Joey Wahler (Host): This is Health Matters: Insights From WCH Medical Experts. Our guest, Kasey McKanna. She's a Physical Therapist with Wood County Hospital. Thanks for joining us, Kasey. I'm Joey Wahler. Welcome.

Kasey McKanna, P.T.: Thanks for having me.

Host: Absolutely. So first, why is fall risk prevention a hot topic these days?

Kasey McKanna, P.T.: I think an obvious answer to that is just the cost that keeps rising. When people fall, there's lots of hospital bills, whether there's a fracture or a brain bleed, therapy, things that are entailed after that. I think that's why there's such concern we want to reduce those secondary things that happen after a fall.

Host: And between the fact that people are living longer as well as some other factors that go along with that, these kinds of incidents are on the rise, right?

Kasey McKanna, P.T.: Very much so. And once someone has a fall, their risk for fall doubles. So, we want to stop that as early as possible.

Host: So naturally, the older you get, it would seem, generally speaking of course, the greater risk there is for having a fall. What are some of the specific reasons though, as we get older that this occurs more?

Kasey McKanna, P.T.: Right. There's lots of different things can happen and sometimes there's a misconception that just because you're older, falling is normal. And I would disagree with that because I think people that are very active, stay active, maintain good strength, good flexibility, those are two big factors that we notice as therapists with the elderly population that may help reduce their fall risk, when they stay active and they stay strong. Whether that's weight training walking, swimming, any kind of exercise activity that they love to do can definitely reduce that risk.

Host: And as we get older and live longer than people did a generation or two ago, let's say, more people are living with chronic conditions longer, right? And that contributes here too, doesn't it?

Kasey McKanna, P.T.: Definitely. I know I've been a therapist for almost 30 years and the patients have become more and more complex and a lot of those comorbidities are mounting and adding up. One common one that we see is diabetes. So when someone is diabetic, generally, several of them can have neuropathy, which means they have impaired sensation in their feet, which is definitely going to impact balance and mobility to some degree. So, all those different kind of factors, all those things play a part.

Host: Along with that, how about the taking of multiple medications on an ongoing basis? Talk if you would please, about the importance of having them managed properly and professionally to make sure they don't cause a fall, right?

Kasey McKanna, P.T.: I mean, dizziness is a very common, I'll say, symptom. Patients come in saying, "I'm dizzy." And usually, we have to spend a little more time weeding through what does that mean, because dizzy doesn't mean the same to every person. Some people say, "Well, dizzy means I'm unsteady, I'm off balance." Whereas someone else may say, "Well, my head feels like it's spinning or that I'm spinning."

So definitely, a common side effect of many medications is dizziness, perhaps maybe a drop in blood pressure and other things that can cause that. So, we do a lot of differential diagnosis when we see patients trying to decide where could that be stemming from. And you're right, medication management, it can be a huge component. If my patient comes in with a laundry list of medications, we talk through, "Who's managing these? Are you taking them regularly? Are they taking them when you feel like it?" Because unfortunately, sometimes patients say, "Well, I don't take that all the time. I take that sometimes." So, yes, that can become another complicating factor in trying to manage all the things that could be contributing to their unsteadiness.

Host: So typically, Kasey, if someone has fallen, how does a PT like yourself go about evaluating someone's balance? Where do you start?

Kasey McKanna, P.T.: Usually, if they've had a fall already, we talk through maybe exactly how did that happen? Maybe it's a simple thing, like throw rugs in their home or not having a path to their bathroom well-lit. There's a lot of investigative-type questions that we ask maybe to figure out why they fell in the first place. And so, that might be the start to it, taking a really good subject of history, having good information about their own past medical history. Sometimes patients don't like to list those things. They don't think how that maybe applies to what we're doing. But things like the neuropathy that we spoke about before or multiple medications that they're taking, all those factors play a role.

So when I see the patient, I start with that subjective history. And then, we, of course, do the general screening that we do for all patients. We look at range of motion, how flexible are they, what is their strength like? Do they have normal sensation, particularly in their feet, because that's a huge factor? We might ask some questions about their vision, because some people don't realize that visual-- not necessarily acuity, but your vision-- does play a role in your balance. Especially those people and elderly that either have poor sensation, they have to rely on another system to help them with their balance. And so, vision is also another component that we screen.

And then, of course, we take them through standardized balance testing to find out are they within the fall risk category. Could they need a device? Maybe they're doing really well and they just want someone to reassure them that, "Hey, I'm where I'm supposed to be."

Host: I'm going to ask you about devices in just a moment. But first, how much of that diagnosis that you just discussed involves collaboration with a general practitioner, a specialist if one is involved, others that are on the case?

Kasey McKanna, P.T.: I would say we get referrals probably primarily from family physicians. Occasionally though, we do get some from some of our more specialty services like Neurology or Orthopedics or maybe Internal Medicine. Those are definitely different types of specialties that we confer with.

If I think that there's something that's maybe not been diagnosed or seems questionable to me, I definitely reach out to those specialists to ask for some more guidance or maybe further testing-- let's get some things ruled out-- because physical therapy doesn't fix everything. We can help a lot of things, but sometimes we need help from others, too, to get to the bottom of what's causing it.

Host: And speaking of which, in terms of helping, how can physical therapy typically help to reduce someone's risk for a fall? What do you do?

