Therapy Achievements is dedicated to helping people with physical, cognitive and visual limits re-gain function and reach their potential. By providing out-patient physical, occupational and speech therapy services, we help people maximize their independence and reach their potential. Our multi-disciplinary team approach to rehabilitation enables us to tailor your plan of care to your specific and unique needs.
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Written by Jaime Richardson, Speech Therapist
May is Speech Therapy Month. And Speech Therapy Month is a great month for a new beginning! Do you feel fatigued? Have muscle stiffness? Difficulty swallowing? Trouble getting your words out? Or trouble putting things in order to complete daily tasks that typically are routine? If so, you are not alone. These things can happen if you have Stroke, Brain Injury, Parkinson’s Disease, Multiple Sclerosis, or other Neuromuscular conditions.
The good news is that these symptoms that can be treated. Many people living with these problems can gain more independence and enjoyment in everyday activities by attending Speech Therapy. And Speech Therapy Month is a great month for giving it a try!
We may be the place just for you. Our Speech Therapists at Therapy Achievements will give you an individualized evaluation. Using the results from the evaluation, a treatment plan will be tailored to your needs. The evaluation may include assessment of your muscle strength, flexibility and coordination for speech and swallowing and your ability to concentrate, pay attention to and remember information.
Please talk to your doctor about your symptoms and see if therapy is the right course for you. Therapy Achievements wants to be your advocate and help provide the plan of care specific to your needs at this time. Contact us for more information today! May Speech Therapy Month be the beginning of something beautiful for you!
Jaime Richardson MS, ccc-SLP
Jaime Richardson joined Speech Therapy at Therapy Achievements in 2015. She has a degree in Sociology with minor in Psychology from the University of North Alabama and Master’s in Speech Language Pathology from Alabama A and M University. She specializes in swallowing disorders and cognitive rehabilitation. She works with people with Brain Injury, Memory Impairment, Stroke, Multiple Sclerosis and Parkinson’s Disease. She is certified in VitalStim , Myofascial Release, and the LSVT Program.
Jaime loves to read, play the piano and enjoys composition with interests in sound and proper hearing mechanics for functional healthy daily living. She is a native of North Alabama and loves the outdoors!
Therapy Achievements is a Rehabilitation Center that provides Physical, Occupational and Speech Therapy for Balance and Movement, Speech and Swallowing, Swelling from Lymphedema and Edema, Driving Rehabilitation and Functional Living Skills for visual and cognitive re-training. We help people with Brain Injury, Stroke, Multiple Sclerosis, Parkinson’s Disease, Lymphedema, Head and Neck Cancer, Vertigo and Dizziness, and other disorders that interfere with mobility and function. We offer VitalStim Technology, Saebo Technology, LSVT LOUD Treatment, LSVT BIG Treatment, and Neuro-Developmental Treatment.
Speech Therapy after Laryngectomy: Vocal and Swallow Rehabilitation
Three men. Three different symptoms. Alexander McGuiggan noticed a hoarse voice at Christmas and by March his voice had deteriorated to a whisper.
Stewart Farmer noticed difficulty breathing that suddenly progressed and he was constantly short of breath.
Alec Smith noticed a tickly throat and husky voice at the end of the day. Two years later he had no voice, a bad cough, was breathless and produced huge amounts of phlegm and mucus.
Each of these men had different symptoms, yet each was diagnosed with cancer of the larynx. And each of them underwent treatment that included a laryngectomy, radiation therapy and speech therapy. Fortunately, each had success with their treatments. With the help of speech therapy after laryngectomy they were able to re-gain their ability to speak and swallow.
Speech therapy after laryngectomy teaches people to breath in a new way. It helps people re-gain olfactory function. But most importantly, it is vital for learning to speak and swallow. Speech therapy often starts before surgery or radiation therapy. To understand treatment and therapy, it is first important to understand the mechanism of cancer of the larynx, then the components of therapy:
The larynx is located at the upper end of the trachea. It contains two bands of muscles called vocal cords. Vocal cords prevent food and liquids from entering the airway, and are important for breathing, speaking and swallowing.
Cancer of the larynx:
Cancer of the larynx occurs when malignant cells enter the larynx. It may be caused by excessive smoking, drinking, or exposure to HPV. Often times, the cause of larynx cancer is unknown.
Medical treatment of larynx cancer may include one or a combination of the following treatments:
- Radiation therapy
Surgery: Partial vs Total Laryngectomy
For people who require surgery, they will have one of two possible procedures:
- Partial Laryngectomy: this involves removal of the part of the larynx harboring the tumor.
