Category: Balance

How to Prevent Falls and the Injuries that Can Happen

11/19/2020

How Falls Happen?
Falls can happen to anyone. Falls can happen in a variety of ways. And sometimes falls can cause injury, not just to our pride but also physically.

Although falls can happen to anyone, our risk increases as we age.

Falls are the leading cause of injury among older Canadians, and
20-30% of seniors experience one or more falls each year.

Don’t let these stats scare you. We are all bound to fall at least once in our life whether that be:

tripping over some toys,
slipping on ice, or
losing our balance

What is important to know that falls can be prevented and shouldn’t be something we have to worry about as we age.

Causes of falls may include

poor balance
decreased muscle strength
reduced vision or hearing and
unsafe conditions in and around the home.

Luckily these are all factors that can be modified or improved to help keep you on your feet.

How to Prevent Falls
1) Stay Active

“Move it or lose it”. Staying active is so important to help reduce your risk of disease, declining cognitive function and of course falls. Engaging in physical activity is one of your best defences against falls.
Myth: “If I limit activity, I will not fall”. Doing less can actually increase the risk of falling as it leads to decreased strength and endurance.
Exercising and staying active builds strong muscles to improve your balance, strength and mobility which are all needed for falls prevention.
Strength or resistance training can help build strong muscles, while cardiovascular training can help build up your endurance. Improving your endurance helps to keep you active for longer periods of time without needing to take a rest break.
Strength and endurance training don’t require fancy gyms or equipment – they can include body weight exercises that can be done in the comfort of your own home. If you are curious about how to build your strength and endurance, talk to your physical therapist.

2) Improve your balance

Improving your balance can lead to reduced falls and fear of falling, faster walking speed and overall improved physical functioning.
Balance relies on three body systems:
- Proprioception – our muscles and joints provide information that tells us where our body and limbs are in space
- Vestibular system – small canals in your inner ear that detect your head movements and its position in space
- Visual system – being able to see our environment to determine if there are any incoming hazards that may throw you off balance.

If you find you are having trouble with your balance, speak to your physical therapist. A physical therapist can help determine if one of these three systems is under performing and provide you with specific exercises to get the system back on track and improve your balance.

3) Reduce fall hazards in your home

Be mindful of pets – leashes and wandering pets can trip you up.
Avoid having boxes or small items on the floor. Keep them on a shelf at eye level or out of the way of frequent walking paths.
If possible avoid having area rugs in your home. Especially for those who tend to shuffle their feet, it is easy to get caught up in the rug and fall.
Keep pathways and stairwells well lit, especially at night. You may want to consider using a night light.
Consider installing equipment to help you get around your home. This can include:
- grab bars to help stabilize and/or pull you up
- hand rails in stairwells
- a bed rail to help you get in and out of bed
- or a Lifeline medical alert system that will notify a service provider if you do fall.

Consider speaking to a physical or occupational therapist as they can help you choose the right aid for your home.

4) Walking Aids

Consider using a walking aid or cane which can provide support to help you get around easier. Don’t be embarrassed about using aids for daily living – they not only help keep you safe but active as well.

If you are someone who struggles with balance or has a history of falls, come and talk with one of our physical therapists who can help you reduce your risk and fear of falling.

We have created some simple videos on Senior Strength that you or someone you know may find beneficial --- be sure to check them out!

If you live in the Luther Care Village in Stonebridge, don’t miss out on a presentation on November Thursday 19th at 2:30 by physical therapist, Alex, as she talks about falls and falls prevention.

References:
https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publications/publications-general-public/you-prevent-falls.html#health

Alex Wojcichowsky

Physiotherapist

Alex's Bio

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Balance - Vestibular Components, Visual Inputs, and Proprioception

5/17/2019

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Balance is a difficult concept to define. Some people seem to have a natural sense of their own body in space, others are chronically tripping over thin air and running into furniture. There are several different systems in the body that must work together cooperatively to maintain normal balance. These chiefly include the vestibular system, the visual system, the brain/brain stem, and the muscles and joints of our body. Each of these play a different role in the coordination of balance.

Vestibular system:
The vestibular system itself has multiple components that contribute to the sense of our position in space and the movement of the head in relation to the body. These include the semicircular canals and the organs that reside within our inner ear. The semicircular canals include three different structures that are oriented in three different planes, anteriorly, horizontally, and posteriorly. These are paired between the left and right side in such a way that both sides will provide the same information to the brain no matter the position that the head is in.

