1. Better Balance Program
Crystal Myers, DPT
Sarah McBride, DPT

2. Fall Statistics
• Falls among older adults are common and dangerous, with
known significant morbidity and mortality.
• Approximately one-third of community-dwelling older adults
will fall each year.
• 20-30% of falls result in moderate to severe injuries,
including traumatic brain injury (TBI), cervical fractures, and
spinal injury.

3. Fall Statistics
• Falls are the most common cause of hospital admissions
for trauma among older adults and are the fifth leading
cause of death in older adults.
– Older adults injured from falls and admitted to the
hospital are significantly more likely to be discharged
to long-term care than other age-matched patients
admitted to the hospital from the emergency
department (ED) for other reasons

4. Cost of Falls
– In 2000, $19 billion was spent on fall-related
injuries for people aged 65 years and older.
– By 2030, nearly 1 in 5 Americans will be aged
65 years or older.

5. What is the Better Balance
Program?
• Educational tool guided by evidence
based practice to assist in identifying and
addressing impairments that may lead to
imbalance.

6. Mission of the Program
• Identify individuals who are at risk for falling
• Help at risk individuals take steps to reduce falls
before they happen
• Encourage healthy aging by facilitating older
adults to remain mobile and independent
• Reduce hospitalizations

7. Who Will Benefit?
• Individuals who:
– Have fallen recently
– Demonstrate difficulty getting up from a chair
– Have difficulty walking or are unsteady
– Are physically inactive
– Are fearful of falling

8. Who Will Benefit?
Individuals Who:
- Complain of dizziness or lightheadedness
–Have problems with the senses, such as impaired
vision, numbness or neuropathy
–Demonstrate muscle weakness
–Have neurological or arthritic/orthopedic conditions that
limit physical abilities

9. Balance or Postural Control
• The ability to locate and maintain one’s center of
gravity within or over one’s base of support
during static and dynamic tasks
• Controlled by interaction of sensory and motor
systems
– Disruption of these systems leads to imbalance and
increased risk for falls

10. Causes of Balance Problems
-Sensory
-Motor
-Cognitive

11. Sensory Input
– Peripheral Sensory Systems
• Visual: detects movement of head or environment,
reference for verticality
• Vestibular: detects linear and angular head/eye
movement and position relative to gravity
• Somatosensory: provides info about body’s
position relative to surface

12. Motor Output
• Maintenance of postural control
– Static Postural Control
» Normal sway
» Reflexes
– Automatic or Reactive Postural Responses
» Response to stimuli
» Strategies
– Anticipatory Postural Responses
» Occur before actual stimulus
– Volitional Postural Movements
» Conscious control, trained responses

13. Reactive Postural Responses
• Occur in response to stimuli
• Strategies
– Ankle: response to small perturbation
– Hip: response to larger or faster perturbation
– Stepping: force strong enough to displace
COM outside of BOS, step to regain COM

14. Imbalance
• If any of these systems are compromised
may lead to imbalance and subsequent
falls

15. Physical Therapy Evaluation
• Identify impairments
– Outcome measures
• TUG, BERG
– Movement assessment
• Range of motion, Strength
• Identify risk factors
– Intrinsic versus extrinsic

16. Intrinsic Risk Factors
• >80 • Gait Deficit
• Arthritis • History of Falls
• Balance Deficit • Impaired ADLs
• Cognitive Impairment • Medications
• Depression • Muscle Weakness
• Dizziness • Sensory disturbances
• Fear of Falling • Use of assistive
devices

17. Extrinsic Risk Factors
• Inadequate lighting • Inadequate stairs
• Loose carpets (railing, depth)
• Unlevel floor • Unstable furniture
transitions • Unsuitable footwear
• Clutter • Unlocked wheelchair
• Electrical Cords • Weather conditions
• Lack of Appropriate • Pets
adaptive equipment

18. Physical Therapy Treatment
• Individualized treatment plan for each
patient
• Appropriate medical referral if needed
– Medication management
• Four or more
• Classifications linked to increased risk of falls
– Benzodiazepines, sleeping medications, neuroleptics,
antidepressents, anticonvulsants and class 1A
antiarrhythmics
– Blood Pressure

19. Treatment
•Education
- Extrinsic
changes
- Awareness of
intrinsic factors

20. What Can Physical Therapy
Do to Help?
• Address the following Impairments
– ROM
– Strength
– Coordination
– Gait
– Endurance
– Safety

21. What Can Physical Therapy Do
to Help
• Address vestibular dysfunction
– Vestibular Treatment, Habituation Exercises
• Assess need for assistive devices

22. What CRR has to offer
• Computerized balance testing and training
– Testing can monitor progress during treatment
• Better Balance trained Physical
Therapists
– 5 Physical Therapists, 3 Physical Therapy
Assistants