According to the National Institutes of Health, falls are the leading cause of injuries for older Americans. Health care providers have spent many hours working with seniors to prevent falls, usually concentrating on strengthening exercises. In spite of that effort, the mortality rate from seniors' falls increased 39 percent from 1999 to 2005. Thankfully, however, a new treatment protocol may change things.
Several years ago, physical therapists, nurses, and physicians at Gentiva Health Services developed a fall prevention program that has produced impressive results. Nationwide, 96 percent of patients treated by the Safe Strides program showed a reduction in fall risks as measured by the standardized Berg and Tinetti tests.
According to Vicky Patrick, PT, the Safe Strides Director in Gentiva's local Midsouth Home Health office, the key to this success is that while traditional programs focused mainly on exercise, the Safe Strides program is designed to work on all the systems that influence balance.
"There are four systems that affect balance: the vestibular, the somatosensory, the ocular motor, and the muscular-skeletal" Patrick said. "The largest is the vestibular or inner ear system. Most people think that when you have inner ear problems, you're dizzy." But with seniors, it's usually subtler than that. Their vestibular system is like a weak muscle that hasn't been exercised. "Seniors tend to keep their bodies, particularly their heads, stiff and still because they're don't want to fall. But you have to move your head around to stimulate the inner ear. You can stimulate the inner ear with something as simple as a rocking chair, where you're moving back and forth, so the fluid in your ear is moving." Patrick and her staff will walk with patients, encouraging them to turn their head to each side and to look up at various things, as they move.
The somatosensory system deals with the brain's ability to process inputs and have a reaction. "Have you ever stepped on a stone where your ankle twisted, then immediately popped back into position?" Patrick asked. "The sensation of your foot being in an awkward position goes to the brain, which corrects it, resulting in the muscle response to pull the ankle back right."
Some seniors with poor circulation or diabetics who've lost circulation in their feet have a hard time feeling the floor, making it difficult to balance. "Their feet feel like blocks of wood," Patrick said. "We want to help people re-learn where their body is in space, so that when they have a loss of balance, they can correct it. We'll have them walk barefoot in grass, or on a plush carpet, or they might stand on a four-inch thick foam pad. We want them to be able to feel the surface they're on, which will enhance the working of their somatosensory system."
When working with the ocular motor system, Patrick explained that they are not so much concerned with the patients' actual vision, but rather with their ability to track an object and to focus on something. "Suppose you're in line at the grocery," Patrick said. "And someone calls your name from behind. Your ability to keep your balance as you're turning around, and to immediately focus on the person behind you is controlled by your ocular motor." If this isn't functioning well, seniors can become disoriented when turning fast and fall. To facilitate improvement here, Midsouth therapists have patients stare at an object, remaining focused on the object while turning their head from side to side.
The key is enhancing all these senses. "The brain gets information from the eyes, the inner ear, and the feet, and reacts to that information, which is all balance is," Patrick said. Developing these senses is particularly important when other senses, like eyesight, wane with age.
After working with these three sensory systems, the Midsouth therapists focus on the muscular skeletal system, doing basic strengthening exercises. All the programs are done at patients' homes or at assisted living facilities, where patients reside.
Midsouth keeps performance statistics, testing patients when they begin and again when they complete the program. The Birmingham Midsouth program has matched the Gentiva national success rate, with 96 percent of patients showing improvement.
Of course, in order to maintain their improvement, patients must continue practicing the program, and thus far, they appear to be doing that, as follow up evaluations have found close to 92 percent of patients have not had any falls in six months to a year after completing the program.
The results have been gratifying for Vicky Patrick. "When I see someone who's been scared because of a horrible fall, someone who's scared so badly that they change their lifestyle, to see them get back up and believe they can handle things now, makes the job really worth it."
