Balanced Physical Therapy

Balanced PT distributed this article to area doctors on 10/25/07

With your help, many of the fall injuries experienced by our community dwelling seniors can be prevented.  Identifying those at risk for fall injuries and referring those patients to fall prevention programs could help thousands of seniors right here in the Durham / Chapel Hill region.  Please consider Balanced Physical Therapy’s Balance C.A.M.P. for any person screened positive for risk of accidental falls.   When you prescribe fall prevention, most good physical therapists will put patients through a course of proprioceptive rehabilitation, lower extremity strengthening, and gait training.  Balanced Physical Therapy’s Balance C.A.M.P. provides your patients with the added advantage of thorough vestibular assessment and rehabilitation. 

Falls present a serious threat to seniors, both physically and emotionally.  More than a third of seniors age 65+ fall each year, and 20% to 30% of them suffer moderate to severe injuries that reduce mobility, reduce independence, and increase the risk of premature death.¹Â  Elderly persons who fall are three times more likely to be committed to a nursing home.²Â  One quarter of elderly patients who have fallen report that fear of falling again causes them to avoid essential activities such as mobility in the home, bathing, and dressing.³Â  The literature shows strong consensus that family practitioners should screen every adult age 65+ for risk of falls.

Studies published in the Journal of the American Medical Association, Annals of Internal Medicine, and other journals have shown prescriptions for physical therapy to reduce accidental falls among seniors.^4-6  Vestibular rehabilitation for both central and peripheral disorders also has strong support from the literature.^7-16  Balance C.A.M.P. can reduce the risk of fall injury for any one of your patients screening positive for risk of falls.  For each patient, Balance C.A.M.P. begins with a thorough assessment that will identify very specific characteristics that can contribute to accidental falls (e.g. gaze instability, leg weakness, suboptimal proprioception, postural deficits, gait problems, limited range of motion, etc.).  The assessment will help Balanced PT therapists choose specific training and rehabilitation paths that address each patient’s specific deficits.  We find this individualized approach more efficient and more effective than putting every patient through essentially the same course of therapy.  Balance C.A.M.P. often reaches vestibular rehabilitation goals in two to fifteen visits and orthopedic rehabilitation goals in eight to sixteen visits.  Patients achieve the very best long-term results when they maintain and build on their gains by continuing exercises at least once per week, long-term.  Like most good fall prevention programs, Balance C.A.M.P. empowers patients with a home exercise plan, but Balance C.A.M.P. also provides your patients with the convenient option of joining a fun and supportive exercise group at Balanced Movement Studio. 

References

1. Alexander BH, Rivara FP, Wokf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992; 82 (7): 1020-3.
2. Kiel DP, O’Sullivan P, Ten JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care 1991;29:221-8.
3. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-7.
4. Province MA, Hadley EC, Hornbrock MC, Lipsitz LA, Mulrow CD, Ory MG, et. al. The effects of exercise on falls in elderly patients: A pre-planned meta-analysis of the FICSIT trials. Journal of the American Medical Association 1995;273:1341-7.
5. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Annals of Internal Medicine 1994;121:442-51.
6. Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Physical Therapy 1993; 73(4):254-65.
7. Herdman SJ, Clendaniel RA, Mattox DE, et al. Vestibular adaptation exercises and recovery: acute stte after acoustic neuroma resection. Otolaryngol Head Neck Surg. 1995; 113:77-87.
8. Strupp M, Arbusow V, Maag KP, et al. Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology. 1998;51:838-844.
9. Yardley L, Beech S, Zander L, et al. A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care. Br J Gen Pract. 1998; 48: 1136-1140.
10. Blatt PJ. Unilateral vestibular lesions secondary to acoustic neuroma: review and case studies. Neurology Report. 1996; 20:30-40.
11. Borello-France D, Whitney SL. Physical therapy management of patient with bilateral peripheral vestibular loss: a case report. Neurology Report. 1996;20-54-60.
12. Cass SP, Borello-France D, Furman JM. Functional outcome of vestibular rehabilitation in patients with abnormal sensory-organization testing. Am J Otol. 1996;17:581-594.
13. Cohen H, Miller LV, Kane-Wineland M, Hatfield CL. Vestibular rehabilitation with graded occupations. Am J Occup Ther. 1995; 49:362-367.
14. Burton JM. Physical therapy management of a patient with central vestibular dysfunction: a case report. Neurology Report. 1996; 20: 61-62.
15. Fitzgerald DC. Persistent dizziness following head trauma and perilymphatic fistula. Arch Phys Med Rehabil. 1995; 76: 1017-1020.
16. Gill-Body KM, Popat RA, Parker SW, Krebs DE. Rehabilitation of balance in two patients with cerebellar dysfunction. Phys Ther. 1997; 77:534-552.

©BMA 2008