Eye On Physical Therapy
Commentary By Dr. Tim Rohrs, DPT
One of the greatest threats to the health of our elderly is falling. Falling in the home is responsible for most of the hip and wrist fractures of the senior population. Many magazines highlight this fact and offer tips to avoid falls. Some of those tips include keeping areas well lit, using double sided tape to tape down throw rugs and wearing non-slip slippers or shoes, not socks. Our body's balance system is an intricate cooperation among many systems.
Most people exhibit balance disorders after a stroke or when very elderly. While an insult to the brain after a stroke can play a huge role in the ability to maintain one's balance it is not the only system involved. The inner ear provides information to the brain to maintain head and neck posture. These impulses let the brain know if the head is oriented upright, slightly cocked left or right or forward or back. It also provides information on velocity while walking and angular velocity while turning corners or just turning the head to look at someone.
The eyes play an important role in balance. The eyes impart information to the brain on head orientation as well as information on ground layout and contour. They help the body prepare for soft sand, hard concrete or the slight resistance offered by grass that has not been mowed in awhile. In addition, the eyes are key in alerting to spilt liquids that may be slippery or to a child's toy left on the floor.
Muscle plays a large role in different capacitates. First muscles must be strong enough to respond to a perturbation in balance. Reaction time and overall strength are needed to try to right the body once balance is thrown off. Muscle also plays an important role in balance because of specialized nerves that reside within muscle which let the brain know how long the muscle is and what position the muscle is in. For instance, if the body is slowly tipping forward and the inner ear and the eyes have not noted this change, the muscle spindles of the calf muscle start to elongate to a certain degree and will let the brain know that this forward sway is happening and hopefully give the person another clue that they are heading south.
Lastly, the joints of the ankle, knee and hip need to have good ROM (range of motion) to maintain balance. The ankles probably play the biggest role and the first line of defense against a fall. The joint needs to have enough flexibility to move in all directions. When that does not happen, it is like trying to balance on a wooden stick; making it very easy to fall.
Physical therapy plays an important role in improving balance in the elderly. A multi faceted approach is taken to address each of these systems. Stretches for mobility strength training help make the joints move better and muscles to react with a stronger contraction. Exercises to decrease reaction time are also incorporated. Lastly, we try to identify which component is the most severely affected. When that is identified we can design a program to strengthen the other systems to compensate for the one that may have had damage to it.