (10 physical therapist, who can take while skewing toward the older stiffness, inner ear problems, are not working properly: ing while turning your head to core strength. Advancing core a fall to the ground in the last minutes warm-up, 30 minutes an older individual through a population can negatively and sedentary • Visual speak with another person) can 12 months?”). stability improves postural proprioceptive exercises, and 10 challenging proprioception affect all ages: lifestyle also can contribute to • Vestibular (inner ear) become problematic. • Pre- and post-intervention assess- steadiness with walking, minutes cool-down). As the par- exercise regime to decrease • One out of five falls causes a balance problems. Common • Somatosensory, which includes A person challenged in turning and reaching. ments on stability tests with “eyes serious injury such as broken medical conditions can play a open” and “eyes closed.” ticipants improved with the exer- the risk of falling. proprioception (awareness of one’s these ways can grow fearful of bones or a . body position), sensation, pain, The purpose of this study cises, training was progressed role, too, including diabetes, performing daily activities, in • Tinetti and Berg tests (functional REFERENCE • More than 95 percent of hip movement, muscles and joints. was to compare the effects of arthritis, stenosis, high blood the process losing muscle tests to objectively determine a into two or three phases. Amat et al. “Effects of 12-week proprio- fractures are caused by falling, traditional and proprioceptive patient's ability to complete ception training program on postural usually by falling sideways. pressure, heart conditions, “The brain coordinates strength as a result of avoiding tasks safely; identifies falls risk). RESULTS stability, gait, and balance in older macular degeneration. impulses from the eye, inner training programs on postural • The direct medical costs for fall strenuous movements. The experimental group adults: a controlled .” Journal stability, gait and balance, and • A force platform assessment of Strength and Conditioning Research. injuries is $31 billion annually. Progressive ear, and body-posi- “Some of the major conse- fall prevention in adults aged (measures the amount of sway significantly improved on sta- 27(8) 2180-2188. That figure could reach $54 neurological disorders, tion senses, and quences of falls among older associated with changes in bility tests with “eyes open” and billion by 2030. such as multiple sends signals to the 65 and older. weight bearing). adults,” according to the CDC, sclerosis and muscular system to THREE BODY SYSTEMS “are hip fractures, brain Parkinson’s disease, move or make injuries, decline in functional Aging is but one of many also present with bal- adjustments to abilities, and reductions in factors that contribute to a bal- CORPORATE OFFICE ALABAMA MARYLAND OHIO TENNESSEE ance dysfunctions maintain balance. If IN: social and physical activities.” ance disorder, or dysfunction, a 8205 PRESIDENTS DRIVE GEORGIA MISSISSIPPI OKLAHOMA VIRGINIA and can affect inde- one or more of the The more risk factors a HUMMELSTOWN, PA 17036 condition that makes you feel Scan for video INDIANA NEW JERSEY PENNSYLVANIA WEST VIRGINIA pendence and safety. senses is not send- person has – older victims typ- 717-220-2100 unsteady or dizzy when walk- www.drayerpt.com KENTUCKY NORTH CAROLINA SOUTH CAROLINA on fall prevention.

