Description. Falls are known to be a major source of injury and accidental death in the elderly. Of the population over 65 years of age, one-third to one-half experience falls annually; of these, half do so repeatedly. Falls are the leading cause of injury in older adults and the primary cause of accidental death in those over age 85. Five percent of falls lead to a fracture, with hip fractures being the most common (greater than 200,000 annually). Further, imbalance in older adults is strongly associated with functional decline and frailty. Certain activities of daily living can no longer be performed, or are avoided due to a fear of falling. Unstable elderly persons become increasingly sedentary, homebound and isolated. Falls and instability contribute to 40% of nursing home admissions.
Poor balance control is a major cause of falls. While mild declines in balance are associated with advancing age, falls are not a normal part of aging. The issue of just how older adults who fall should be treated is currently of great interest to clinicians and researchers. While many intervention studies have shown improvements in balance control, most of these studies cannot trace improvements to any specific factor, because the interventions cover a wide range of of mobility skills. Our approach is to use targeted interventions that address specific mechanisms underlying the relationship between aging and balance control through intervention studies with elderly "fallers". Our first question was whether the senses can be isolated and "re-trained" for better balance control. Pictured is a balance training system called the Smart Balance Master (NeuroCom International, Inc). Leslie Allison, a physical therapist and graduate student, worked with me to use this system in a series of studies at the Erickson Retirement Center in Catonsville, MD. The surface and visual environments are computer controlled to move (individually or in combination) so that individuals can be placed in a challenging balance situation. For example, if the visual surround is controlled to move forward and backward with the forward-backward movements of the body, then the visual information you normally have to control balance is taken away. Similar adjustments can be made with the surface they stand on. Very small movements of the visual surround and support surface were used to make subjects more sensitive to visual or proprioceptive changes, and to minimize balance improvement due to greater strength.
Over an 8-week intervention, these individuals were asked to stand in the Balance Master under progressively more challenging sensory conditions. Such training not only led to significant improvement in balance control, but we can attribute this improvement to better sensory processing. Targeted interventions will allow for more precise and focused treatment for individuals with balance problems.
Calvert G, Spence C, Stein BE (Eds.), Handbook of Multisensory Processes. Boston: MIT press.