The Magazine About Your Health and Caring for Your Body Issue 6 PERSONAL MESSAGE The facts about. by Steve Ryan, PT, MPT and Debbie Ryan, PT, MPT.

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1 The Magazine Abut Yur Health and Caring fr Yur Bdy Issue 6 PERSONAL MESSAGE The facts abut FALLS & FALL PREVENTION IN THIS ISSUE 2 POSITION YOURSELF TO STAY WELL 3 TIPS & TRICKS Exercises fr imprved balance and stability. 4 FAQ Mst frequently asked questins abut Falls and preventin. 5 6 FALLS FALLS AND FALL PRECENTION SIMPLE TEST FEATURED PHYSICAL THERAPIST SUCCESSES CONTACT US FALLS AND FALL PREVENTION: BEST EVIDENCE. Inc. All Rights Reserved. by Steve Ryan, PT, MPT and Debbie Ryan, PT, MPT. The fastest grwing segment f the ppulatin in the United States is the 65 and lder grup f citizens. The baby bmer generatin has nw jined the ranks f the aging ppulatin and while they are prbably the best educated generatin in the histry f this cuntry and have mre access t health infrmatin than ever befre, they will still need t deal with issues like falls and their aftermath. Falls are a leading cause f injury at any age, but the effects are especially devastating t the lder ppulatin. It is calculated that ne third f cmmunitydwelling lder adults aged 65 years r lder fall at least nce annually. Fr thse ver 80, ne half f that ppulatin falls at last nce annually. Fall related mrtality is significantly greater amng thse lder than 70, especially wmen. Many f these fall injuries seriusly cmprmise the mbility and independence f lder adults. Peple wh are 75 years r lder wh fall are 4 t 5 times mre likely t be admitted t a lng term care facility fr a year r lnger. In general, the severity f fall cmplicatins increases with age. Falls and their aftermath create subsequent significant health prblems as apprximately ¼ f all falls result in injury. In the lder ppulatin, this increases the risk f hip fracture and the mrbidity assciated with that injury. There is an increased risk f hypthermia, dehydratin and pressure sres if prlnged lying accmpanies the fall. Once a persn has had a fall r multiple falls, a fear f falling becmes an issue and this can subsequently decrease the activity level f that persn. Decreased activity level leads t Steve Ryan, M.P.T Owner, Ryan Physical Therapy decreased verall strength and endurance, and decreased aerbic capacity. Falls have a unique set f risk factrs. Once yu have ne fall yur risk f subsequent falls is much greater. Falls that ccur indrs are cnsidered a risk factr, particularly if the persn is elderly. A persn that falls and is unable t get themselves back up is at immediate risk fr injury and at high risk fr subsequent injurius fall. It has als been established that persns taking 4 r mre regularly prescribed medicatins are at significantly increased risk. Other risk factrs fr falls are visual deficits and difficulty with ambulatin and balance prblems. Chrnic diseases such as Parkinsn s, CVA s, Diabetic Peripheral Neurpathies can severely impact gait and balance thereby making falls as big a prblem as the disease itself. What fllws is a discussin f fall risk assessment and fall risk interventins.