CENTERS Continued on Page 2    

2 3

Continued from cover CASE STUDY ically have two or more – the triggering a comprehensive Have you had any falls in the Each patient should be greater the chance of falling. But fall-. past year? How many? Have any evaluated carefully so that a Fall- resulted in injury? All Balance Components while factors such as advanced detailed, tailored treatment COMMON QUESTIONS age or a history of falls can't be Have you changed or decreased plan can be developed. Prevention A physical therapist will your activities out of the home By Courtney Myers changed, many more can be ask questions and/or perform because of your balance or fear REFERENCES Tips modified (see sidebar on page of falling? PATIENT HISTORY tests related to motion, strength, Kramarow, E., Chen, L.-H., Hedegaard, H., To prevent falls, focus on 3) to assist in fall prevention. Warner, M. "Deaths from unintentional coordination, vision and balance. If a fall risk is identified, A 71-year-old male pre- The American Geriatrics injury among adults aged 65 and over: modifiable risk factors: The results will help determine will address United States, 2000-2013." National sented to outpatient physical Society recommends that all Center for Health Statistics Data Brief, whether a patient should see a mobility issues such as walking • Talk to your health care provider. Ask therapy with complaints of adults aged 65 and older be No. 199, May 2015. physician or be referred to phys- speed, balance and propriocep- for an assessment of your risk for imbalance and dizziness after screened for falls. The Journal "Physical therapist's guide to balance ical therapy for a formal evalua- tion, strength, flexibility, posture problems," American Physical Therapy falls. Share any chronic conditions oral treatment for of Geriatric Physical Therapy, Association website, MoveForwardPT.com, and any history of falls. tion and customized treatment and pain. accessed January 2017. hematoma (blood) on his in a review of 33 other studies, • Review your medications with your program that can reduce fall The goals will be to improve Shubert, Tiffany. "Evidenced-based brain. He noted that his overall identified 17 independent con- exercise prescription for balance and doctor and pharmacist. Don't forget risk and fear of falling. function and daily activity. over-the-counter medications or level of mobility was affected tributing factors in fall risks for falls prevention: a current review of the Some common questions This will help to counter literature." Journal of Geriatric Physical herbal supplements. and reported several near falls. “community-dwelling” older that might be asked are: instances of patients limiting Therapy. July/September 2011. • Talk to a physical therapist about a He described difficulty adults. It found “significant U.S. Centers for Disease Control and How often do you experience their activities; for example, balance assessment and exercise with activities such as yard interaction” between risk factors Prevention website, cdc.org, accessed problems with your balance? someone who is older and has January 2017. program to build balance, strength work, showering and grocery and a patient's function level. and flexibility. What types of activities are you a history of diabetes, resulting shopping along with overall The Journal of Geriatric doing when you experience in neuropathy (peripheral • Get your vision and hearing checked increased fatigue. The patient annually. Physical Therapy proposed that problems with your balance? nerve damage); knee pain had a history of nasal cancer, physical therapists screen all Do you have any sensation of the • Talk to your family members. Enlist TREATMENT extremity assistance while caused by arthritis; or an injury their help to take steps to make Type 2 diabetes, polyneuropa- older adults seen in their prac- room spinning, or do you feel off- caused by a fall. thy and macular degeneration. Treatment consisted of showering and decreased fear of balance? your home safer. tices, with a positive screen manual stretching of hip flexors imbalance or falls. The patient ASSESSMENT and extensors, gluteal and gen- noted improved sensation in his The patient presented eral lower extremity strength- feet while driving. His Activities- with reduced hip strength and ening, and vestibular exercises. specific Balance Confidence range of motion. He had an He performed vestibular ocular Scale score improved from inconsistent response with reflex (VOR) exercises, static 81.3 percent confidence to testing of sharp/dull sensations Bathroom and dynamic balance activities 92.5 percent confidence. on the plantar surface of both FALL-PROOF • Place a slip-resistant rug next to on both compliant (stable) and feet, indicating a possible loss SUMMARY the bathtub for safe entry and exit. noncompliant (unstable, such of sensation. Patients with balance as foam or balance board) sur- • Use a non-slip rubber mat or He displayed severe loss of problems can present with YOUR HOME faces, and activities with visual non-slip strips in tub or shower. balance with static testing, multiple system deficits. In suppression (eyes closed). • Install grab bars for support inside deteriorating with his eyes addition to vestibular impair- Make these simple changes to help Anodyne (infrared) treatment closed or with a change of sur- ments, we must consider injury prevent falls and eliminate hazards the tub and next to the toilet. was incorporated to both feet face. When asked to turn his to both the somatosensory • Replace glass shower enclosures to improve sensation. in various parts of your house. (proprioception, sensation, with non-shattering material. head, the patient demonstrated decreased walking speed, walk- OUTCOME range of motion and strength) Stairs and Steps ing off to the sides versus After 12 physical therapy and visual systems. treatments focused on all Physical therapists have • Always keep objects off stairs. maintaining a straight path, Kitchen and frequent loss of balance. three of the primary balance the tools to incorporate exercis- • Never stand on chairs or boxes to • Fix any loose or uneven steps. Vestibular hypofunction (a systems (vestibular, visual and es and improve these deficits to reach cabinets or shelves. Use a • Provide enough light to see each poorly functioning vestibular somatosensory), the patient provide the best care available. step stool with a bar to hang on to. stair and landing. system) was apparent given the displayed remarkable improve- It is important to consider all • Store food, dishes and cooking • Make sure carpet is firmly attached above findings. However, addi- ment. The patient reported balance components. improved balance with general equipment in easy-to-reach places. to every step. tional impairments influenced his balance and needed to activities of daily living, includ- • Immediately clean up any liquid or • Make sure handrails are on both be addressed. ing decreased need for upper food spilled on the floor. sides of the stairs.