Melanie Cole (Host): In your everyday life, you might not even think about your balance, and quite often we take our balance for granted, but it’s an important and vital part of our health and well-being. Many elders fall each year due to balance and stability issues, and it’s been shown that falls can reduce the quality of life and may increase the mortality rate for seniors. My guest today, is Jennifer Ballweg. She’s a Physical Therapist with Stoughton Hospital. Tell us about some of the most common reasons that you see that seniors in particular fall.

Jennifer Ballweg (Guest): Common reasons are you can have effects of your medications because they can make you feel lightheaded or dizzy. You can have weakness in your lower extremities, and your core, and your hips. You can have proprioception difficulties such as not being able to feel your feet on the floor due to perhaps diabetic neuropathy or other conditions that are going on. You may have poor vision, which you can’t see objects that are on the floor and you may trip over them. Firm surfaces versus uneven surfaces, such as being outside, your flexibility, and your shoe wear – your footwear is very important in relating to keeping your balance and stability.

Melanie: All great points, Jennifer. Really great points. When we’re talking about balance, what’s involved? You mentioned the word proprioception – explain that for the listeners – and what’s involved in maintaining our balance? And then we’ll talk a little bit about training for it.

Jennifer: Okay, so, there’s three main factors that are actually involved in your balance and stability. There’s your vision – we rely on that primarily. If we’re able to focus on something, even though we feel maybe a little unstable if we’re able to focus we can keep our stability a little easier because we can rely on that vision component. Another one is the proprioception, and as I briefly mentioned before, that’s your ability to be able to feel where you are. For example, you’re walking a wooden floor surface; your feet are able to feel that floor surface. You walk into a carpeted area your feet can detect the difference between the carpet and the floor. It can give you an overall sense of where you are in space. Your ability to – is my leg actually touching the floor or is it off the floor?

And then you have your vestibular system, which is – I liken it to your internal GPS system. If you take away your vision and you take away your proprioception ability, your ability to feel where you are, you have a third system, your vestibular system, that can tell you where your body is in space. If I close my eyes, say I was on some type of amusement ride, and I turned upside-down, I could tell that I was upside-down because my vestibular system is telling me that.

All three of those systems play a factor in your balance and your stability. If you are very reliant on your vision and then your vision starts to fail, your balance and your stability can also start to fail. That’s why we need to keep all three systems going as well as we possibly can so that they can provide an overall excellent balance and stability.

Melanie: So whether it’s overall medicational or proprioceptive as you mentioned, or shoes or footwear -- whatever it is that’s taking away from our balance -- is this trainable? Is it something that, like muscle memory, you work on, and your body will remember and hopefully adapt to those uneven surfaces and such?

Jennifer: Most definitely. It doesn’t matter if you are younger, middle-aged, older, at all of these different ages we can definitely essentially retrain the body to have a better balance and stability. For example, many times people are unable to stand on one leg for very long. You may not think that’s very important, but if you think about how many times you’re standing on one leg, especially -- for example, when you’re walking, you need to stand on one leg to swing the other leg forward. If your stationary balance on one leg is not very good, your walking ability is not going to be very good.

Many times, I’ll start people off who have very poor balance just by trying to stand on one leg. I don’t have them do that standing all by themselves. I have them standing near a counter, hanging on, and just trying to stand on that one leg all by itself, and then progressing to not hanging on. And then you can progress the retraining into incorporating that in a dynamic movement, or a – when you’re walking is a dynamic movement. It’s different between when you’re standing still and when you’re moving -- I am getting back around to your question about can we improve that? Yes, we can. It takes practice, though, and it takes some time. With different types of balance exercises, of example, as I mentioned, the standing on one leg, you can improve over time. Unfortunately, it doesn’t happen overnight.

Melanie: I like to train people in the doorway, too, so that they’ve got both sides right there. It’s always good to start, as you said, with something that they can grab onto. How do you progress? If they start on one leg, and then you progress to a dynamic movement, maybe moving a leg around, throwing off your center of gravity a little trying to adjust to that? Then what would be next? Do you look to some equipment that you can use?

