Maggie McKay (Host): You get to a certain age and balance and falls become a concern and frankly, a topic of conversation. So today we're going to find out about physical therapy for balance and what to expect with Neuro Physical Therapist, Laura Guse.

 Welcome to Stoughton Health Talk. I'm your host, Maggie McKay. Thank you for joining us, Laura.

Laura Guse, Neuro Physical Therapist: I'm happy to be here, Maggie.

Host: So, just right off the bat, how do falls affect individuals?

Laura Guse, Neuro Physical Therapist: Well, first, just for some context, I'm a physical therapist now who is working in an outpatient clinic as part of a neurologic therapy team, and I frequently see patients for follow up care after they've been discharged from the hospital, or maybe even just after a fall. But I think the biggest impact for people who have a fall is their loss of independence.

 They might have injuries which force them to rely on others for help for things even like getting up and down from the toilet or rolling over in bed. And I'm very sad to say that I have had a patient call me from the hospital to tell me he had a fall which caused a broken hip and then he had surgery for that and a week or two later I learned that he had passed away.

That was very sobering for me. And it really brought home the importance of the mission to decrease falls. So in other words, falls are bad. And it's important for us to do everything we can to help people lower the risk for falling because falls do change lives. Often not for the better.

Host: And I do think a lot of times older people might kind of dismiss them because they don't want to call attention to the fact that their balance is off. What are some misconceptions about how to lower risk for falling?

Laura Guse, Neuro Physical Therapist: Well, one thing I found is that a lot of people ask me at, at their age of, you know, seventies, eighties, even nineties, if this can get better and absolutely they can improve their balance no matter what age they are. People who put the work in working on activities that research has shown can improve balance actually do improve their balance.

Another misconception is that just more walking or focusing on strengthening will improve their balance. But I would ask them, if you wanted to learn more about math, would you read an English book? It's the same with balance and falls. If you want to get better at balance, would you just work on walking only?

And the answer to that is no, that is not going to improve your balance. You have to actually put in the work to do challenging balance exercises.

Host: I was so surprised once I had vertigo. So I went to this place. All they do is balance. And I saw so many older people there, doing so many different kinds of exercises with different kinds of tools that I had never even seen. And I thought, wow, that is amazing. So they have places just for that. And I know that a lot of, you know, parks have programs also work balance classes. How do you determine if a person is at an increased risk for falling? And what does the research say about that?

Laura Guse, Neuro Physical Therapist: So actually, there has been quite a bit of work done to create a set of balance tests which can predict if a person has an increased risk for falling or not. For example, there is a test called the five times sit to stand, which is just what it sounds. The person stands up and sits down five times, arms crossed over their chest.

So they can't use their hands to push up and the, they've given this test to a whole bunch of people and they've divided that group up into the people who are fallers and the people who are not fallers. And it turns out that the people who are fallers are more likely to do that test in more than 12 and a half seconds.

And the people who do that test in less than 12 and a half seconds are in the group of not an increased risk for falling. Now that is just one test that looks at one domain, but there's similar outcome measures for different walking tasks. Things like stepping over stuff or walking around things, looking to the right and to the left while they're walking.

These are all things we have to do in daily life and we can do these standardized outcomes that research has shown, if you get a certain score or not, you are or aren't at an increased risk for falling. Even just looking at the gait speed for somebody gives us a lot of information about whether or not they're at increased risk for falling.

All of these tests have cutoff scores that if the patient does better than the cutoff score, they fall on one side of the fence where they're not at an increased risk for falling. And if they fall on the other side of that cutoff score or norm, they are at an increased risk for falling.

So we can pinpoint exactly what parts of balance they're struggling with the most and focus primarily on those.

Host: And if I want to improve my balance, what things can I do?

Laura Guse, Neuro Physical Therapist: So there was a systematic review done which looked at 44 different balance studies and compiled that into general guidelines for how much time and what types of activities can help somebody increase their ability to be balanced. So the results of that were that it's going to take more than 50 hours of exercise over time, which I think is staggering for a lot of people to hear.

But for many people, it took them a long time to get into a position where their balance is not great. So it's going to take a little while to work back from that. So we're talking about probably four or five months, doing activities which actually challenge their balance. So we would want those to be primarily done in standing, trying to stand with feet closer together or on one leg, minimizing the use of hands for help, and then practicing controlled movements of your center of gravity, like weight shifting from one foot to the other foot or minor changes in your weight, subtle movements like forward and backward while your feet are planted on the ground. I think that the most notable thing about this systematic review was that the most effective programs did not even include walking. That's not to say you shouldn't walk, because I do want people walking. It has a lot of aerobic benefits. But that is not an activity that we should expect would improve our balance.

Host: And how do you approach fall prevention?

