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FALL PREVENTION AND BALANCE

 

The function of balance is to maintain stability and relative position in space, while under constant flux. The processing required to interpret and act upon this chaos, is accomplished by a series of sensorimotor control systems and functionally connected networks. The primary structures consist of the inner ear vestibular system, the visual system, and sensory information (proprioceptive) delivered from the extremities via the spine and neck to the brainstem and cortex. From these inputs, the balance system launches corrective factors in the form of reflexes and motor actions that can keep the eyes on a target, while maintaining head and body positions that stabilize the body’s center of gravity.

 
The number of neurons and mechanical actions that are taken by the body are in the billions. Standing erect is an evolutionary wonder, running is even more amazing, and playing competitive sports is the epitome in memory, learning, balance fine-tuning, and neuroplasticity.As a result of the rudimentary origins of balance,the system is designed to adapt to injury with retraining.A human learning how to run on blades following bilateral amputation at 11 months old is a prime example (picture of Oscar Leonard Carl Pistorius). With correct training, the neuroplastic changes that occur create and sustain functionality.

Although there are a variety of conditions that create balance disorders, there are also solutions that lessen the effects or resolve the issues all together. These can be mechanical, such as in Benign Postural Positional Vertigo (BPPV) where realigning the inner ear crystals (otoconia) resolves the issue. Solutions for ear or brain disease or trauma center on physical training, strengthening, and vestibular rehabilitation therapy. The importance of therapy is to create balance system memories and leaning, which in turn make changes in the brain that improve mobility and stability. However, fall prevention is not only medical intervention and balance therapy. It is a practical approach fostering self-management focused on the understanding of fall risk situations and compensatory strategies that can be used to avoid falls. Knowing individual physical abilities and limitations, eliminating environmental obstacles, and maintaining physical activity to support mobility and balance skills.
 

Balance Statistics

 
According to the Centers for Disease Control and Prevention, 800,000 people a year are seen in emergency rooms for falls, typically for bone fractures or head trauma. This is especially critical in the elderly population as 300,000 are hospitalized for hip fractures, of which 20% result in deaths and another 20% are moved into nursing homes.
Among the elderly, between the ages of 65 to 75, who do not report any major health problems or acute balance disturbance, 25% to 35% report a dangerous fall annually. For persons over 75 years of age, the rate of falls increase to 32% to 42%. This makes fall risk screening, balance testing, diagnosis-based strategies, and rehabilitative therapy important issues in modern medicine.
The best outcomes are acquired when a team of specialists collaborate in the diagnosis and treatment early-on when symptoms begin and well before chronic symptoms develop along with anxiety and depression. The costs are not only limited to the actual dollars spent ($31 billion annually), but to the individuals and their families who suffer from loss of function and in some cases, life itself.
 

Symptoms

 
Disorders of balance that produce dizziness or vertigo can be divided into three primary categories; 1). Those produced by vestibular lesions (peripheral, ear), 2). Those that are a result of a central nervous system malady (central, brain), and 3). Those that have both (multifocal). These patients, not including those with peripheral neuropathy of the hands, feet, and legs, complain of a variety of symptoms include the following taken from a number of sources:

 
Primary Complaints
Vertigo
Lightheadedness
Motion Dependent Dizziness Nausea
Vomiting
Disequilibrium
Oscillopsia – visual field motion Visual Sensitivity
Floating or Falling

Secondary Complaints
Fatigue
Headaches
Anxiety
Agoraphobia
Muscle Tension Physical Deconditioning Neck Problems
Seizures 
Sound or Light Sensitivity

Causations

In many common balance disorders, the symptoms are frequently an indication of the type of disorder or disease. For example, vertigo with nausea or vomiting is most often the result of an ear affliction, whereas lightheadedness and unsteadiness may point to either central or peripheral causations. A central causation could be a result of high blood pressure or as complex as multiple sclerosis, hydrocephalus, or traumatic brain injury, whereas, an ear infection or Meniere’s disease would be ear related.
 

To identify the areas involved, diagnostic testing of the ear and brain including nystagmography, electrophysiology, and psychoacoustic testing, and physical measures are often required follow medical evaluation. The results of these findings in conjunction with other tests are important in determining potential causations and ultimately in designing treatment. Primary causations of dizziness complaints include autoimmune, vascular, and neurological diseases, acoustic and barometric trauma, head or neck injury, medications, skeletal and muscular disorders, hormone imbalances, and infection amongst others. The physicians who specialize in balance provide a variety of tests to identify potential causes and provide a variety of medical interventions. For example,

In the clinical view, patients with sites of lesion in the ear or brain have symptoms that last for seconds, minutes, hours, days, months, or years. Most disorders occur in different time domains because of the mechanisms involved. For example, BPPV lasts for seconds, migraine related vertigo with nausea and vomiting can last for hours, damage from viral infections can last for months, and bilateral vestibular loss produces chronic unsteadiness when walking, but not when sitting still in a lite room will require special consideration.
 