Next to the semicircular canals are the utricle and saccule. These sensory organs also help to provide information on the position of our head in space, but are more interested in acceleration both vertically and horizontally. Inside these organs are small crystals or otoliths that are embedded in the cellular membranes. Since these otoliths are a bit denser than the surrounding tissues and fluids, they are acted on by gravity more powerfully. When our head moves quickly or changes speed in general, these pressures in the utricle and saccule create electrical signals for the brain to interpret and coordinate.

Visual system :
We rely on our vision a great deal when it comes to orienting ourselves in space and with our environment. The eyes provide a wealth of information about where we are, how we are moving, and allows us to keep track of all of the elements in an ever-changing environment. The visual system has a very close relationship to the vestibular system and the brain/brain stem. In fact, there are a series of reflexes that exist within the brain that allow our eyes to hold steady in difficult circumstances, such as reading in a bouncing car, or being able to follow objects even as we change the orientation of our head such as watching a plane fly overhead. These reflexes rely on the ability of the brain and vestibular system to agree very closely on the position of the head and the necessary eye movement to keep everything in focus.

If there are any discrepancies in this communication it can lead to a feeling of slowness, eye fatigue, and accompanying dizziness and disequilibrium. There is a constant rechecking going on that makes sure that what the eyes are seeing and the vestibular system are reporting match up. What this means is that any compromise to vision or even changes in lighting can affect this communication and relationship.

Muscle and Joints:
The muscular system and proprioception are another key component of balance. The feet act as our contact point to the environment when we are standing or walking. The feet themselves are quite sensitive and good at measuring both pressure and force in a fine-tuned manner. I like to think of it as the steering wheel on the highway, it never holds perfectly still even when the road is straight and the constant adjustments and small twitches are what keeps everything in place in a dynamic fashion.

The information from the feet and ankles is sent to the brain to provide a sense of how our body is oriented. When walking on an incline or a decline this can get more complicated, with more muscle activity and more information being sent to the brain. If this information conflicts with the information from the vestibular or visual systems there can be confusion in the processing in the brain and a lack of ability to adapt to the environment (such as missing a step or stumbling/staggering).
All of these fine-tuned movements and measurements happening in the body allow for a number of places where things can break down. Sometimes, this system alone can lead to balance difficulties as inaccurate information from the feet, ankles, joints, and muscles can lead the brain to make poor decisions based on faulty information. Even in people who are experiencing primarily vestibular dysfunction it is often necessary to train the muscles of the lower extremities to develop control, strength, and power. The strength and power are often overlooked, particularly in an older population, but it is vital that the muscles of the foot and ankle be able to make the adjustments needed to maintain balance.

What can happen in some situations is that the brain will recognize an adjustment needs to be made, perhaps in a more challenging environment, but the ankles and feet are not powerful enough to make the necessary correction. This can lead to stumble, stagger, or fall, depending on the situation. Beyond the feet and legs themselves there is also the consideration of the core musculature that holds our spine and hips stable while moving or statically positioned. These muscles and the general control of this area from a proprioceptive perspective can greatly affect the control of our bodies and provide other strategies for maintaining balance outside of the ankle. While the ankle is the first line of defence for the average challenge to our balance, the hips and lower back can create changes in the center of gravity.

In an ideal situation, a small challenge to our balance would rely largely on the ankles and their respective muscles to adjust. However, if the challenge is large or fast, the hips can shift to absorb some of the force and to significantly alter the center of gravity. If the movement of the hips themselves is not enough, leaning the trunk/torso by utilizing the core musculature can also be implemented to regain or maintain equilibrium.

All of this is happening in a fraction of a second and is typically coordinated by the brain without much conscious effort. That being said, it is possible to train these responses and these systems. Much like any skill, progressive practice and repetition with guidance from a skilled practitioner can typically provide improvement in strategies and functional outcomes.

~Trent, PT

References

Vestibular Rehabilitation: 4th Edition. Herdman, Susan. Clendaniel, Richard. ISBN 9780803640818. F.A. Davis. July 2014.
Current concepts and future approaches to vestibular rehabilitation. Tjernstrom, F., Zur, O., Jahn, K. J Neurol 2016. DOI 10.1007/s00415-015-7914-1.
Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis. Lesinski M., et al. Sports Med 2015. DOI 10.1007/s40279-015-0375-y.

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How to Prevent Falls and the Injuries that Can Happen

Balance - Vestibular Components, Visual Inputs, and Proprioception

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