Balance and Falls Prevention

Balance and Falls Prevention, What is it?

Balance and Falls prevention is a fantastic service offered by most physical therapists. Falls happen. It is estimated that one in three people over the age of 65 will fall.  However, those numbers may be low since many falls go unreported.  Those who fall once are at a greater risk of falling again, as the risk of falling another time more than doubles after one fall.  As people live longer than ever before, identifying those at risk for falling and providing essential care to those who have fallen is important to keeping people healthy and independent.

Only about half of those who have fallen report episodes of falling.  Many older adults fear losing their independence or don’t want to worry family members about falling.  This frequently means those who have fallen may be less likely to seek medical attention for the injuries sustained because of a fall.

The results of a fall can be devastating.  Injuries can include broken bones, muscle strains, ligament sprains, head injuries, cuts, and bruises.  In some cases, people can die because of a fall.  Falls can also affect patients psychologically as well, and many people are more fearful of falling again if they have fallen once.  The limited mobility or loss of independence with a fall-related injury can sometimes trigger depression or anxiety as well.

Many falls are preventable.  Sometimes, simple environmental changes like removing throw rugs, increasing lighting, and having anti-slip mats in the bathtub or shower make the home safer. Research also shows those adults who are more active are less likely to fall or get injured if they do fall.  Being active includes not only cardiovascular activity and strength exercises, but balance activities as well.

Balance and Falls Prevention, Why Do You  Need It and What Causes It?

Balance is maintaining an upright position while standing, walking, or sitting.  Many things influence balance, including vision, inner ear function, sensation in the limbs, strength, and flexibility.  Multiple systems work together for maintaining good balance in a variety of postures.

Maintaining balance and reducing fall risk is important.  Many things can contribute to decreased balance and increased fall risk.

  • Abnormality of gait pattern
  • Aging
  • Brain Injury
  • Concussion
  • Dehydration
  • Dementia or Alzheimer’s disease
  • Diabetes
  • Environmental factors (poor lighting and tripping hazards like throw rugs or clutter)
  • Generalized weakness
  • Inner ear infection
  • Influenza
  • Lack of activity or a sedentary lifestyle
  • Low blood pressure
  • Medications
  • Multiple sclerosis (MS)
  • Pets that get underfoot
  • Parkinson’s disease
  • Poor footwear
  • Pneumonia
  • Spinal cord injury
  • Stroke
  • Uneven surfaces or terrain
  • Urinary tract infection
  • Vertigo
  • Vision loss
  • Vitamin D deficiency

Symptoms You Need Balance and Falls Prevention

Falls occur suddenly and without warning.  People have a natural reflex to react against falling, yet despite this reaction, falls still happen.  People rely on input from several systems in the body to respond to a potential fall.

If a fall does happen, the severity of injuries can vary.  Mild symptoms may include bruising, joint stiffness, and muscle soreness. This would be typical of strained or sprained soft tissue (muscles, tendons, and ligaments) that happened while protecting the person during the fall.

In other cases, symptoms can be quite serious.  Immediate medical attention is needed in the following circumstances:

  • Blurred vision
  • Deep cut with significant bleeding
  • Deformity of a joint
  • Hitting the head during the fall, or upon landing from the fall
  • Injuries to the face, neck, or head
  • Loss of consciousness or “blacking out” (before or after the fall)
  • Pain with or inability to bear weight or difficulty rising from the fall without significant assist
  • Severe, sharp joint pain immediately after the fall
  • Significant swelling of a joint
  • Suspicion of a fracture

Symptoms may not appear right away.  Sometimes, symptoms from a fall-related injury start a few days after the fall has happened.   It is important to monitor symptoms for a few days after a fall and seek medical care if new symptoms begin that did not occur right away.

Patients taking blood thinners need to be especially cautious.  A blood thinner can easily cause bruising and internal bleeding which may not be visible on the outside.  Being examined by a physician is recommended, even if no injuries are easily seen.

How Balance and Falls Prevention Diagnoses You?

Understanding why the fall occurred is very important.

Environmental reasons like throw rugs or improper lighting can be addressed with changes to the home.

If a medical condition is thought to be contributing to the fall, an appointment with a medical provider is necessary.  By asking questions about the patient’s history and what occurred around the fall, completing a physical examination, and assessing for injuries, a medical provider can get a clearer picture of the things that can be contributing to fall risk and develop a plan to address the problem.

Medical providers and physical therapists work closely together to treat patients who have fallen or are at risk for falling.

Balance and Falls Prevention Treatment

Physical therapists (PT’s) are the experts in movement and balance.  PT’s conduct an evaluation of the patient that includes assessment of the patient’s strength, flexibility, sensation, walking pattern, and balance.  They perform tests of the neurological system to see how well it is working and identify any areas that are not coordinating well.  Based on the findings of the examination, the PT and patient will develop a treatment plan and goals.

These four key areas are important to preventing and minimizing fall risk:

  • Balance training
  • Physical Activity
  • Medical Management
  • Environment/Home Modifications

A balance program developed by a PT will work to improve the patient’s ability to stay safe in varying conditions and environments.  This will test the patient’s balance systems to accept higher and higher challenges.  As the brain and body work together better, the patient becomes more confident as well, and their fall risk decreases.

Just as balance is important, so too is staying active.  Regular exercise is vital to good health, and that activity can be as simple as walking or gardening.  Some people enjoy bowling, yoga, fishing, or golf, and others like to do more intense activity like fitness classes or running.  The most important things are that the activity is enjoyable and can be done consistently.   Having an activity partner – a friend or family member who likes to do the same activity – helps make it more fun.  Before starting any exercise program, people are encouraged to talk to a medical provider to make sure they are safe to begin.

Beyond balance and staying active, regular check-ups and medical screenings are also important in preventing falls.  Some require an appointment with a medical provider, and some of these may be offered at community wellness fairs, which are often staffed by trained personnel from local medical facilities.

  • Medication review
  • Blood pressure check
  • Lab testing as determined by a medical provider
  • Foot screening (especially important for diabetics) to check for reddened areas, ulcers, blisters, or sensation loss
  • Vision examination
  • Balance screening

Other safety considerations of Balance and Falls Prevention

The home environment can be hazardous and can contribute to fall risk as well.  A few simple changes can make the home safer.

  • Eliminate clutter, electrical cords, and throw rugs from walkways
  • Install grab bars in showers, tubs, and around toilets
  • Stabilize furniture and keep it out of main walking paths
  • Install handrails on steps
  • Differentiate the edge of steps with a bright color of paint or tape
  • Make pets more visible or audible with a lighted collar or a bell
  • Install lighting in dark areas and use motion-detector lights
  • Turn on lights when getting up at night
  • Maintain exterior of home with regular snow removal, lawn mowing, and level sidewalks
  • Test and change batteries regularly in smoke and carbon monoxide detectors

Next Steps

Taking the first few steps to reduce fall risk is easy, and can be started by making some changes at home, scheduling an appointment with a medical provider, and doing a screening.

As consumers of health care, all patients have a choice in finding the right provider who meets their needs.

In all states, patients can see a PT first, without a physician’s order.  However, every state has different regulations and insurance carrier coverage may vary.  Physical Therapy Direct Access By State offers information on direct access in each state.

Find A Clinic will direct patients to a physical therapy provider in their geographical area and will help them identify one in their region that has top national outcome rankings.

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