- Total Laryngectomy: this involves removal of the entire larynx and some adjacent tissues
If a total laryngectomy is required, it results in the following changes:
- The trachea is re-directed and is no longer connected to the nose and the mouth
- A permanent opening called a stoma is created at the base of the neck that cannot be reversed or closed
- Air passes in and out of the lungs through the stoma
Laryngectomy Vs. Tracheostomy
Laryngectomy and tracheostomy are two procedures that create an opening in the trachea with placement of a stoma. Although they are similar in this way, they are different in the following ways:
|A hole is created in the trachea through an incision through the neck||Complete removal of the larynx with re-direction of the trachea.|
|Mainly used to treat airway obstruction.||Used to treat cancer of the larynx|
|Patient is still able to breathe through the nose and mouth||Patient now breathes through a stoma|
|Speech occurs through a speaking valve. There is no change in the voice and it sounds normal.||Speech occurs through TEP or electrolaryx. Speech is never “normal” again.|
|Changes are usually temporary||Changes are permanent and not reversible.|
Pulmonary Changes after Laryngectomy:
Because the trachea is re-directed and is no longer connected to the nose and the mouth, patients who undergo laryngectomy can no longer cough mucous into their mouth or blow their nose. Instead, they cough up mucous through the stoma. Inhaled air no longer humidified by the nose and mouth. Instead, air must be moistened by spraying the stoma filter with water.
Swallowing Changes after Laryngectomy:
With laryngectomy, the epiglottis and hyoid bone are removed and the esophagus is reconstructed. Because of this, there is disruption in air pressure regulation, saliva production, and peristalsis during swallowing. In addition, the sense of taste and smell are disrupted as air no longer passes through the nose.
After a laryngectomy, the skin around the stoma needs to be cleaned twice a day to prevent odor, irritation and infection. If the skin becomes irritated or red, it should be left uncovered and use of solvents should be avoided for two days.
The most important part of stoma care is to make sure no water or foreign objects enter the stoma. People with laryngectomy must be very careful while bathing, showering or shaving. They need to avoid cleaning the stoma with thin paper towels or tissues to prevent paper from entering the stoma. Instead, they should use a cloth towel. In addition, they need to avoid spraying anything directly into the stoma. Instead, they should spray the stoma cover with water 2-3 times per day to keep it hydrated.
Speech Therapy after Laryngectomy
Speech therapy after laryngectomy includes:
- Swallow Rehabilitation – transitioning from a feeding tube to eating by mouth
- Pulmonary Rehabilitation – learning to protect the airway and breath in a new way
- Olfactory Rehabilitation – using the Nasal Airway Induced Maneuver to maximize smell and taste
- Vocal Rehabilitation – training in esophageal speech techniques and voice production devices
Olfactory Rehabilitation: The Nasal Airway Induced Maneuver
Because air no longer passes through the nose, taste and smell are impaired after laryngectomy. Fortunately, there is an exercise called the Nasal Airway Induced Maneuver that can help. In one study, 46% of laryngectomy patients trained in this maneuver re-gained their sense of smell. Also called “Closed Mouth Yawning”, it involves lowering the jaw, the floor of the mouth, the tongue, and soft palate with lips closed. This induces negative pressure in the oral cavity and oropharynx which generates airflow in the nasal cavity.
Vocal Rehabilitation: 3 types of speech
Because laryngectomy involves removal of the vocal cords, normal vocalization is not possible. There are three types of alternative speech:
1. Esophageal Speech
- Air is swallowed into cervical esophagus
- The swallowed air is expelled out causing vibrations of the pharyngeal mucosa
- These vibrations, along with articulations of the tongue cause speech to occur
Obstructions to Esophageal Speech:
Impediments to development of esophageal speech can include:
- Cricopharyngeal spams (this may be treated with cricopharyngeal myotomy or Botox injections to enable development of esophageal speech)
- Reflux esophagitis
- Thinning of muscle wall in PE segment
- Denervation of muscle in the PE segment
- Poorly motivated patients
Advantages of Esophageal Speech:
- Hands are free
- No further surgeries or equipment are required
Disadvantages of Esophageal Speech:
- Significant training is required and 40% of patients are not able to develop esophageal speech
- Quality of voice is poor
- Patient is only able to speak in shorts bursts and cannot speak continuously
- Patients are not able to control loudness and pitch control
- Frequency is 65 Hz which is significantly lower than normal male and female voices
2. Electrolarynx Speech
- Battery operated vibrating device is held in the submandibular region
- Muscle contracture and changes in facial muscle tension causes the rudiments of speech
- Initial training to use the device begins before surgery
Advantages of Electrolarynx:
- Easy to learn how to use
- Allows immediate communication
- Additional surgery is avoided
- Can be used while training in other Vocal Rehabilitation techniques
Disadvantages of Electrolarynx:
Starting at $600, cost could be an issue for some
Speech quality is mechanical
Difficulty to use on the phone
3. Tracheo-Esophageal Prosthesis (TEP) Speech
- A small hole is made in the rear of the stoma leading to the esophagus. Once this puncture heals, a prosthesis is fitted and inserted into the opening.
