Author: Deena Gerstenhaber, PT, DPT
Balanced Bodies for a Balanced Life
We all want a balanced life. Some people mean this figuratively, wanting to find balance between their responsibilities and leisure. For many people across the world, especially those older in age, wanting a balanced life becomes much more literal. Frequent loss of balance can negatively impact a person’s quality of life. It can make people fearful to participate fully in their daily routine and force a person to avoid activities they once enjoyed. The US Center for Disease Control and Prevention reports that one in four Americans over the age of 65 fall each year. This leads to 3 million emergency room visits, 800,000 hospitalizations, and unfortunately, 28,000 deaths. Despite these figures, falling isn’t a normal part of aging and can be prevented. The following systems of balance as well as cognition play an important role in avoiding falls.
- Somatosensory System
If you close your eyes and move your leg, you can still tell where it is thanks to a special type of somatosensory input called proprioception. Proprioception helps us maintain our balance by sending information to the brain so we can make quick adjustments in our movement to keep us upright. If we’re walking up hill, in a crowd where people bump us, or on slippery sidewalks, we need this sense of proprioception to prevent us from losing our balance.
- Vision System
We rely on our vision system to take in information about our environment. We use our eyesight to assess environmental risks that effect our movement. If the ground is uneven or there is an obstacle in the way, our vision helps us plan ahead to prevent a fall. In addition, we can use our vision to sense what vertical is and use that to keep ourselves vertical too.
- Vestibular System
Our vestibular system helps us maintain our balance through a peripheral and central system. The peripheral vestibular system is made up of canals in our inner ear that act almost like a level within our head. Instead of a bubble in water, there are crystals in fluid which tell us if we’re turning or tilting, speeding up or slowing down. As we move, the little crystals in the canals move and tell the brain information about what is happening to prevent us from feeling dizzy. They are also responsible for maintaining our visual gaze stability so when we turn our head, we can keep focus. The central vestibular system within the brain is responsible for processing the information from all the other systems and helping the body to make appropriate adjustments to maintain our balance.
Minor changes in cognition are a relatively common part of aging. Dementia and other neurologic disease like Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, and stroke can lead to more significant cognitive decline. No matter how severe, cognitive changes that impair a person’s reasoning skills, attention, executive functioning, safety awareness, and processing speed are correlated with an increased risk of falls. The sharper our brain is, the faster and more accurate we can make decisions and perform movement reactions to prevent falls.
If you’re noticing changes in one or more of these areas, it’s time to request an evaluation with your physical therapist. We know what you’re thinking. “Physical therapy is for people with injuries, after orthopedic surgeries, and pain.” It’s well known that physical therapists (PTs) can help strengthen muscles, but what many people don’t realize is that PTs are also experts at strengthening balance and preventing falls. Through specialized assessments, PTs determine which areas of balance are impaired for their clients and tailor plans to address them. They then create evidence-based treatment plans utilizing manual techniques, specialized exercises, modalities, and education to train their clients to have better movement responses to balance challenges. Improving the physical balance of the body can help a person live a longer, safer, and more balanced life.
Center for Disease Control and Prevention. (Sept 2017). Take a Stand on Falls. Retrieved from https://www.cdc.gov/features/older-adult-falls/index.html#:~:text=Each%20year%2C%20more%20than%20one,800%2C000%20hospitalizations%2C%20and%2028%2C000%20deaths.
Woo MT, Davids K, Liukkonen J, Chow JY, Jaakkola T. Falls, cognitive function, and balance profiles of Singapore community-dwelling elderly individuals: key risk factors. Geriatr Orthop Surg Rehabil. 2017; 8(4):256–262. doi:10.1177/2151458517745989.
Susan W. Muir, Karen Gopaul, Manuel M. Montero Odasso, The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis, Age and Ageing, Volume 41, Issue 3, May 2012, Pages 299 – 308, https://doi.org/10.1093/ageing/afs012
APTA Choose PT Guide. (Feb 2018). Physical Therapy Guide to Falls. Retrieved from https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-falls
Summit Professional Education. Vestibular Rehab & Balance Training: Comprehensive Evaluation and Treatment Strategies for Dizziness and Balance Disorders. Presented by Karen Hogan-Curran, PT, DPT. Jan 20 2018