Fall statistics:
1 in 4 people over 65 fall each year.
Falling once doubles your chance of falling again.
1 in 10 falls results in injury leading to at least 1 day of inactivity or requires medical attention.
Each year there are 3 million ER visits related to falls in the elderly.
Each year there are 1 million hospitalizations related to falls.
319,000 of those are for hip fractures.
There is a 17-25% increased risk of mortality in 1 year following hip fracture.
The most common cause of TBI is falls.
Balance, Vestibular & Posture
Our balance, vestibular and postural control systems are all very closely related and intertwined.
The vestibular system includes:
Eyes - how well they work together and can you stabilize your gaze when your head is moving or the world is moving around you.
Ears - semi-circular canals and structures in the vestibule provide feedback about how your head and body are moving in space.
Feet - provide input to the body regarding the surface you are standing on.
We have 4 strategies for maintaining balance:
Ankle
Hip
Stepping
Reaching/grabbing.
As people age, the hip and stepping strategies become less effective due to impaired strength and mobility.
We also have 4 states of postural control:
Steady state - ability to control your center of mass over a base of support in a predictable environment.
Proactive/anticipatory - small adjustments in the muscles before and after a voluntary movement to maintain stability which could be disrupted by the action.
Reactive - ability to recover stability following an unexpected external force.
Adaptive - ability to modify sensory and motor systems in response to changing task and environmental demands as well as maintaining postural control while moving through space (think learning a new sport/skill).
Base of support, surface, environment, head movement, and background can all impact balance and reactions.
Physical changes that can impact balance include lower extremity range of motion, especially at the ankles, medical conditions (vestibular, neurologic, orthopedic), neuropathy, spinal postural changes, and weakness.
3 types of Vertigo:
Peripheral - related to the inner ear and treated with corrective maneuvers.
Central - treated with eye exercises or habituation exercises (repeating a provocative movement until the brain accepts it as non-threatening).
Cervico-genic - treated with postural control exercises, relaxation techniques and manual therapies.
Maintain a healthy balance and vestibular system:
Staying hydrated, treating allergies before symptoms arise, eating regularly to maintain blood sugar levels, get regular vision and hearing exams, practice good sleep habits, transition slowly between lying down, sitting and standing, if you feel off balance while moving, focus on a non-moving target in the distance.
What can you do to improve/maintain balance?
Wear proper footwear, treat limiting symptoms, walk with intent and purpose regularly, strength train and stretch, move in all directions.
Break the fear of falling/fall cycle where someone has a fall (or is afraid they might) so they stop moving, which makes them weaker and more likely to fall.
Review medications with MD as many cause dizziness, remove all tripping/slipping hazards from the home, make safety modifications before they are necessary.
PT can pull all of this together with a thorough evaluation to tease out the cause of balance/dizziness impairments and recommend a program to target problem areas. We begin with simple tasks/training and gradually progress the level of difficulty with the goal of improving safety/mobility to perform required and desired daily tasks and activities that are important to each individual client. Strength training is the #1 activity that must be performed to maintain safety and balance.
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