Jennifer: Yeah, we have the fortunate opportunity to have different types of things that people can stand on or walk in in our clinic. One of the common things we use is like a foam square, or a cushion per se – it’s a piece of foam we have people standing on. You may ask, “Why would we have people standing on foam?” Well, the floor is nice and hard, and you can feel where it is, and the foam is a little bit squishy, giving you more of an uneven surface as if you’re walking out in the yard – which would be an uneven surface. Anybody who’s been out in their yard knows that their yard is not completely solid in all spots. There’s divots; there’s perhaps a recent rain that had made it a little squishy. We can progress to that foam. We can have them standing on the foam. We can set up a mini obstacle course where they’re walking on flat surface and transition to foam. We can have them stepping over objects like hurdles because when you’re stepping over an object, again, you have to be on that one foot to clear the other foot over the object.

There’s different – you mentioned standing there on one leg and moving another leg to give you a little bit of off balance. One of the exercises is very common, and we call it a standing three-way kick. You would stand on one leg, and you would move the other leg, keeping your knees straight in front of you – excuse me, keeping your knee and swinging your leg forward, then out to the side, and then backward. And again, starting with hanging on when doing this, and then progressing to trying to do that motion without hanging on, but being near something so that you can grab onto it in case you lose your balance. The last thing we want people to do is fall.

Melanie: You said it doesn’t happen overnight and it takes practice – if you were to tell someone in their 60s or 70s it’s really good for you to start to work on – and sometimes these people suffer from vertigo as well, or have balance and dizziness disorders, which we’ve talked about before – what do you tell them as a timeline of if they do start doing some of this training they might actually feel a little more confident going down the stairs or walking around in their backyard. What do you give them as a timeline?

Jennifer: Well, I tell my patients when they’re here, “You’re not going to like my answer,” because I can’t give a specific timeline because everyone is different. Like you mentioned, they might have other conditions that are factoring in like they have some dizziness issues or possibly a medication that is throwing their balance off but that medication is very important to their health. Depending on the person, depends upon how quickly it will take for them to improve their balance. And also, it also matters that they do practice it.

One of the things that I do – I actually do this because everyone over the age of 30 should be working on their balance and stability. When I’m brushing my teeth, I stand near the counter because you need to brush – well, you should brush your teeth for at least two minutes, twice a day. I stand on one leg because I’m right near the sink in case I get a little wobbly, and I count for 30 seconds on one leg and 30 seconds on the other. By the time I do twice on each leg, I’ve got my teeth brushed, and I’ve got my balance worked out for the day.

As a timeline for people to regain their balance, if they practice it and they do it every day, they’ll get more benefit more quickly and have a better response with that. That’s why I say it’s very dependent upon every person is very different in how they progress or how well they do. They may have some outside factors. If folks have medical conditions that are a little harder for them to do certain activities, that doesn’t mean that they won’t be success, it just takes them a little bit longer.

Melanie: Wrap it up for us, Jennifer, with your best advice because even you mentioned younger people should be doing this – about balance and stability and the importance of training for this and kind of maintaining it like you’re brushing your teeth or doing weight training or cardiovascular – as something you have to kind of just do now and for the rest of your life, but how important it is.

Jennifer: Well, according – and I got this information off the American Physical Therapy Association Website, which is www.APTA.org. According to the Centers for Disease Control and Prevention, 2.5 million older people are treated in the Emergency Room for fall injuries each year. The average healthcare cost related to falls – now this is an average – is $35,000 per fall.

Melanie: Wow.

Jennifer: When you think about it like that – and that’s an average – and they’re not even going into if people have the aftercare after the Emergency Department visit. Say you fell, and you broke a hip, you would have your care afterwards after possibly, let’s say they recommended that you had surgery to fix that, then you have the recovery time after that, the care after that, the inability to do – say you’re employed, maybe you’re not able to return to work. You’re not able to care for yourself, so you either have to have family or others to come and care for you. Maintaining our balance and stability is really important to our overall lives because it keeps us moving, it keeps us independent, and you’re able to do the things that you want to enjoy and do if you avoid falling.

Melanie: That is great advice, Jennifer, thank you so much. And great information about exercises. Very useable information that people can use right now, today. Listeners, this is great information from a Physical Therapist at Stoughton Hospital. You’re listening to Stoughton Hospital Health Talk, and for more information, you can go to StoughtonHospital.com, that’s StoughtonHospital.com. This is Melanie Cole. Thanks, so much, for listening.