- To speak, you cover the stoma with your thumb or finger and simply force air through the prosthesis into the esophagus. This air movement vibrates the walls of the esophagus and you can create sounds and words normally with your lips, teeth, and tongue, etc.
- The prosthesis has a one-way valve in it to prevent swallowed food and liquids from entering your stoma. Additionally, your stoma can be covered with a special valve, called a Hands-Free that closes when you wish to speak, thus forcing air into the prosthesis.
- TEP is considered the gold standard among various voice rehabilitation procedures.
TEP Can be indwelling or non-indwelling:
|Indwelling Prosthesis||Non-Indwelling Prosthesis|
|Can be left in place for 3-6 months||Removed and cleaned every 2-3 days|
|Requires a specialist for placement||Can be place by patient|
|Less maintenance||Periodic maintenance|
Advantages of TEP:
- Can be performed after laryngectomy, radiation or chemo therapy, neck dissection
- Fistula can be used for esophago-gastric feeding during immediate PO period
- Easily reversible
- Speech develops faster than Esophageal Speech
- High success rate
- Speech is intelligible and closely resembles laryngeal speech
Disadvantages of TEP:
- Unless using the Hands Free model, patients need to manually cover stoma during voicing
- Patients must have good pulmonary reserve
- Additional surgical procedure is needed to introduce it.
- If not applied correctly, posterior esophageal wall could be punctured.
By working with a speech therapist trained in these alternative speech options, people who undergo laryngectomy can re-gain the type of speech and voicing that works best for them.
It is encouraging to know the number of laryngectomies decreased by 48% between 1997 and 2008, and the number of new cases of laryngeal cancer decreased 33% during the same time. For those who face laryngectomy, advances in technology and the availability of speech therapy after laryngectomy ensure they will be able to re-gain the best possible speech and swallow function for the best possible quality of life.
Mandy Bell and Jaime Richardson are two of the speech therapists at Therapy Achievements who work
with Head and Neck cancer patients. They are certified in myofascial release and have advanced training in treatment of swallow dysfunction.
For more information on how Therapy Achievements can help with treatment of Head and Neck cancer or to set up an appointment, call 25-509-4398.
Brain Injury Awareness
March is Brain Injury Awareness month and to increase brain injury awareness in Huntsville, the Alabama Head Injury Foundation sponsored a float in the Saint Patrick’s Day Parade. Members from local brain and spinal cord injury support groups braved the cold to raise awareness of brain injury and steps to prevent it.
Think Ahead and learn the common causes of TBI, so you can take steps to prevent TBI during everyday activities, at work, while playing sports, or during a deployment. Safety measures you should take before getting on a bicycle or motorcycle, driving and playing sports include:
Wear a helmet (and make sure your children wear helmets) when you:
- Ride a bike, motorcycle, snowmobile, scooter or all-terrain vehicle
- Participate in a contact sport, such as football, ice hockey or boxing
- Use in-line skates or a skateboard
- Play baseball, softball, football or lacrosse
- Ride a horse
- Ski or snowboard
- Zip line, rock climb, bungee jump, hang glide or participate in any other activity that involves heightsWear a seat belt… of alcohol or drugs, including prescription medications.
Wear a seat belt…
Every time you drive or ride in a car, truck or other motor vehicle, wear a seat belt. Small children should always sit in the back seats of cars, away from airbags, and use safety seats or booster seats appropriate for their size and weight (according to state laws).
Never drive while vision-impaired or under the influence…
of alcohol or drugs, including prescription medications.
Prevent falls by:
- Clearing tripping hazards such as loose rugs, uneven flooring or walkway clutter
- Using nonslip mats in the bathtub and on shower floors, and installing grab bars next to the toilet, tub and shower
- Installing handrails on both sides of stairways
- Improving lighting throughout the home
- Exercising according to your doctor’s instructions to improve lower-body strength and balance
Make living areas safer for children by:
- Using safety gates at the top and bottom of stairs
- Installing window guards at open windows
- Making sure that your child’s playground is made of shock-absorbing material, such as hardwood mulch or sand
- Supervising children carefully, especially when they’re near water
Know the signs:
Concussion, also known as mild Traumatic Brain Injury, often goes undetected or undiagnosed initially because the symptoms can be subtle and varied. Think Ahead to recognize mild TBI by learning common signs and symptoms.
