When physical therapists guide older individuals through balance training exercises that focus on position sense, the elderly are less likely to fall than if they participated in programs that focus only on education, a new study finds.
The results of the study suggest that it is possible for physical therapists to help individuals train their central nervous system to respond to sensory challenges so that they can maintain balance better and in doing so, prevent falls.
However, the study pointed to a need for ongoing balance training with a physical therapist as a means to improve balance and generalized postural responses within various environments.
According to the National Safety Council, falls are a major problem for individuals age 65 and older, with one-third suffering from a fall each year. Falls are the number one cause of hospital trauma admissions, injuries and accident-related deaths in this age group. In 2002, fall-related injuries were the cause of death for approximately 13,000 Americans.
The National Safety Council expects the number of people over age 65 to double by the year 2030, which will potentially double the number of falls in this age group.
“Maintaining balance is a complex process that relies on multiple sensory systems working together,” said lead author Kelly Westlake, PT, PhD, a postdoctoral fellow at the Biomagnetic Imaging Laboratory, Department of Radiology at University of California, San Francisco. “These include vision, a sense of position in space (proprioception), and the vestibular system, which is a mechanical fluid system located in the inner ear that helps the body maintain equilibrium as the head moves.”
To stay balanced, a person must adjust continually to changing sensory information. With aging, altered sensory systems make it more difficult to adapt to these changes and sustain a stable posture.
Physical therapists led participants through hour-long sensory-specific balance classes three times per week for eight weeks using the FallProof Program exercise program. The therapists individualized the program – developed by Debra Rose, PhD, professor in the division of kinesiology and health promotion and co-director of the Center for Successful Aging at California State University at Fullerton – to each patient’s needs and abilities.
The training emphasized static and dynamic balance exercises in differing sensory conditions. A physical therapist guided each individual through exercises that involved standing or walking on various support surfaces such as rocker boards, foam or narrow beams and various positions such as standing in a tandem, semi-tandem, on one leg or in a feet together position.
To increase the difficulty of the tasks, the physical therapists altered visual and vestibular cues. To alter visual cues, participants closed their eyes, performed a reading or tracking task or performed balance tasks with a distracting background. To change vestibular cues, participants tilted their heads backward or moved their heads from side to side and up and down.
The study appears in the October 2007 issue of Physical Therapy, the official journal of the American Physical Therapy Association.
“The most important finding in this study is that it is possible to train an individual’s central nervous system to help them maintain balance and prevent falls,” said Westlake. “Most functional activities require quick processing and constant reassessing as new challenges are met. For some people, walking on uneven surfaces can lead to imbalance and falls. That there is a possibility to train our brains to recognize and respond quickly to these altered sensory signals could lead to decreased fall-related injuries and an increased quality of life.”
The study included 36 participants over the age of 65, who researchers randomly assigned to either a balance exercise group or a falls prevention education group.
The main outcome measure was the center-of-pressure (COP) velocity change score, which measures the difference in the rate of a person’s postural sway with and without a sensory challenge. Participants in the balance exercise group remained more stable than did participants in the education only group.
Participants who received education only had a decrease in balance confidence and there were no changes seen in balance confidence in the balance exercise group.
“Balance training is something physical therapists can teach older adults to practice at home by altering support surfaces to increase awareness of sensory cues using tools like those we used such as rocker boards, narrow beams or foam, as well as practicing balance on one leg,” Westlake says. “Vision can be eliminated with a blindfold, engaged with a reading task or distracted with a pattern on the floor. Older adults can challenge their vestibular system by moving their heads from side to side while speaking to another person or looking at various objects.”
She said that since most falls occur after a slip or a trip, upcoming projects will assess if training can improve balance in these circumstances, as well as if physical therapists can use sensory-specific balance training to help adults who already have some balance difficulties.
The American Physical Therapy Association is a national organization representing more than 73,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at www.apta.org/consumer.
