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Dynamic Chiropractic Canada – September 1, 2009, Vol. 02, Issue 05
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How to Implement an Effective Fall Prevention Screening and Balance Training Program

By Jasper Sidhu, BSc, DC

Balance and fall prevention training is increasingly becoming a primary tool in the chiropractor's arsenal of treatment strategies. The importance of this treatment approach cannot be underestimated. With an increasing number of seniors needing to improve their strength and prevent potentially catastrophic falls, balance training can be an effective component of comprehensive chiropractic care, broadening the scope of your practice and ultimately leading to greater referrals. Let's discuss the research and statistics supporting the need for balance and fall prevention training, as well as the key components of a successful balance training program and how to implement them.

Why Balance Training Is So Important

Extensive research suggests the need for balance and fall prevention training pertaining to the senior population.1-4 It is common knowledge that fall prevention is one of the most critical issues in senior health, making it an essential component of any program. According to a study from the American Journal of Epidemiology, approximately 30 percent of community-dwelling seniors experience at least one fall each year.5 This statistic is that much more important considering 40 percent of falls that result in hospital stays are attributable to hip fractures.6 Unfortunately, these injuries will become even more prevalent as our population ages.

Moreover, falls account for 65 percent of all injuries among seniors, with an estimated cost to our health care system of $2.4 billion annually. Caring for seniors injured from falls represents a whopping 41 percent of this cost.6 As health care professionals, we need to be a part of the solution. Implementing balance screening and fall-prevention conditioning programs will allow us to do just that.

Become the Balance Expert in Your Community

Balance training is usually looked at as a rehabilitation component of patient care. However, as the statistics show, the real difference maker is in the prevention of falls. That's why screening should always be the first part of a comprehensive program. If you want to expand your practice to attract a larger geriatric market, incorporating computerized balance screening technologies may be the way to go. Some of these technologies even provide portable balance assessment, screening and treatment.

By offering balance and fall-prevention screening programs, you can effectively become the balance expert in your community. The program is initially used to identify people at risk of falling. Once this is established, you can offer services such as balance training, fall-prevention conditioning programs and overall wellness initiatives. A re-evaluation report can be easily sent to all interested parties. The screening process is a great way to get in the door with various geriatric organizations, thereby providing a unique service that allows you to leverage your practice for follow-up care.

Building Your Balance Training Program

The second step is to provide an exercise solution. This can come in the form of balance training, overall strengthening and conditioning regimens, and flexibility and mobility programs. A recent database review concluded that exercise interventions do reduce the risk and rate of falls.7-8 The questions clinicians ask is whether a simple clinical exercise program can be effective enough for the senior population, or if it requires a comprehensive assessment of multifactorial intervention. Research suggests exercise and balance training, even in short-term interventions, can help prevent falls.9 Therefore, simple exercises that can be instituted in an office setting can be effective.

When you think about balance training, simple one-leg standing exercises or standing with the eyes closed probably comes to mind first. Low-tech tools and rehabilitation programs are excellent ways to get into the balance market if you don't have the space or initial investment to progress to more comprehensive programs. The only limitation is that it won't set you apart from the competitors; the advantage, however, is that it allows you to see how balance and proprioception training can make a change in your patients' function and treatment outcomes.

Utilizing rocker and wobble boards and other unstable surfaces can start a patient off in the right direction. Home exercises can be provided to reinforce what you teach at your facility. Other exercise strategies have been gaining popularity as well. For example, tai chi is regarded as an effective intervention to maximize health, particularly in the elderly population.. Some studies have shown the effectiveness of tai chi in balance and fall prevention,10-11 while others have had mixed results.12 Regardless, tai chi is an excellent group exercise program that can be done in groups and results in greater interaction between seniors. Sometimes the social interaction is just as important as the program itself.