- Headaches or neck pain that do not go away;
- Difficulty remembering, concentrating, or making decisions;
- Slowness in thinking, speaking, acting, or reading;
- Getting lost or easily confused;
- Feeling tired all of the time, having no energy or motivation;
- Mood changes (feeling sad or angry for no reason);
- Changes in sleep patterns (sleeping a lot more or having a hard time sleeping);
- Light-headedness, dizziness, or loss of balance;
- Urge to vomit (nausea);
- Increased sensitivity to lights, sounds, or distractions;
- Blurred vision or eyes that tire easily;
- Loss of sense of smell or taste; and
- Ringing in the ears.
If you think you, or someone else you know, has a TBI, please Think Ahead and seek medical help as quickly as possible to improve chances of a full and complete recovery.
Therapy Achievements helps people with brain injury recover function after brain injury. Our staff has extensive experience working with brain injury after trauma, stroke, or medical conditions that impact brain function. We offer physical, occupational and speech therapy to help people re-gain balance, the ability to walk, and hand function. We provide visual and cognitive re-training, training in activities of daily living and identify adaptive equipment to help people re-gain the ability to participate in functional activities. Programs are tailored to an individual’s needs and we are in-network with most health insurance providers. Have you or someone you know suffered from brain injury? Call us today at 256-509-4398.
Brain and Spinal Cord Injury Support Group:
Brain and spinal cord injury occur in young adults – people between the ages of 18 and 34 – more than any other age group in the United States. Every year 1.7 million people sustain a brain injury and 12,000 people sustain a spinal cord injury . Brain and spinal cord injury are correlated to risky behavior such as:
- * Injury-prone sports: Skateboarding, football, cheerleading, hockey, and skiing are among the top injury-prone sports
- * Distracted Driving: Texting, Using a cell phone or smartphone, Eating and drinking, Talking to passengers, Grooming, Reading, including maps, Using a navigation system, Watching a video, Adjusting a radio, CD player, or MP3 player are the top reasons for distracted driving
- Substance Abuse: 30% of people requiring rehabilitation after injury were intoxicated at the time of their injury
- Exposure to violence and violent behavior: The Centers for Disease Control and Prevention (CDC) estimates that 11% of traumatic brain injury deaths, hospitalizations, and emergency room visits combined are related to assaults
Young adults are more likely than other age groups to be engage in or exposed to risky behaviors and men are two and one-half times more likely to die from injuries resultant from accidents (unintentional injuries), homicide, and suicide – the three leading causes of death in young adults.
One of the most devastating and long-lasting result of brain and spinal cord injury is isolation. The National Resource Center explains after injury, many survivors describe feeling lonely — even when they are surrounded by other people. This loneliness may arise for many different reasons.
- Difficulty talking to other people or understanding what others are saying are common problems survivors face after injury. Communication problems can make relating to other people and explaining your thoughts and feelings very difficult. These problems can lead to feeling misunderstood and isolated.
- Many survivors feel self-conscious after their injuries. They may worry about being different or less capable than other people. Self-consciousness can make it harder to spend time with other people or seek out new relationships.
After injury, many survivors worry about what others will think of them and may feel nervous about being around other people. They may be afraid of being hurt or rejected by other people.
- Many survivors notice they are more irritable after their injuries. When irritated, they may say or do things they regret later on. Some survivors try to stay away from those they care about for fear of behaving poorly. Family and friends may also avoid you if they are worried about what you might say or do.
- Fatigue and low energy are common problems after brain injury. Survivors may not have the energy to do things they used to enjoy or to spend time with friends and family. Family and friends may also worry about tiring you out when they invite you to do something.
- Pain and other physical problems often make it harder for survivors to do things they used to enjoy. You may also have trouble leaving the house, traveling, or visiting other people. Injury-related limitations make it harder to nurture and build relationships.
- Many survivors are not able to drive or work after their injury. Lack of transportation and money may make it hard to visit others or do things you enjoy.
- People generally make friends through work or being involved in social or recreational activities. After injury, survivors often stop working and may not be involved in sports, church, and other activities. You may lose contact with friends and co-workers because you don’t see them as much.
- Friends and family may feel uncomfortable because they don’t know what to say, how to act, or how to help. Discomfort may make it harder for them to relate to you or spend time with you. Help them out by letting them know about your positive and negative feelings and what they can do to help you
In Huntsville, the “All Cracked Up” Brain and Spinal Cord Injury Support group is one way young adults can overcome the isolation of brain and spinal cord injury and start connecting with people who understand. The group meets on second Saturdays from 11:00 – 1:00 to eat lunch, play games, plan events and share what’s happening in each others lives. Shannon shares, “One of the most valuable benefit of the brain and spinal cord injury support group is finding a place where you feel comfortable and can talk with people who “get it,” who truly understand your issues. What surprised me was all of the how helpful it was to share “strategies,” those amazing little tools that help you do things you couldn’t do otherwise. Many of us struggle with performing simple everyday tasks like getting dressed in the morning and making supper. Group members share “strategies” for what works for them — and it feels like a light bulb lights up inside your head!”