2 Psitining YOURSELF t STAY WELL (STRATEGIES FOR STAYING ON YOUR FEET) Many medicatins have side effects such as dizziness and rthstatic hyptensin, nt t mentin the many interactins between the medicatins themselves, which can have deleterius effects n balance. If yu are an lder adult r if yu are the significant ther r caregiver fr an lder adult, yu may have experienced a fall yurself r have had t help smene get ff the flr as a result f a fall. Yu may have had t call 911 fr assistance. While falls are a significant health risk fr peple f all ages, they are the #1 cause f injury in lder adults. Frequently, it s the injuries assciated with a fall r repeated falls that ultimately cst lder adults their independence. Their mbility can be severely cmprmised and their living situatin may have t change ut f necessity. If they are n lnger able t care fr themselves r be cared fr by family r significant thers; a lng term care facility may becme the nly viable alternative. While the great majrity f these facilities are caring and cmpassinate places, many senir citizens find themselves there prematurely due t injuries frm falls. There are several predispsing factrs, which place lder adults at increased risk fr falls. One has t cnsider medical cnditins like diabetes where ne f the cnsequences f the disease is diabetic neurpathy. This is a tingling, r burning pain r numbness f the feet. Imagine yur sensatin stpping at abut the ankle. Navigating arund the supermarket becmes a whle different type f challenge when yu are nt sure where yur feet are. If yu have been recently diagnsed as a type II diabetic, take it seriusly and fllw yur dctr s advice. This is smething yu d nt want t prgress. Older adults with diabetic neurpathy have 4 times as many falls as adults wh d nt have this cnditin. Many lder adults have multiple medical prblems and they are at increased risk fr falls because they must take multiple medicatins. Many medicatins have side effects such as dizziness and rthstatic hyptensin, nt t mentin the many interactins between the medicatins themselves, which can have deleterius effects n balance. Sme f the heart and bld pressure medicatins have fairly narrw therapeutic ranges s they must be mnitred clsely fr side effects. Prescriptin sedatives, antidepressants, and psychtrpic drugs have all been assciated with increased risk f falls. It is imprtant, particularly if yu take 4 r mre medicatins - 2 -

3 n a daily basis, t review yur medicine with yur primary care practitiner at apprpriate times. Visual deficits such as cataracts, glaucma, and macular degeneratin can increase risk. Yu are ging t trip r miss a step if yu cannt see where yu are ging. If yur visual acuity is lacking, see what yu can d t imprve it. Likewise, make sure the lighting in yur hme is adequate, particularly in areas yu frequently traverse. Arrange yur furniture s that yu have rm t walk arund freely. Install grab bars in the bathrm and shwer t prevent slipping and install a nn slip rubber mat n the flr f the tub r shwer. Remve any lse thrw rugs r secure them firmly t the flr. Staying as active as yu can as lng as yu can is an excellent preventive measure. Lsing mbility is ne f the greatest, if nt the greatest risk. Activities like walking and swimming help maintain verall mbility. Mvement activities like Tai Chi have been shwn t be effective in maintaining balance. Older adults tend t lse muscle mass unless they d resistance training. Maintaining strength is critical, particularly in the legs and cre musculature in preventing falls. If yu d fall, yu need t have the strength t get yurself up. Finally, knw yur limitatins. If it is a task yu cannt cmplete with ease, d nt risk a fall by trying t cmplete it. Get help, r let it g fr the time being. Tips and Tricks EXERCISES FOR IMPROVED BALANCE AND STABILITY 1) Stand next t a wall r beam. Place yur nearest hand n the wall fr stability. Lift the leg clsest t the wall, by bending the knee t 90 degrees. Hld ten secnds. Repeat 10 times. Rest in between if yu need t. Turn arund, place yur ther hand n the wall, lift the ther leg up and hld 10 secnds. Repeat 10 times. 2) Stand with yur feet slightly apart. Bend bth knees slightly t abut 30 degrees (1/4 squat). Hld 1-2 secnds and straighten up. 3 sets f 10. 3) Stand with yur feet slightly apart. Rest yur hand lightly n the wall r n a nearby table r desk if yu need t. Rise up n the balls f yur feet tgether. Hld 1-2 secnds. 2 sets f 10. 4) Sitting in a chair, place yur arms ut in frnt f yu, interlck yur fingers and stand up withut using yur hands. Cncentrate n using yur abdminal, thigh and buttck muscles t stand up. 2 sets f 5. 5) Lying n yur side, with yur hips and knees flexed tgether. Ankles tuching each ther. The trick t making this wrk is keeping the hip frward while yu lift the tp knee up abut 6 inches ff the bttm ne. Yu shuld feel it in the muscles right behind the hip jint. A great exercise fr the hip rtatrs, which we tend t frget abut. 3 sets f 10 n each side ) Get n all furs with knees and hands 12 inches apart. Keep yur back flat and yur head straight. Life each arm frward by itself and hld 5-10 secnds. Lift each leg backward behind yu, straightening it but keeping it clse t the grund. Lift the ppsite arm and leg (right arm, left leg) at the same time and hld fr 5-10 secnds. Then repeat n the ppsite side. 7) Stand inches behind a chair. Slwly bring ne leg straight backwards. D nt bend the waist. Hld this psitin fr 2 secnds. Return leg t the starting psitin. Alternate legs and d 10 reps with each leg

