Physical Therapy for Balance and Fall Prevention

About Fall Risk Assessment, Treatment, & Prevention Planning

According to the U.S. Congress Fall Prevention Act, falls are the leading cause of injury deaths among individuals who are over 65 years of age. The 65+ population will double by 2030.

The Fall Prevention Act found that, “A national approach to reducing elder falls, which focuses on the daily life of senior citizens in residential, institutional, and community settings is needed. The approach should include a wide range of organizations and individuals including family members, health care providers, social workers, architects, employers and others.”

Since 2003, the U.S. Congress has funded education and research, enacted the Keeping Seniors Safe From Falls Act of 2006, and most recently the Safety of Seniors Act of 2007.

As a result, Medicare now recommends that all Medicare patients receive an annual Fall Risk Assessment.

At Optimum Wellness Centers, the assessment is just one part of a complete program to help reduce the risk of falls. This page explains our comprehensive program for assessment, treatment, and prevention.

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Picture of balance and fall prevention physical therapy session.

1 Balance & Fall Risk Assessment: Simple & Painless

Picture of woman gripped to a cane who is afraid of falling

A fall risk assessment is the first step for reducing fall risk and reducing the fear of falling.

A major problem confining older people to their homes is the fear of falling. In many cases, this turns out to be a surprise for families because most elderly people are afraid to talk about since they fear it will lead to a loss of independence.

Many seniors are afraid of falls, but even more afraid to admit it.

That’s why Medicare recommends that all Medicare patients receive an annual fall risk assessment. When followed, this recommendation helps address one of the most difficult aspects of balance and dizziness problems in the elderly— the fear of losing independence. Leading experts suggest that the often unspoken fear of losing independence as a consequence of admitting the fear of falling can be a significant obstacle to beginning prevention planning at the earliest opportunity, when it can provide the greatest chance to reduce the risk of a debilitating fall.

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Comprehensive Balance & Fall Risk Assessments Include Four Types of Evaluation

  • Individual risk factors

  • Physical therapy tests and measurements

  • Review of drug interactions

  • Home safety questionnaire

Evaluation #1: Individual Risk Factors

Common risk factors ranked by significance**
1 Muscle weakness
2 History of falls
3 Gait deficit
4 Balance deficit
5 Use of an assistive device
6 Visual deficit
7 Arthritis
8 Impaired ability to do your own activities
9 Depression
10 Cognitive impairment
11 Age > 80 years

According to JAGS: AGS/BGS Guidelines, If you have 1 of the above risk factors, there is a 27% chance that you will fall within the next year. If you have 4 or more your chances are 78%.**

Evaluation #2: Physical Therapy Tests and Measurements

Consult your doctor to evaluate other medical conditions and drug interactions that may contribute to your fall risk profile.
Muscle Strength A detailed assessment of each individual muscle’s strength is performed to identify key muscles that may be weak. Emphasis is placed on the muscles that are most active during standing, balance, and walking. Weakness in these muscles can lead to falls.
Balance Balance during standing and walking is assessed both on firm surfaces like the floor and on uneven surfaces like carpet. It is important to test balance with the eyes open and with the eyes closed to get the most accurate and meaningful results from these systems. Physical therapy  exercises can help improve responses to factors that challenge stability.
Functional Limitations Assessment of specific functional tasks such as stair climbing, curbs, and ramps is completed. Other aspects of walking are assessed like pivot turns and sudden stops to see if balance is sufficient to complete these activities safely. Physical therapy exercises can help restore functional limitations.

Evaluation #3: Drug Interactions and Adverse Side Effects

This information is not a substitute for complete medical advice from your doctor. However, your physical therapy balance and fall risk assessment will include a review of all medications and supplements.

Artists rendition of drug interactions.As we age, we become increasingly susceptible to the adverse side effects and interactions of drugs. This fact is compounded by the likelihood that more drugs are added over time to help manage newly diagnosed conditions.

As part of your fall risk assessment and prevention planning program, it’s important to periodically review your symptoms and determine which ones may be due to medication. It’s extremely important to avoid mistaking any adverse symptoms you may be experiencing for normal aging when they may be more directly related to adverse drug side effects and interactions.

Please do not stop taking any prescribed medication without consulting with your doctor. Many medications must be gradually weaned to avoid serious complications.

Evaluation #4: Home Safety

When you are prone to falling, your home can either support you or become a reason for your falls. The following is a list of common things that make a difference in lowering the risk of falls due to home hazards. Look around your home environment and think about how well your home is helping you avoid falling. Then think about how you can change things to make it less likely that you will fall.

  • Avoidable Trips – Remove all clutter, electrical cords, low furniture, or other things that are in your pathways.
  • Handholds – Make sure sturdy handholds are placed room to room in case you feel unsteady or lose your balance.
  • Lighting – Make sure lighting is adequate, especially in the bathroom, kitchen, and bedroom.
  • Footwear – Avoid loose fitting slippers and wear comfortable shoes.
  • Bath & Toilet – If you have difficulty getting in the bath or up and down from the toilet, consider assistive fixtures and equipment recommended by your physical therapist or medical supplier.
  • Stairs – Identify and resolve difficulties with stairs. This may require modifications to room configurations or limiting use of living levels.
  • Reach – Make sure all household items are accessible without extended reaching or standing tip-toe.
  • Outside – In the places you walk outside, identify and fix areas with uneven surfaces, cracks, or slippery hazards.
  • Help – Make sure you have a way to get help quickly should you fall or are unable to get up.
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2 Balance Treatment & Fall Risk Prevention

Your Physical Therapist Will Summarize Your Evaluation Results and Formulate a Treatment Plan That Is Designed Specifically For You.

  • If muscle weakness or tightness is found, then you will begin a series of exercises that will strengthen and loosen the muscles.
  • Balance deficits can be treated through a series of exercises designed to specifically target and improve the body’s balance systems. These exercises have been proven in clinical studies to improve balance regardless of the person’s age.
  • As strength and balance improve, we can tie it all together by working on any functional skill that you are having difficulty with.
  • How long will it take to see improvement? Most patients experience improvements within 4-6 visits, attending two to three times weekly.
  • Will Medicare pay for treatment? Physical therapy treatment for balance problems including muscle weakness, difficulty walking, dizziness and history of falls are covered services by Medicare, as well as most other insurance plans, within the limitations of coverage guidelines.
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Balance Retraining
Static/Dynamic Balance Retraining
Habituation/Adaptation
Strengthening/Aerobics
Education/Customized Home Program
Gait Training
Functional Retraining (curbs, stairs, uneven surfaces)
Neurological Evaluation & Treatment
Neuromuscular facilitation exercises
Assessment of abnormal muscle tone
Assess and provide with assistive device (PRN)
Annual Fall Risk Assessment
Therapeutic Exercise
Progressive resistive strengthening
Muscle stretching