“All Cracked Up” is open to people ages 17 to 40ish and meets on second Saturdays at Therapy Achievements. For more information, to get a schedule of meetings, or to get on the mailing list, contact Karen at 256-509-4398 or firstname.lastname@example.org.
Maryann is the proud new owner of “Lilies”, a floral painting by Cynthia Parson’s. Maryann attends therapy for treatment of lymphedema at Therapy Achievements where some of Cynthia’s work is displayed. “I’ve been admiring that painting for quite a while and really enjoyed looking at Cynthia’s work during my therapy sessions. I finally decided I wanted it and now it’s mine!”
Cynthia has a number of other florals, still lifes and pet portraits on display at Therapy Achievements. Stop by and take a look. You might be the next proud owner of a Cynthia Parson’s painting!
Check out this new brace for walking with foot drop! People with foot drop can’t lift the front part of their foot due to weakness or paralysis of the muscles that pick up the toes. Lots of people have foot drop and it can happen when foot muscles become weak after stroke, brain injury, multiple sclerosis, neuropathy or other injuries. Foot drop can happen to one foot or both feet at the same time and can happen to people at any age.
Walking with foot drop is difficult because when the toes don’t lift, they tend to drag along the ground. This can result in tripping or falling. To avoid dragging the toes, people with foot drop may lift their knee higher than normal or may may swing their leg in a wide arc. Or, they may wear a brace to hold the foot in place. Some people don’t like walking with braces because they can be awkward and uncomfortable.
To help people with foot drop, the Saebo company has come out with a new product to make walking with foot drop easier. The SaeboStep consists of a lightweight, uniquely designed foot drop brace that provides convenience and comfort while offering optimum foot clearance and support during walking.
Want to try it out? Our physical therapists have extensive experience in helping people with foot drop. They can help you find the right brace to walk more efficiently with less pain. Give us a call today at 256-509-4398!
Treatment for Multiple Sclerosis:
Amanda Adcock presented “One Treatment Option for Multiple Sclerosis” at the Huntsville Multiple Sclerosis Awareness Group Meeting on 1-17-17. Here are highlights from her presentation:
Multiple Sclerosis is an Autoimmune Disease:
- Multiple Sclerosis occurs when your immune cells attack healthy parts of your central nervous system
- B & T immune cells are thought to
- Multiple Sclerosis is thought to be triggered by a genetic predisposition AND environmental exposure
- 50 different genes are associated with Multiple Sclerosis
If You Have MS, Be your own advocate
- Is your current treatment for multiple sclerosis working?
- Partner with your healthcare provider
- Use diagnostic tests to judge your disease activity
- Evaluate your personal preferences and goals for treatment
- Does the schedule and delivery method of your treatment work with your lifestyle?
- Is used to treat adults with relapsing MS
- Is for people who have tried two or more MS medications and have not achieved desired results
- Is thought to recognize and remove certain B & T immune cells thought to cause MS.
- Is given in 5 consecutive days in an IV infusion. The IV infusion takes about 7 hours.
- Your body slowly begins to replace the cells that were removed with new cells.
- You will have a monthly blood draw to monitor your B & T immune cell levels.
- 12 months after your first treatment, a second dose of IV infusion is given in 3 consecutive days.
- Most people will not need to take any further treatments. Some people will need to take a third dose.
- In a 2 year trial, people taking Lemtrada had 49% fewer relapse than people taking Rebif
- People taking Lemtrada had 42% less disability progression as measured by the Expanded Disability Status Scale
The New Year is a time of reflection. Each January, roughly one in three Americans resolve to better themselves in some way. Will a New Year bring a New You? See if your New Year’s resolutions make the top 5 list:
Lose Weight and Get Fit
Weight loss and getting fit are the most popular resolutions. Healthy weight and regular exercise are associated with more health benefits than anything else known to man. To increase your successfulness, set reasonable goals and partner with someone who can help keep you accountable.
Whether it’s your home, office or closet, being organized helps decrease stress and increase your effectiveness. Look for a local professional organizer on www.findmyorganizer.com to help you get the job done or Google “de-clutter” for hundreds of tips on how to tackle disorder.
Spend Less, Save More
Work, money and the economy are the biggest cause of Americans’ stress, according to research recently released by the American Psychological Association (APA). Certified financial planners (CFP) can help you get a handle on your finances. Find one on www.fpanet.org.
Learn Something Exciting
Whether you take a course or read a book, you’ll find education to be one of the easiest, most motivating New Year’s resolutions to keep. Life-long learning classes are available at UAH (www.osher.uah.edu), and ASU (www.athens.edu/CLL).