4 FAQ What can I d in the hme t help prevent falls? Be sure that yu always have adequate lighting thrughut yur huse. Use a nightlight when getting ut f bed at night. Remve any bstacles lying n the flr and secure any thrw rugs firmly t the flr. Install grab bars in the tub r shwer and handrails alng hallways. In the tub itself, install nnslip strips r a rubber mat n the flr. Always wear apprpriate ftwear. What medical cnditins increase fall risk? Peple with Parkinsnism have an increased risk due t rigidity f the trunk and limbs. These peple have difficulty initiating mvement, such as standing and walking. The effrt that it requires affects their balance s they are likely t fall particularly when first standing up. Peple with diabetic neurpathy have decreased sensatin r numbness f their feet, s they cannt feel the grund. This creates a great deal f uncertainty when standing and walking. Any medical cnditin that causes visin deficits als increases risk. Peple wh have painful jints, recent surgery, and depressin are all assciated with increased fall risk. I have had a cuple f near falls, and nw I am very afraid f falling. What can I d abut it? First make yur hme envirnment as risk free as pssible. Stay within yur limits as far as husehld tasks g. If yu cannt d it easily, get help r leave it rather than risk a fall. Yu can build yur cnfidence by exercising and staying active. Strengthening and balance exercises alng with mbility regimens like tai chi have been shwn t be effective in preventing falls. Yu can test yurself by lying n the flr and seeing if yu can get up yurself (make sure yu have smene t help yu if yu find yu can t). This is actually a gd exercise t practice as part f yur rutine. Part f the fear f falling is als the fear f the inability t get back up. Hw can Physical Therapy help? Preventing falls effectively requires a multidisciplinary apprach. Physical therapy can effectively address the lss f mbility and strength, as well as the gait and balance issues. There is gd evidence that integratin f therapeutic exercise and balance regimens alng with prpriceptive activities imprves verall functinal mbility and thus reduces the risk f falls. Imprtant questins t ask abut Falls and Falls Preventin Take this simple test... YES NO Have I had ne r mre falls indrs ver the last six mnths? Am I able t get myself up frm the flr frm a lying psitin? Have I develped a fear r anxiety abut falling? D I take 4 r mre medicatins n a daily basis? D I feel dizzy r unsteady when I first sit up frm a lying psitin? D I feel dizzy r unsteady when I first stand up frm a sitting psitin? D I have numbness r tingling in my feet? D I regularly need an assistive device (cane, walker) fr walking? D I need assistance with any f my activities f daily living? D I have significant pain in my hips, knees, r ankles when I walk? D I have difficulty mving frm sitting t standing due t pain in my hips, knees and ankles? D I exercise r perfrm sme type f sustained physical activity fewer than 3 times a week? D I feel like I am ff -balance when I have t lift r carry an bject? Has there been any deteriratin f my gait that I (r thers) have nticed in the last 6 mnths? Am I lder than 80? Simply place a check mark in the apprpriate bx. If yu answered yes t 2 r mre questins yu may need t see a Physical therapist - 4 -

5 Featured Therapist Allisn Palank, MPT Allisn Palank graduated frm St. Lius University with her Bachelr s degree in Exercise Science in May f She received her Master f Physical Therapy Degree frm St. Lius University in January Allisn has been a staff member at Ryan Physical Therapy since September f Her previus wrk experience includes rthpedic and geriatric physical therapy. She has a strng interest in manual therapy and cntinues t further her clinical skills and knwledge thrugh cntinuing educatin and mentring prgrams with ther therapists. Allisn is an active member f her prfessinal rganizatin as well as a vlunteer at her church with the religius educatin prgram. In her free time she enjys running, playing sccr, glfing and spending time with her daughter, Madelyn. What patients are saying... SUCCESSES I began therapy several mnths ag. I had n balance, had truble walking and wuld fall a lt. When I began therapy here I was thinking abut being in a wheelchair. This place here is a miracle. I am prgressing every time I cme. I have seen a 75% prgressin. I nw just use a walker in crwds. I wuld refer anyne here- it wrks! - A.H. This is the first time I have had PT and did nt knw what t expect. When I first started therapy, I was barely able t walk and was in pain mst f the time. Allisn, my assigned therapist started me n a prgram t strengthen my leg and ankle muscles that wuld enable me t walk again withut a cane r assistance. I am very pleased with the results I have btained in what I cnsider t be a shrt amunt f time (10 weeks). I n lnger need a cane t walk and am nw wrking n the last phase f my therapy - R.K. I had bth f my knees replaced. I was in hme therapy fr 2 weeks befre cming t ryan PT. I thught the therapy was great! I did very well there. I was advancing s well that I wuld g t wrk fr 4 hurs after therapy. I am blessed that therapy went as well as it did, I attribute that t Steve. - R.S. I had a ttal knee replacement and had hme therapy fr 2 days befre cming t Ryan PT. the therapy went smthly. It was quite amazing t me. I knw fr sure it was the excellent therapy I received there, that s what helped me recver as fast as I did. I am up and arund just like new. The therapy is what did it! -M.S.

