What might be viewed as a “simple” fall can be incredibly devastating. In many cases, if an older individual falls and breaks a hip or other bone, they can quickly enter a downward spiral—and, unfortunately, even perish from the after-effects of such an injury.
Neuro Physical Therapist Laura Guse wants to greatly diminish that risk. She has, in the past, experienced a patient passing away in this manner—and is working diligently to make sure it doesn’t happen again.
“That was very sobering for me. And it really brought home the importance of the mission to decrease falls. Falls are bad. It’s important for us to do everything we can to help people lower the risk for falling because falls do change lives. Often, not for the better.”
Misconceptions Surrounding Balance Training
One misconception Guse hears is that older individuals, in their seventies, eighties, even nineties are “too old” to improve their balance. The truth is, anyone of any age can work to achieve better balance.
Another misconception is that simply walking more or focusing on strength training will improve balance. “I would ask those people, if you wanted to learn more about math, would you read an English book? It’s the same with balance and falls,” she notes. “If you want to get better at balance, would you just work on walking only? The answer to that is no, that is not going to improve your balance. You have to actually put in the work to do challenging balance exercises.”
Tests to Assess Balance
There has been extensive work done to create a set of balance tests which can predict if a person has an increased risk for falling. For example, there is a test called the “five times sit-to-stand, which is just what it sounds. The person stands up and sits down five times, arms crossed over their chest.
“They can’t use their hands to push up. Experts have given this test to a whole bunch of people and they’ve divided that group up into the people who are fallers and the people who are not fallers. It turns out that the people who are fallers are more likely to do that test in more than twelve and a half seconds. The people who do the test in less than twelve and a half seconds are in the group of not an increased risk for falling,” explains Guse.
This is just one test, that looks at one domain, but there are similar outcome measures for different walking tasks. For instance, stepping over items or walking around obstacles, looking to the right and to the left while they’re walking.
“Even just looking at the gait speed gives us a lot of information about whether or not they’re at increased risk for falling,” she adds.
Balance Training Recommendations to Get Back to Baseline
A systematic review looked at 44 different balance studies and compiled that data into general guidelines for how much time and what types of activities help individuals increase their ability to be balanced. The results of that analysis revealed that it would take more than 50 hours of exercise over time.
“I think that can be a staggering number for people to hear. But, for many people, it took them a long time to get into a position where their balance is not great. So, of course it’s going to take a little while to work back from that. We’re talking about probably four or five months, doing activities which actually challenge their balance,” states Guse.
What Happens at a Balance Training First Visit?
Guse assesses three primary factors when trying to decrease the risk of falling. She first asks people about their home environment. Are there stairs, and if so, do they have a railing? Are there grab bars in the bathroom? What about clutter, throw rugs, or even pets that a person might trip over?
Second, she looks at how individuals move throughout their day. Do they spend a lot of time on uneven surfaces (e.g. yard work, walking on roofs or up and down curbs, watching grandkids at the park)?
Finally, she checks individuals’ balance to get a sense of their overall risk for falling by using those standardized outcome measures.
“I’ll pay attention to which types of balance were giving them the most problems. For example, if they struggle with being able to take a step fast enough to prevent a fall, like if they slipped on the ice or something, that would require reactive balance. Do they have that skill set? Or, how about some typical walking tasks, like being able to turn around quickly while you’re working in the kitchen?”
Guse then creates an exercise program that’s focused only on a person’s unique issues.
Don’t Wait Until Tragedy Occurs
Ultimately, Guse encourages people to reach out if they feel like they might be entering a stage where they’re at an increased risk for falling. She mentions that there are many community classes available in which individuals can participate.
“A lot of the classes in the community do meet the criteria that’s needed. That can be a fun thing and a social thing and something people might even look forward to. If you feel like your balance is going down a little bit, take an active role in trying to get back to where you were because chances are you probably can improve it,” she notes. “Also, this is not for just yourself, but also for peace of mind for your family members.”
