Fall Prevention Program

Falling among older people and the neurologically ill is a challenging problem with potentially serious consequences. Much research has gone into determining effective intervention programs to address this concern. Because recurrent fallers are most likely to experience injury from repeated episodes, they constitute an important target group for diagnostic and preventative efforts. At The Clinic for Neurology we provide a comprehensive evaluation to determine the origin of imbalance and develop an effective and individualized treatment plan taking into consideration the patients lifestyle, medical condition, and individual needs.

Evaluation Tools

Evaluation tools include video Electronystagmography or VNG to help differentiate if the problem originates from the central or peripheral nervous system, Computerized Dynamic Kinesthetic Ability Trainer (CDKAT) assessment to test the patient's ability to coordinate vision, proprioceptive, and vestibular systems in keeping their balance, and a comprehensive evaluation by our physical therapist. The physical therapy evaluation includes determination of fall risk factors, both extrinsic and intrinsic, a BERG balance test, assessment of strength and flexibility, and gait and postural assessment. A physical therapy program is designed to address deficits in any of these areas as well as teaching proper fall recovery and development of an effective home program. A neurological exam by one of our neurologists is available upon your referral.

The Dizzy Patient

The dizzy patient can be a challenge to diagnose. More than 200 conditions can produce symptoms of dizziness. The VNG helps the neurologist determine if the dizziness is originating from the inner ear or the CNS. The Epley maneuver has been determined to be 80% effective in treating vertigo resulting from Benign Paroxysmal Positional Vertigo. The physical therapy program is specifically designed to treat the dizziness with an understanding of the cause of the dizziness. Vestibular therapy consists of individualized exercises designed to habituate excessive visual dependence or improve various balance strategies.

CDKAT

The computerized dynamic kinesthetic ability trainer is a machine consisting of a dynamic platform on which the patient stands, a computer screen providing a visual prompt requiring the patient to shift their weight and follow a cursor. The patterns require the patient to either hold statically or move to the extremes of their limits of stability in circles, squares, crosses or diagonal patterns. Hand rails are provided. The patients find this type activity both challenging and fun. Normative data is available and currently being updated.

Extrinsic Reasons Contributing To Fall Risk (from above)

1. Poor or excessive lighting
2. Loose carpets and cords
3. Fragile support structures
4. Use of standard low toilet seats
5. Slippery floor surfaces

Intrinsic Reasons Patients Fall (from paragraph above)

1. Weakened hip strategy or ankle strategy
2. Weakened large muscle groups, particularly the lower extremity extensors
3. Decreased flexibility, specifically of the lower extremity flexors
4. Fear due to recent fall or deconditioning
5. Dizziness or Vertigo
6. Poor visual acuity
7. Neuropathy or other sensory deficits
8. Arthritic conditions and leg edema

BERG Balance Scale

The BERG Balance Scale discriminates older alder adults at risk for falls. It has been shown to have excellent inter-rater and test-retest reliability and good internal consistency. Fifteen skills are tested, ranging from easier to more challenging, beginning with sitting balance and concluding with single leg stance. The risk for falling has been correlated with the score on the BERG test. To measure functional gait skills, the Dynamic Gait Index is a very useful tool we use. This helps us determine how a patient negotiates visual and physical obstacles when walking. Functional goals can be set using these assessment tools.

How to Refer A Patient To Our Program

• If your patient is experiencing vertigo and you would like a videonystagmography test, they will need a prescription stating “VNG”. We can fax the pre-test instructions to you or mail them to the referred patient.
• If the primary problem is falling or imbalance, the physical therapist can treat by direct referral from any physician with a prescription for physical therapy evaluation and a qualified diagnosis such as gait disorder, or other diagnosis of musculoskeletal or neurological origin. In addition to evaluating the patient’s balance, the physical therapist can also treat musculoskeletal problems the patient may be having. Please indicate on the referral if other areas need attention.
• Finally, if you wish to refer your patient for neurological evaluation, Dr. Hull or Dr. Morgan will happily accept your referral and then determine how or if our program might be helpful.

To refer a patient for physical therapy or VNG testing, click here for a prescription form. You may fax the completed form to us at 256-551-1902. Any additional information you can send will always help us better treat your patient. We will inform you of test results and/or progress.

HOW CAN EXERCISE HELP PREVENT FALLS?

Balance Therapy” provided by a physical therapist specializing in fall prevention emphasizes body awareness and improvement of reactive strategies to regain stability when balance is lost. Studies suggest that having adequate muscle strength and flexibility alone are not enough to maintain balance. The body’s balance system is very complex, relying on kinesthetic, visual, vestibular and other sensory coordination. Balance training “specificity” is a key component to preventing falls. Athlete’s use this principle when training for a specific event. Maintaining adequate balance to live and function into later life must also be “training specific”.

While strength and flexibility are important, balance as a skill must also be emphasized in a “fall prevention program.”

To train balance, postural control strategies are used. An “ankle strategy” is used when the body moves as a single entity about the ankle joint, in other words, swaying the upper and lower body in the same direction. This strategy is subtle and used to maintain postural stability. Impairments in the central or peripheral nervous system will alter one’s ability to maintain normal postural stability. Adequate flexibility and strength in the ankles and adequate foot sensation and proprioception are necessary in using an ankle strategy.

To prevent an impending fall, a “hip strategy” may be used, where the upper and lower body move in opposite directions to control balance. An effective hip strategy requires adequate hip range of motion and power, and particularly lateral stability. When hip or ankle strategies are inadequate to maintain balance and cannot be improved, an assistive device is necessary to improve safety.

When a force results in displacement beyond the maximal stability limits, a “step strategy” can be used. Taking a step widens the base of support and alters the center of gravity. To utilize a step strategy, one must have adequate central processing, a rapid response time, and adequate lower body muscle strength, power, and flexibility.

These strategies come natural to the young and “able bodied” person. Physical inactivity in the elderly contributes to loss of muscle strength, especially the antigravity or postural muscles, loss of flexibility, and decreased speed in which they execute their movements. Older adults with dysfunctional vestibular problems feel dizzy or unsteady and are experiencing associated alterations in their sensory systems.

Multiple systems contribute to maintaining one’s balance and mobility.

Sensory, motor, and cognitive systems are integral in the development and maintenance of good balance and mobility. Age associated changes can be addressed by a multidimentional program including physical therapy for “training specificity” and improving fitness.

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