Treatments
 

The best outcomes for treating balance disorders After obtaining any necessaryFall Prevention Treatments emergency medical treatment for acute distress, the cause and mechanisms in the balance network that are involved need to be determined. Outcome of treatment evidence shows that early treatment and intervention reduces the This starts with an evaluation by the primary care physician and then a Neurologist or ENT physician, and an Audiologist. The Audiologist will provide a series of diagnostic tests to identify the site of lesion, degree of severity, and provide a rehabilitating plan frequently working with physical therapists.
 

Results from physical therapy can be divided by type of injury to the balance system. The ability of the central nervous system to rebalance the Improvement from Vestibular Rehabilitation Therapy (VRT) provides significant benefit, even for those with more significant disorders. From the American Institute of Balance the following diagnostic categories cover the range of balance disorder types. From a variety of sources, the amount of average improvement from adaptation, substitution, or repositioning therapies is suggested.


 

Treatment regimens for the different disorder types vary considerably. In the case of BPPV, one 10-minute session using Canalithic Repositioning can resolve the vertigo, in unilateral vestibular losses, three months of physical therapy exercises twice a day is typical, and even longer for those with central deficits.
 

Fall Prevention
 

Fall prevention requires a proactive position. Most elderly patients feel that the ability to stand and walk means that they are balance adequate. However, this is far from the truth. Based on the epidemiology, starting at the age of 65 years old, a balance screening should be conducted. To reduce the incidence of fall is not just taking care of a balance disorder with specialized therapy, but an integrated approach to lifestyle, mindfulness, and maintenance. As humans age, reflexes and strength decrease putting balance and stability at risk and an important lifestyle concern needing accommodations. Adding and using handrails in the home, removing area rugs, keeping areas well lit, and not walking backwards, are some examples. Being mindful of the surroundings, including steps and other obstacles or being aware of fatigue causing weakness must be added to the daily lexicon. Most importantly, physical exercise, including long walks, housework, gardening, and social engagement are important in maintaining strength and balance through practice. Physical and Occupational therapists working in hospitals and private clinics provide a wide variety of services in these areas.

The balance system is not one system, but a network of systems that complement each other to produce stability in a chaotic environment. When balance is disturbed either by disease, age, or accident, the type of damage to the ears or brain have specific symptoms and testing findings that aid in the diagnosis, treatments, and rehabilitation regime. To reduce the risk of falling, seniors may consider home and public accommodations, being aware of the obstacles to better balance, and maintaining a degree of physical competency.

 

Treatments

The best outcomes for treating balance disorders After obtaining any necessary emergency medical treatment for acute distress, the cause and mechanisms in the balance network that are involved need to be determined. Outcome of treatment evidence shows that early treatment and intervention reduces the This starts with an evaluation by the primary care physician and then a Neurologist or ENT physician, and an Audiologist. The Audiologist will provide a series of diagnostic tests to identify the site of lesion, degree of severity, and provide a rehabilitating plan frequently working with physical therapists.

Results from physical therapy can be divided by type of injury to the balance system. The ability of the central nervous system to rebalance the Improvement from Vestibular Rehabilitation Therapy (VRT) provides significant benefit, even for those with more significant disorders. From the American Institute of Balance the following diagnostic categories cover the range of balance disorder types. From a variety of sources, the amount of average improvement from adaptation, substitution, or repositioning therapies is suggested.

 

Treatment regimens for the different disorder types vary considerably. In the case of BPPV, one 10-minute session using Canalithic Repositioning can resolve the vertigo, in unilateral vestibular losses, three months of physical therapy exercises twice a day is typical, and even longer for those with central deficits.

Fall Prevention

Fall prevention requires a proactive position. Most elderly patients feel that the ability to stand and walk means that they are balance adequate. However, this is far from the truth. Based on the epidemiology, starting at the age of 65 years old, a balance screening should be conducted. To reduce the incidence of fall is not just taking care of a balance disorder with specialized therapy, but an integrated approach to lifestyle, mindfulness, and maintenance. As humans age, reflexes and strength decrease putting balance and stability at risk and an important lifestyle concern needing accommodations. Adding and using handrails in the home, removing area rugs, keeping areas well lit, and not walking backwards, are some examples. Being mindful of the surroundings, including steps and other obstacles or being aware of fatigue causing weakness must be added to the daily lexicon. Most importantly, physical exercise, including long walks, housework, gardening, and social engagement are important in maintaining strength and balance through practice. Physical and Occupational therapists working in hospitals and private clinics provide a wide variety of services in these areas.

The balance system is not one system, but a network of systems that complement each other to produce stability in a chaotic environment. When balance is disturbed either by disease, age, or accident, the type of damage to the ears or brain have specific symptoms and testing findings that aid in the diagnosis, treatments, and rehabilitation regime. To reduce the risk of falling, seniors may consider home and public accommodations, being aware of the obstacles to better balance, and maintaining a degree of physical competency.

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