Kasey McKanna, P.T.: Right. So during that assessment process, we try to identify what we think are the top factors that could be contributing. So if there is a flexibility issue, maybe they don't have good ankle range of motion, maybe their ankles are extremely stiff. That's one that maybe a patient wouldn't identify on their own. But we notice, "Hey, your ankles are really stiff." And I always educate patients that your ankles are kind of your first responders when it comes to balance. When you first stand up, if your ankles don't respond correctly, something up the chain has got to make that adjustment, or you might start losing your balance. So, simple flexibility of the ankle could be a really easy thing that we could address through stretching. Perhaps it's an ankle weakness problem. And so, we might do strengthening type exercises.

And then, of course, just challenging people. Most people, if they don't feel steady or they're fearful of falling, they do everything they can to avoid feeling that way, right? And our job is to say, "Nope, we got to work into those positions where you don't feel as comfortable to build your confidence and help you get a little bit better with that activity." So, those are things that we do with them, of course, in the clinic, and then provide maybe some home things that they could be practicing that are safe to get those things a little bit better.

Host: Yeah. One of the great things about physical therapy for just about anything it seems is that you and yours will typically provide homework, home exercises that people can do on their own in between sessions, right?

Kasey McKanna, P.T.: You know, it's funny, you find patients that either love that, "Give me as much as you can give me, and then other patients that say, "Oh, homework." I mean, I'm a believer in if you can do two or three exercises consistently and stick with it, I'd rather give you two and three that you do religiously than bombard you with 10 and you don't do any of them. So, knowing your patients and how you think they're going to respond is also, I think, an important component too. Not everybody responds the same to the home exercise idea.

Host: How much of reducing the risk of falling, Kasey, is simply adjusting our lifestyle, especially activities as we age, knowing that in some cases we simply can't do what we used to?

Kasey McKanna, P.T.: Yeah. If I found the key to that, I wouldn't be doing therapy anymore. Definitely trying to work through some of those things, helping patients realize maybe what's safe to do. In our minds, most of us don't feel our age, right? We think that we can do more than we can do, or our bodies can do more. And I find PT is probably juggling patients between those two either educating patients on, "Hey, if you're going to keep doing that, let's do it this way, so it's safer and your risk for fall is less, versus continuing what you're doing and getting into trouble." Same goes the other way. If they're not doing enough, they are may be more sedentary, and we have to really encourage them. If you want to get to the lifestyle that you want, there has to be some work put in and you've got to be a little more active.

So, trying to identify those things and I think doing it in an encouraging way is key too. Reminding them that we're on the same team, you know, "We want you to get better and this is the path that we need to at least try to get there."

Host: Now, I know that for instance, personally, I don't have a problem with falling, at least not yet. But with the staircase in our house, Kasey, I find that in recent years, more often I'm grabbing onto the handrail when I go up and down the stairs, not so much because I'm worried about falling if I don't have a proper grip, but I think it has more to do with the fact that I know that if I do fall for whatever reason, it's probably going to be worse than when I was 20 or 25 years old. So, I'm just being careful.

Kasey McKanna, P.T.: Very true. What I usually try to tell patients in the clinic, sometimes we challenge them with things that I wouldn't ask them to do at home because I do want to maybe push the envelope on what they are capable of doing. But then, we always go back to, "When you're at home, this is how I would like you to do it so that it's safe," right? We want them to always be safe.

Host: A couple of other things here, particularly for the elderly. How dangerous can falling be in terms of injury, whether it be to the body, to the head, to make clear to people that it is important to try to ward this off in any way possible?

Kasey McKanna, P.T.: Definitely. I mean, osteoporosis is really common in the elderly, especially women. So, the more brittle your bones become as you age, you're at higher risk for fracture. So, a fall definitely puts you in that higher risk category. And most falls, hip fracture is the one that pops in my mind. And we know there's a link to morbidity just to hip fractures in the elderly, because they just cannot recover from it.

Brain bleeds, you know, if someone hits their head, that's a really serious one too. And that can happen to anybody. I guess that's regardless of age. But just hitting your head when you fall is another one that a lot of patients just don't think, "Oh, that's not going to happen to me." And we see it all the time, we see it constantly, so...

Host: Then, finally here, in summary, Kasey, how can those joining us get the help they need, even if they think they may be at risk of falling?

Kasey McKanna, P.T.: Talking with your primary care physician is probably the best start. Someone that you see on a fairly regular basis. We have patients a lot of times that will come in and say, you know, "I haven't had a fall, but I've been concerned about that," or "I've had several near falls. I've felt myself just feeling more unsteady lately and I just want to know what I can do to ward that off, things that I can do to make my balance a little bit better."

And so, a physician can easily write a prescription for physical therapy. I've had some that say, "PT evaluate and treat" or "Do a balance screening." Anything really that could get you in the door. And then, once we have our discussion, we talk through, you know, "What are your concerns? Do you feel like it's a weakness issue? Do you feel like it's strictly just balance? Are there other issues where there is dizziness?" We also have therapists that treat vestibular problems that can also create balance issues and falls as well. So, there's a lot that kind of goes into it just to make sure that we're getting to the source of the problem.

Host: And in working through that, you've got to put the ego aside if you're a patient, right? And just realize that you're in good hands with someone like yourself, and it happens to the best of us.

Kasey McKanna, P.T.: It really does. And I always commend the ones that come in. I say, you know, "Worst case scenario, we get through the end of this and you don't need me, or you only need me for a visit or two," right? Just encourage them that we're trying to get to the goals that they want to achieve.

Host: Well, folks, we trust you are now more familiar with fall prevention. Kasey, keep up all your great work. Thanks so much again.

Kasey McKanna, P.T.: Thank you.

Host: And for more information, please visit woodcountyhospital.org/medical-services/rehabilitation-services/physical-therapy. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Health Matters: Insights From WCH Medical Experts.