By Will Broaddus
Just as fall prevention has moved to the top of the agenda at many public health organizations, Gordon College in Wenham has expanded its Center for Balance, Mobility and Wellness. Three weeks ago, the center relocated from a small, shared space in the college's athletic center to a 6,500-square-foot facility at the Brigham Athletic Complex.
The expansion was in response to a growing demand for the center's services, according to Peter Iltis, an exercise physiologist and director of the department of kinesiology at Gordon. The center started with one patient in 2002, and since has treated 1,000 mostly elderly people who struggle with their balance.
"We were bursting at the seams," Iltis said.
The increase in clients at the center reflects statewide and national trends: An April 9 report on mortality by the Massachusetts Department of Health and Human Services warned of a "significant increase" in fall-related deaths and injuries among the elderly in Massachusetts; and the National Safety Council, an initiative of the U.S. Congress, declared next week, June 23 to 27, "Falls Prevention Week."
"The awareness level (of falls) has gone up," said Sean Clark, the research director at the Center for Balance, Mobility and Wellness. "An aging population is taking more of the health-care dollar."
In addition to having more space, the center is also more accessible, because it now accepts walk-in clients who can continue therapy as long as they want for $55 a month. Previously, just insurance coverage was accepted, which covered only specific courses of treatment. Patients quickly lost their therapeutic gains, according to Marie Lucey, a physical therapist and the center's clinical director.
"To help people sustain is really what is needed," Lucey said. "Insurance doesn't pay for maintenance that helps people prevent falls."
Expansion at the center has included additions to its therapeutic equipment: A new machine, ActiveStep, operates like a treadmill, except that it trips patients as they walk on its surface. The supporting harness that keeps them from falling to the ground also contains sensors that measure how well they recover from the jolt.
"It measures initial recovery time, and the speed and size of that initial recovery step, as well as where the upper body is," Clark said. Six measurements in all are recorded, providing information that helps center staff assess a patient's ability to maintain his or her balance.
Not only does ActiveStep measure falls but, according to its promotional materials, the machine can also be used for therapy. The falls it causes modify patients' reactions, which helps prevent future falls. According to Clark, center staff are currently exploring this element of ActiveStep's design.
The center is also trying to make therapy fun, by exploring the use of Dance Dance Revolution, an arcade game that directs people to follow dance steps in time with recorded music.
"We use age-appropriate music, like big bands," Clark said.
Other devices at the center include Frenzel lenses, a goggle-like device that allows therapists to observe eye movements that can reveal the presence of vertigo, a disturbance of the inner ear. Vertigo can be treated with physical therapy.
Balance Master features an enclosure, like a booth, that has moving walls. The way patients react when the walls move, such as exerting pressure with their feet to steady themselves, is measured by sensors.
"Balance Master measures how you integrate sensory information, and how you control your body as you sense it in space," said Clark.
These devices are supplements to an evaluation process that checks a range of factors. Posture, flexibility, the quality of sensation in the feet, even the choice of footwear can influence a patient's stability.
"Soles that grip aren't always a good thing, if you have trouble picking your feet up," Lucey said.
Most therapies at the center are based on the principle that, as Lucey said, "If you don't push the balance system, it won't adapt."
To that end the center features an obstacle course of stairs to climb, pulleys to pull, and solid plastic cones for patients to navigate, all while suspended in a safety harness. Each of these challenges mimics a different situation from everyday life that can make a patient unsteady, Clark said.
A roomful of exercise machines, chosen for use by a clientele 55 years old or older, supplements these obstacles with basic conditioning.
"Those people who stay involved are living longer," Lucey said.
Fall statistics
Over one-third of adults in the U.S. 65 and older fall each year.
For older adults, falls are the leading cause of injury deaths, and the most common cause of nonfatal injuries and hospital admissions for trauma.
In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion for nonfatal fall injuries.
— Centers for Disease Control
Falls are the fourth leading cause of injury death in Massachusetts and the leading cause of injury-related hospital stays and emergency department visits.
From 1999 to 2005, approximately 74 percent of fall fatalities were among residents 65 years and older.
In 2005, total hospital charges for fall-related injuries in Massachusetts exceeded $525 million.
— Massachusetts Department of Health and Human Services
Fall questions
Do you wear supportive, rubber-soled, low-heeled shoes? Avoid shoes with thick treads.
When carrying items, do you make sure they do not block your view? Avoid carrying bulky items in two hands.
Do you divide large loads into smaller loads, leaving one hand free to grasp the railing? If you use a cane, avoid carrying items while ascending and descending stairs.
Do you turn on lights before entering a room?
Is carpeting securely fastened down? Avoid scatter rugs or plush carpeting.
Is there a light switch at the top and bottom of stairs?
Do floor mats have nonskid backing?
Does your shower or tub have nonskid surface?
Do you have a light or flashlight within each reach of your bed?
Is there a phone within reach of your bed?
— Gordon College Center for Balance and Mobility fall prevention checklist