Vibration exercise is another technology that has made its way into balance, proprioception and strength training for the senior population. This technology can be used in clinics that have minimal space and provides an effective exercise alternative for seniors who may not be able to engage in conventional training. Recent research suggests vibration exercise decreases the risk of falls and fractures,13-14 and improves balance in the elderly.15-17

How to Market Your Services

Regardless of the specific balance and exercise program you want to initiate, focusing on patient demographics, space availability, and your ability to recruit the right people to implement the program is crucial to success. If you are targeting independent seniors, the structure of your program will be different than if you are dealing with elderly living in retirement homes. The latter may require more attention and time in addressing multifactorial issues prior to initiating a fall prevention screening program.

Space capacity is another factor in the type of program to offer. Smaller space may lead to utilizing technologies such as vibration platforms and computerized balance training systems that can provide balance, proprioception and strengthening exercises.

Partnering up with a local community centre may also be beneficial in attracting a larger group. Balance, fall prevention and conditioning classes can increase the exposure of your practice not only to the seniors, but also to their families. Such classes can sometimes be looked at as "loss leaders," meaning that any return on investment and time may not be directly attributed to the classes themselves, but to the increased exposure of your clinic to the community at large.

Whenever you intend to set up these type of programs, this fact must be taken into consideration before becoming frustrated at the energy expended to keep these programs going. Having a partnership with trainers in your area can also allow you to expand your services without taking time away from building your own practice. Delegation is key to the success of such community-based marketing programs.

As the population ages, we need to take a proactive approach to position ourselves at the forefront of senior care. Providing valuable services to the community through fall prevention screening, balance training and conditioning will increase the exposure your clinic receives. Working with various professionals in the community will lead to success for your practice, but more importantly, will lead to better health care for our elderly population.

References

  1. Iwamoto J, Suzuki H, Tanaka K, Kumakubo T, Hirabayashi H, Miyazaki Y, Sato Y, Takeda T, Matsumoto H. Preventative effect of exercise against falls in the elderly: a randomized controlled trial. Osteoporos Int, 2009;20(7):1233-40.
  2. Rose DJ. Preventing falls among older adults: no "one size suits all" intervention strategy. J Rehabil Res Dev, 2008;45(8):1153-66.
  3. Costello E, Edelstein JE. Update on falls prevention for community-dwelling older adults: review of single and multifactorial intervention programs. J Rehabil Res Dev, 2008;45(8):1135-52.
  4. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc, 2008;56(12):2234-43.
  5. O'Loughlin JL, et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American Journal of Epidemiology, 1993;137(3):342-354.
  6. The Economic Burden of Unintentional Injury in Canada. The Hygeia Group. Smartrisk, 1998.
  7. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 2009;15;(2).
  8. Rose DJ, op cit.
  9. Petridou ET, Manti EG, Ntinapogias AG, Negri E, Szczerbinska K. What works better for community-dwelling older people at risk to fall? A meta-analysis of multifactorial versus physical exercise-alone interventions. J Aging Health, 2009;21(5):713-29.
  10. Wong AM, Lan C. Tai chi and balance control. Med Sport Sci, 2008;52:115-23.
  11. Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney Tai Chi Trial. J Am Geriatr Soc, 2007;55(8):1185-91.
  12. Logghe IH, et al. Lack of effect of tai chi chuan in preventing falls in elderly people living at home: a randomized clinical trial. J Am Geriatr Soc, 2009;57(1):70-5.
  13. Von Stengel S, et al. [Effect of whole body vibration exercise on osteoporotic risk factors.] Dtsch Med Wochenschr, 2009;134(30):1511-6.
  14. Gusi N. Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskelet Disord, 2006;7:92.
  15. Rees SS, et al. Effects of whole body vibration on postural steadiness in an older population. J Sci Med Sport, 2009;12(4):440-444.
  16. Cheung WH, et al. High-frequency whole-body vibration improves balancing ability in elderly women. Arch Phys Med Rehabil, 2007;88(7):852-7.
  17. Kawanabe K, et al. Effect of whole-body vibration exercise and muscle strengthening, balance, and walking exercises on walking ability in the elderly. Keio J Med, 2007;56(1):28-33.

Click here for more information about Jasper Sidhu, BSc, DC.

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