6 FALLS and FALLS PREVENTION: Best Evidence FEAR f Falling Affecting Yur Life? call tday fr a FREE CONSULTATION Find ut if physical therapy can help yu ease the pain and help yu gain a new utlk n life WE CARE ABOUT YOU! Call us tday fr a free cnsultatin at Hagerstwn (301) r visit us at Ryan Physical Therapy Steve Ryan, M.P.T Mt. Aetna Rad Hagerstwn, MD Since falls amng the aging ppulatin is becming a cstly issue and awareness f the prblem is grwing, what can Physical Therapists d abut it? There is n medicatin that prevents falls; in fact, medicatin is frequently a cntributr t the prblem. What abut thse patients with chrnic cnditins, such as diabetes, Parkinsnism, and dementia? Patients can be referred directly t physical therapy fr fall preventin r be assessed fr the risk factrs, even if they are seeing the Physical therapist fr sme ther prblem. What assessments are there fr accurately predicting future fall risk? The Timed up and g test (Pdsiadi and Richardsn, 1991) has been shwn in many, but nt all studies t be an accurate predictr f future falls. Its value in the physical therapy clinic is that it is quick and easy t administer. It is als a valuable tl t bjectively measure patient prgress. The patient is seated in a chair and is asked t stand, walk 10 feet, turn arund and be seated again. The therapist with a stpwatch times the test. Different studies have recmmended varying cutffs as predictrs f fall risk, but generally individuals with an average scre f 10 secnds r less are freely mbile and have a lw risk f future falls. Individuals with a scre f secnds are cnsidered t be independently mbile and have a lw t mderate risk f future falls. Fr this grup, further identificatin f ther fall risk factrs may be apprpriate. Individuals with a scre f secnds are cnsidered t have a mderate t high future risk and a cmprehensive fall risk assessment is recmmended. Individuals with a scre f 30 secnds r greater have variable mbility and a cmprehensive fall risk evaluatin is strngly recmmended. Fall preventin prgrams that are multidisciplinary have been shwn t be the mst effective. Exercise and balance training alne have nt been shwn t be a cnsistently effective interventin. When cmbined with ther effrts such as assessing medicatin and alchl cnsumptin, visin screening, envirnmental assessment, depressin screening, and assessment f neurlgical and cardivascular status the exercise and balance aspect becmes an integral part f the prgram. Other risk factrs that shuld be assessed are cntinence and ft prblems. The mst imprtant steps in any fall preventin prgram are t identify thse persns wh have previusly experienced a fall, determine the ptential fr future falls, and reduce individual fall risk factrs. This is accmplished thrugh baseline screening, cmprehensive evaluatin, and treatment f nging health prblems. Physical therapists, as part f the medical team, can greatly cntribute t reducing the frequency and severity f falls thrugh utilizatin f evidence based exercise and balance regimens, which have been shwn t be effective in imprving gait, balance, and pstural stability.