To better yourself the most, help others. Donate your time, blood, money or items that you no longer use to make a difference for someone in need.
Don’t think you can get fit, get organized, learn something exciting or help others because of injury or illness? Therapy Achievements can help you re-gain movement, balance, and thinking skills disrupted by brain injury, stroke, Parkinson’s Disease, Multiple Sclerosis or other disorders. We offer physical, occupational and speech therapy to help you identify goals, develop a plan to achieve them and help you to reach your potential. Let us help you welcome in a New Year with a New You!
Balance & Fall Prevention: Strategies for Intervention
Balance & fall prevention are a matter of urgent concern to many older adults and their caretakers. According to a 2008 report by the Center for Disease Control:
- One third of those over the age of 65 have a fall every year
- One out of 10 falls results in a serious or even fatal injury.
- Falls are a major cause of death in people over the age of 65.
Because a fall can have devastating and even fatal consequences, fall prevention is of utmost importance. The good news is there are easy and simple steps you can take to prevent falls.
Balance & Fall Prevention: Balance
Balance is a key component to fall prevention. Good balance is made up of:
- Correct sensory information from your eyes (visual system), muscles, tendons, and joints (sensory motor input), and the balance organs in the inner ear (vestibular system).
- The brain stem making sense of all this sensory information in combination with other parts of the brain.
- Movement of your eyes to keep objects in your vision stable and keep your balance (motor output).
As we age, postural sway tends to increase and balance control tends to decrease. Factors that contribute to this change include changes in:
- Physiological and psychological function
- Development of diseases
- Use of drugs that affect the visual, vestibular and proprioceptive function
As a result, if some people slip, trip, or loose their balance it is less likely they will be able to recover equilibrium in time to prevent a fall.
Balance & Fall Prevention: Who Falls?
Frail older adults were matched for age, number of health problems and medications use. Those who fell compared to those who did not had:
- Higher levels of nutritional risk
- Poorer leg strength and balance
- Poorer psychological well-being
- Female gender
- Disability of lower extremities
- Hearing impairment
Sensory impairments are a substantial problem for older Americans: One out of six has impaired vision; one out of four has impaired hearing; one out of four has loss of feeling in the feet; and three out of four have abnormal postural balance testing. Not only are sensory impairments a problem, but they increase with age: Vision and hearing impairments each double, and loss of feeling in the feet increases by 40% in persons aged 80 years and over compared with persons aged 70-79 years.
Balance & Fall Prevention: The Visual System
Visual Acuity is the clarity or sharpness of vision. Cataracts are the most common cause of vision loss in people over age 40 and cataract surgery dramatically decreases the number of falls due to poor vision. Patients had a 78% decrease in the risk of falls the year after cataract surgery on one eye. But . . . the number of falls that required hospitalization doubled between first and second eye cataract surgeries. This emphasizes the need for timely provision of second eye surgery and appropriate refractive lenses management between surgeries. Poor visual acuity not only increases risk of fall but can result in dizziness. The percentage of patients who reported dizziness dropped from 52 percent to 38 percent six months after cataract surgery. But . . . the percentage of patients who reported falling after surgery dropped only slightly, from 23 percent to 20 percent. Researchers found a significant link between post-operative falls and the patient being switched to multi-focal lenses. “Unrelated to their cataract surgery status, people who wear multi-focal lenses have been shown to have increased fall rates,” says Dr. Lewerenz from the Lewerenz Medical Center.
Bifocal/multifocal glasses distort depth perception while walking or climbing stairs. This is because the glasses are usually designed to be used looking down while reading. When the eyes are focused downward while walking looking through these same lenses, depth perception becomes greatly distorted. Other conditions that affect depth perception include Anisometropia – eyes with differing refractive errors, a cataract in only one eye, macular degeneration or gluacoma when one eye is frequently affected more than the other.
When contrast sensitivity is impaired, there is a limited ability to see well in low lighting or situations where there is little difference in colors and textures. Poor contrast sensitivity also can increase your risk of a fall if you fail to see that you need to step down from a curb onto similarly colored pavement. Low contrast sensitivity can occur with eye conditions such as cataracts, glaucoma or diabetic retinopathy.
Balance & Fall Prevention: The Sensory-Motor System
Muscle weakness, especially in the legs, is one of the most important risk factors. People with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance. Conditions that contribute to muscle weakness include:
Infection: Pneumonia, UTIs, Meningitis
Nutrition & GI Dysfunction: Vitamin D Deficiency, Dehydration, Malnutrition, Ulcers, Bowel obstruction
Organ Dysfunction: Thyroid: Hyperthyroidism, Hypothyroidism; Heart: Cardiac insufficiency, arrhythmia; Liver: Hepatitis, Cirrhosis; Kidneys: Renal insufficiency
If weakness is due to a medical condition, you may need help from physical therapy to develop an individualized treatment program to help you re-gain the strength you need to reduce your risk of falls.
