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The Balance and Fall Prevention Center at Ohio Valley Hospital
By Nancy Kennedy


Good balance is one of those things that we take for granted – until we lose it. A balance disorder makes it difficult to navigate and function in daily life, and can cause secondary problems such as loss of appetite, depression and a diminished quality of life. The greatest problem, though, is that loss of normal balance increases the risk of falling, and a bad fall can be devastating, especially for seniors, leading to serious injury, loss of independence, disability and even death. According to the Centers for Disease Control and Prevention (CDC), one in four people age 65 or older will experience a fall this year, and one in five falls will cause a fracture, head injury or hip injury.

Falls are common, but they are not an inevitable part of aging, says Virginia Renegar, P.T., M.S., a staff physical therapist at Ohio Valley Hospital’s Rehabilitation Service and an expert in balance disorders, vestibular rehabilitation and fall prevention. “My focus in the Balance and Fall Prevention Center is primarily balance,” she explains. “The vestibular system ages just like the skin and the eyes, but you can improve your balance through exercises and special training, which we provide to each patient with an individualized plan. Even if you are fit and healthy, anyone can get a disease that causes problems in the vestibular system. Inner ear problems, ear infections, neurological conditions, concussions and stroke are some of the conditions that can impact the vestibular system.”

Balance is complex. It’s defined as the ability to maintain the body’s center of mass over its base of support, and the body achieves and maintains balance through an intricate system of sensory input, musculoskeletal and central nervous system mechanisms. Poor balance is often caused by a combination of problems that affect several of the systems that control balance.  There is often not a clear cut answer or single diagnosis to explain poor balance, which can be frustrating for people. People with balance disorders may experience vertigo, dizziness, nausea, anxiety and depression; some will become sedentary due to their fear of falling. A sedentary lifestyle leads to deconditioning, loss of stamina and an increased risk for heart disease. It also leads to increased fall risk.

Every second of every day, an older adult falls, reports the Centers for Disease Control, and some of these falls will result in serious injury, death and loss of independence. But there are simple ways to decrease the risk of falling.
People who have good balance can do exercises to maintain it; others who may be experiencing problems with balance should see their primary care physician, who may order tests to determine the cause. In either case, the fall prevention program at Ohio Valley Hospital offers individualized therapy plans to help maintain or improve balance. If you have fallen, or if you feel unsteady when you stand or walk, be sure to tell your physician. Certain medical conditions and medications can increase the risk of falling, and your doctor can help determine your risk.

Tips to prevent falls:

• wear good shoes that fit well
• get an annual eye exam and update your glasses - ask your doctor to review your medications with you
• make your home safe by having good lighting, minimal clutter, and grab bars in the bathroom
• do not use throw rugs in your home
• have railings put on all staircases

Vestibular rehabilitation is a specialized branch of physical therapy that aims to alleviate or improve problems related to vestibular disorders. Renegar has additional training in vestibular rehabilitation and works one-on-one with her patients.  Patients first have a comprehensive evaluation of their needs and abilities, then a customized exercise program to strengthen muscles and improve balance is developed. Patients learn to negotiate uneven surfaces, curbs, and stairs and to maintain balance while making directional changes. Strengthening the muscles in the legs is one component, and is critical to healthy aging. “People lose 1% of their leg strength every year after age 50, and ½% of their bone density. Loss of strength can be addressed,” Renegar says. The key, she says, is consistent exercise. Most people respond positively to the program and will gain increased strength and balance. “I get a sense of satisfaction when a patient tells me, ‘I walked up the stairs without even thinking about it, ‘” Renegar says.

A common cause of chronic balance problems is benign paroxysmal positional vertigo, or BPPV. BPPV is a sudden sensation of spinning that occurs when a person changes directions quickly or moves the head abruptly. It is not a serious condition but it can lead to falling. BPPV is treated with repositioning maneuvers, most commonly the “Epley” maneuver.  This type of vertigo usually responds quickly to treatment.

For those with balance issues, the CDC has a program called STEADI: Stopping Elderly Accidents, Deaths and Injuries, which healthcare professionals can use for screening for balance problems.  The Otago Exercise Program is an evidence based exercise program that is available through physical therapy providers.  It includes exercises for balance and strengthening as well as a walking program.
                 

In addition to the specialized Balance and Fall Prevention Program, Ohio Valley Hospital’s Rehabilitation Service offers a broad range of programs designed to return people to their optimum state of mobility and functioning following injury, illness, surgery or a decline in health. Physical therapy, therapeutic Pilates, speech therapy and occupational therapy are offered for both inpatients and outpatients.

To learn more about Rehabilitation Services at Ohio Valley Hospital, visit www.ohiovalleyhospital.org.



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