Balance

Better Balance Program

Crystal Myers, DPT

Sarah McBride, DPT

• Falls among older adults are common and dangerous, with known significant morbidity and mortality.

• Approximately one-third of community-dwelling older adults will fall each year.

• 20-30% of falls result in moderate to severe injuries, including traumatic brain injury (TBI), cervical fractures, and spinal injury.

Fall Statistics

Fall Statistics

• Falls are the most common cause of hospital admissions for trauma among older adults and are the fifth leading cause of death in older adults.

– Older adults injured from falls and admitted to the hospital are significantly more likely to be discharged to long-term care than other age-matched patients admitted to the hospital from the emergency department (ED) for other reasons

Cost of Falls

– In 2000, $19 billion was spent on fall-related injuries for people aged 65 years and older.

– By 2030, nearly 1 in 5 Americans will be aged 65 years or older.

What is the Better Balance Program?

• Educational tool guided by evidence based practice to assist in identifying and addressing impairments that may lead to imbalance.

Mission of the Program

• Identify individuals who are at risk for falling

• Help at risk individuals take steps to reduce falls before they happen

• Encourage healthy aging by facilitating older adults to remain mobile and independent

• Reduce hospitalizations

Who Will Benefit?

• Individuals who:– Have fallen recently– Demonstrate difficulty getting up from a chair– Have difficulty walking or are unsteady– Are physically inactive– Are fearful of falling

Who Will Benefit?Individuals Who:

- Complain of dizziness or lightheadedness

–Have problems with the senses, such as impaired vision, numbness or neuropathy

–Demonstrate muscle weakness

–Have neurological or arthritic/orthopedic conditions that limit physical abilities

Balance or Postural Control

• The ability to locate and maintain one’s center of gravity within or over one’s base of support during static and dynamic tasks

• Controlled by interaction of sensory and motor systems– Disruption of these systems leads to imbalance and

increased risk for falls

Causes of Balance Problems

-Sensory-Motor-Cognitive

Sensory Input

– Peripheral Sensory Systems•Visual: detects movement of head or environment,

reference for verticality•Vestibular: detects linear and angular head/eye

movement and position relative to gravity•Somatosensory: provides info about body’s

position relative to surface

Motor Output

• Maintenance of postural control– Static Postural Control

» Normal sway

» Reflexes

– Automatic or Reactive Postural Responses

» Response to stimuli

» Strategies

– Anticipatory Postural Responses

» Occur before actual stimulus

– Volitional Postural Movements

» Conscious control, trained responses

Reactive Postural Responses

• Occur in response to stimuli• Strategies– Ankle: response to small perturbation– Hip: response to larger or faster perturbation– Stepping: force strong enough to displace

COM outside of BOS, step to regain COM

Imbalance

• If any of these systems are compromised may lead to imbalance and subsequent falls

Physical Therapy Evaluation

• Identify impairments– Outcome measures

•TUG, BERG

– Movement assessment•Range of motion, Strength

• Identify risk factors– Intrinsic versus extrinsic

Intrinsic Risk Factors

• >80• Arthritis• Balance Deficit• Cognitive Impairment• Depression• Dizziness• Fear of Falling

• Gait Deficit• History of Falls• Impaired ADLs• Medications• Muscle Weakness• Sensory disturbances• Use of assistive

devices

Extrinsic Risk Factors

• Inadequate lighting• Loose carpets• Unlevel floor

transitions• Clutter• Electrical Cords• Lack of Appropriate

adaptive equipment

• Inadequate stairs (railing, depth)

• Unstable furniture• Unsuitable footwear• Unlocked wheelchair• Weather conditions• Pets

Physical Therapy Treatment

• Individualized treatment plan for each patient

• Appropriate medical referral if needed– Medication management

•Four or more•Classifications linked to increased risk of falls

– Benzodiazepines, sleeping medications, neuroleptics, antidepressents, anticonvulsants and class 1A antiarrhythmics

– Blood Pressure

Treatment

•Education- Extrinsic

changes- Awareness of

intrinsic factors

What Can Physical Therapy Do to Help?

• Address the following Impairments – ROM

– Strength

– Coordination

– Gait

– Endurance

– Safety

What Can Physical Therapy Do to Help

• Address vestibular dysfunction– Vestibular Treatment, Habituation Exercises

• Assess need for assistive devices

What CRR has to offer

• Computerized balance testing and training– Testing can monitor progress during treatment

• Better Balance trained Physical Therapists– 5 Physical Therapists, 3 Physical Therapy

Assistants