San Diego State University’s Daniel Goble, professor in the School of Exercise and Nutritional Sciences, studies “proprioception” — the ability to know where we are in space. And, as we age, proprioception decreases. “Imagine you are sitting down and you have your feet under a desk,” Goble explained. “Even without seeing your feet, you know where they are approximately and what direction they are pointing — that’s proprioception,” Goble said. “When proprioception begins to fail, we can’t sense those things and as a result we may misjudge or misstep. In the elderly, that misjudgment could result in a dangerous fall.” Regular physical activity seems to be a beneficial strategy to preserve proprioception and prevent falls among older subjects. Some studies have demonstrated that the regular physical activity can attenuate age-related decline in proprioception.
Balance & Fall Prevention: The Vestibular System
The Purpose of the vestibular system is to determine head and body orientation in comparison to gravity. It is comprised of:
- 3 semicircular canals
- 5 sensory organs
- Hair cells
Function: The semicircular canals contain fluid that moves in the opposite direction of the head movement. The fluid deflects hair cells that line the semicircular canals and fire the 8thcranial nerve (vestibular nerve). When the vestibular system is not working correctly, symptoms
- Vertigo, Nausea
- Visual Changes
- Decreased concentration/memory
- Muscle fatigue/aches
Putting It All Together- The Brain Stem
Information from your vision, muscles, tendons, joints, and balance organs in your inner ear are all sent to the brain stem. The brain stem also gets information from other parts of the brain called the cerebellum and cerebral cortex, mostly about previous experiences that have affected your sense of balance. Your brain can control balance by using the information that is most important for a particular situation. For example, in the dark, when the information from your eyes is reduced or might not be accurate, your brain will use more information from your legs and your inner ear. If you are walking on a sandy beach during the day, the information coming from your legs and feet will be less reliable and your brain will use information from your visual and vestibular systems more. Once your brain stem sorts out all of this information, it sends messages to the eyes and other parts of your body to move in a way that will help you keep your balance and have clear vision while you are moving.
Balance & Fall Prevention Strategies
Fall prevention occurs in two primary ways:
- Treating physiological and psychological factors & eliminating offending drugs which contribute to balance impairment.
- Modifying the living environment.
Physical therapy can be a critical component to balance & fall prevention. A physical therapist can help to determine:
- Which systems are working correctly and which are not
- If information from these systems are being “put together” or “integrated” correctly.
- How to improve these systems to keep your balance
- Which exercises you can do to improve how your body uses all these systems together.
Up to 85% of falls occur in the home and simple home modifications can go a long way in fall prevention. Most falls occur in the bedroom, bathroom, kitchen and stairs. Risk factors include: low bed heights, poorly equipped chairs and toilets, low-lying objects or floor coverings, poorly visualized door thresholds, slippery (highly polished) floor surfaces or wet floor surfaces, unsecured rugs, and poorly lit walkways and stairs.
To be effective, environment modification must accommodate balance problems and be aesthetically pleasing. By watching a person maneuver about his or her living environment, a therapist can determine which areas increase risk. The therapist will observe the client:
- Walking over all the different ground surfaces in the environment.
- Transferring from beds, chairs, toilet, in and out of the bathtub or shower, in and out of the car.
- Reaching up and bending down to retrieve objects from low and high surfaces
- Navigating stairs.
Other factors to be evaluated include:
Footwear that provides stability and a non-skid surface is important for good balance. Range of motion and/or strength limits often cause difficulty bending down to apply footwear. Because of this, people often wear loose fitting slippers. Elastic shoe laces, long-handled shoehorns, reachers, shoes with Velcro fasteners, or orthopedic shoes may be necessary to decrease the risk of falls.
Thick carpets should be replaced with ones made of uncut low pile. Patterned carpets should be avoided. Area rugs should have nonskid backings. Throw rugs should be removed.
Getting up at night in a darkened bedroom reduces the visual function component of the balance system. Night lights, leaving a bathroom light on, and using light switch plates that contrast the color of the wall and can be illuminated assist with night visibility. Persons with cataracts experience difficulty with glare, are sensitive to bright lights, and may suffer further visual impairment if lighting is too bright. Light sources should be positioned to eliminate glare and shadows.
Good lighting is essential in stairways. Patterned carpets or floor coverings disguise step edges and must be removed. Step edges can be enhanced by painting or taping the edges in a contrasting color. Handrail should extend at least 12 inches beyond the end of the stairway and should be a contrasting color to the wall.
Walkers typically don’t fit in bathrooms because of space limitations and balance is assisted by clutching doorknobs, bare walls, sinks and towel bars.