Laura Guse, Neuro Physical Therapist: Well, from my perspective as a PT, there are three primary things I consider when I'm trying to decrease risk for falling. First, I'm going to ask the person about their home situation. Are there stairs to get into your home? Do they have a railing on them, grab bars in the bathroom, a lot of clutter around your living room or throw rugs, or a dog that can get underfoot?

It's really important to optimize where we live to be a safe environment. Second, I'm going to look at the kinds of things that they do. Do they spend a lot of time on uneven surfaces like, while they're doing yard work? Or are they, like, walking on roofs or up and down curbs, watching grandkids at the park? Or even trying to get up and down the stairs at a football stadium safely that might not have railings. And some of you are aware of a local location like that in Madison. But third, I'm going to check their balance to get a sense of their overall risk for falling by using those standardized outcome measures that we talked about.

And I'll pay attention to which types of balance were giving them the most problems. For example, if they struggle with being able to take a step fast enough to prevent a fall, like if they slipped on the ice or something, that would require reactive balance. And do they have that skill set? Or how about some typical walking tasks, like being able to turn around quickly while you're working in the kitchen?

Or stepping over a dog toy or looking back and forth while you're crossing the street. So, once I get an understanding of the person's risk for falling and the activities they're struggling with the most, I, first, I might immediately recommend that they start using a hiking stick or something like that just if they're falling, the first priority was you have to get them to stop falling. But the overall goal would be to get them back to doing those activities without the assistive device. And, we would create an exercise program that's focused only on their issues. If they're already good at something, why would we bother working on that over and over, but focus on the things that are most difficult and tasks that are right at the edge of their ability. So we don't want them to be too difficult that the exercises themselves cause a fall, but we don't want them to be so easy either, because if they're already easy, we're not going to get any benefit.

Host: Laura, you mentioned the dog toy, tripping on that. I like to think I have pretty good balance, because I do. However, it's the dog toy that's going to be the death of me. I am telling you, I cannot, I can't even tell you how many times I've almost taken a fall because of those little tiny dog toys. So you really have to like be aware of what's on the ground around you.

Cause you know, even though you might know what to expect in your own home. Your dog, a grandchild, your spouse, someone else might leave something on the floor and you don't see it. So I'm constantly like looking around, or when I go running at the park, same thing, a crack in the sidewalk, which there are many of that again, a teeny tiny crack. I once fell head on chin on the pavement and you just, you got to be so careful, so aware, right?

Laura Guse, Neuro Physical Therapist: Yes, absolutely.

Host: In closing, is there anything else you'd like to add that we should know?

Laura Guse, Neuro Physical Therapist: So I would just encourage people to, if they feel like they're becoming an increased risk for falling, reach out in some way. There are many community classes, and the Safer Communities website lists several community classes that focus on lowering risk for falling. I would encourage people to get out and do some of those, and try to get up to that 50 hours in 4 to 5 months.

And a lot of the classes in the community do meet the criteria that's needed. And that can be a fun thing and a social thing and something that people actually might even look forward to. If you feel like your balance is going down a little bit, take an active role in trying to get back to where you were because chances are you probably can improve it.

Host: Like you said earlier, you've got to put in the work. It's not just going to happen magically. Just in closing a little bit off topic, but I'm wondering what, how you feel about those devices you wear, say around your neck, that if you do fall and you live alone, you press the button and someone comes and helps you. Do you think everybody who's over a certain age living alone should have one of those?

Laura Guse, Neuro Physical Therapist: Absolutely. Yes, um, I've heard too many stories of people who fell and they could not get up, and they were on the ground for a day or two or more. And a lot of health complications can come, you know, the most recent one I heard of, the person had kidney failure and broke a hip. So in any case you would want something that it would ask you if you fell, right?

So something with fall detection so that if you fell it would say, are you okay? And then if you don't respond, they would automatically send help. And if you do respond, oh, no, no I just dropped my thing on the floor or whatever. But yes, definitely. And not for just yourself. But for peace of mind for your family members, because otherwise they could feel guilt because maybe they didn't check in on you that day and you don't want them to go the rest of their lives wishing they had called you on a day when you fell.

So definitely, I highly recommend those. Absolutely.

Host: Absolutely. I agree with you wholeheartedly. Well, Laura, thank you so much for sharing your expertise. This has been so useful and educational and I'm sure helpful to people who are wondering about their own balance and how to prevent falls.

Laura Guse, Neuro Physical Therapist: I've been happy to be here. Thank you.

Host: Dr. Laura Guse. For more information on preventing falls, please visit safercommunity.net/falls-prevention. If you're interested in exploring a wider range of health related podcasts, check out the Stoughton Health podcast library at stoughtonhealth.com. Thank you for listening. I'm Maggie McKay.

This is Stoughton Health Talk, a podcast from Stoughton Health.