These structures are either not stable or not designed to support the weight of someone. Grab bars provide stability and are designed to support a person’s body weight if installed properly. Toilet grab bars that attach to the toilet allow a person to exert maximum force straight downward with the hands and arms which provides support during transfers. High-rise toilet seats reduce the amount of leg strength required to lower and raise oneself from the toilet and the amount of forward bending required to maintain control during sit to stand.
Slip resistant bath rugs or mats can help reduce slippage on wet surfaces. Soaps and shampoos should be placed to avoid reaching overhead or stooping. Grab bars in the shower or bath provide support during entrance and exit. Tub transfer benches, tub seats or shower seats along with a flexible handheld shower hose enable bathing to be completed in sitting.
Beds height should not be too high or too low. Beds should be approximately 18 inches in height, measured from the floor to the top of the mattress. Bed leg risers can be purchased to increase the height of a bed that is too low.
Mattresses that are too soft make pushing up into sitting difficult. A firm mattress enables support when pushing up. Bed rails may be added to a bed to provide extra support. They must be securely fastened to do so.
Chairs that are low or without armrests are difficult to transfer on and off of. Chairs should have armrests approximately 7 inches above the seat and extend at least 1 inch beyond the seat edge for maximum leverage. Avoid cross rails on chair legs, which prevent the person’s legs from sliding underneath the seat to assist in rising. Chair legs should not slide when leaned on. Chairs should be stable enough to support a person’s weight when leaned on. Drop-leaf and pedestal-type tables tend to tip over when weight is applied to the edge and should be avoided.
Kitchen carts should can be used for transferring items such as food, utensils, and dishes from one part of the room to the next. Frequently used items should be arranged to they are located between a person’s hip and eye level to avoid reaching up or bending down.
Keeping active is one of the most important factors to fall prevention. By being mindful of factors that put you at risk for falling and taking preventative measures will keep you on the road of independence!
Keeping active is one of the best things you can do for balance & fall prevention
Athletes with Multiple Sclerosis
“I have Multiple Sclerosis, but Multiple Sclerosis doesn’t have me.” That quote comes from Don McNeal, a two time National College Football Champion (1978, 1979) who played for Alabama under coach Paul “Bear” Bryant. McNeal spoke at the Multiple Sclerosis News and Views Conference in Huntsville, AL Thursday, 8-18-16 and shared how he and other athletes with multiple sclerosis struggled and cope with this debilitating disease.
Born and raised in Atmore, AL native, McNeal was a star on the Escambia County High School football team. After high school, he played football for Alabama University under coach Paul “Bear” Bryant. In addition to helping his team win two National Championships, McNeal was Captain of the Team in 1979 then drafted as a defensive back by the Miami Dolphins in 1980. McNeal played in two Super Bowls with the Dolphins: Super Bowl XVII in January 1983 and Super Bowl XIX in January 1985. During those seasons, McNeal was named the Dolphins’ Player of the Year. He retired at the end of the 1989 season having played his entire pro career with the Dolphins. In 1992 he was selected as a member of the University of Alabama All-Centennial Team in 1992 and in 2008 was inducted into the Alabama Sports Hall of Fame in Birmingham, Alabama.
After retirement from football, McNeal became actively involved in his community. He served as a drug-rehab counselor, teacher, coach, lay pastor, board member, and frequent public speaker. He was a pastor at New Testament Baptist Church in South Florida and speaker for Power Talent. To this day, he remains active with associations that assist youth and adults.
McNeal was diagnosed with multiple sclerosis in 2014. Multiple Sclerosis is an incurable, auto-immune disease and that damages the myelin sheath surrounding sensory and motor nerve fibers. Depending on which nerves are affected, it can cause impairment in vision, sensation, strength, endurance and coordination. It has begun to sap McNeal’s strength and coordination and he now uses a power scooter to assist with mobility. McNeal believes repeated NFL concussions brought on his ailment. He and a number of athletes with multiple sclerosis and other disorders suing the league for damages . They are not looking for sympathy. They want empathy. “There are a lot of former players who are trying to do the right thing,” he said. “I hope the NFL will do right by us.”
McNeal spoke at the Huntsville Multiple Sclerosis Treatment Conference Thursday 8-18-16 . His mission is to share hope and inspiration with those facing Multiple Sclerosis. “Coach Don Shula always told me no matter what, always show your class,” said McNeal. That meant standing tall and facing what was to come with poise and grace. “That’s what I’m trying to do here.”
McNeal, ever the optimist, refuses to feel down about it, but turns his energy toward helping others. A man of deep religious faith, he still spends three days a week at Dade Christian School in Miami Lakes. “He has such a good spirit,” said McNeal’s wife Rhonda. “He never complains, and even picks me up when I have a bad day. His positive attitude is why everyone still wants him around here.”