Fall Prevention: When Does this Apply to You?
-Currently using a walker/cane or another form of walking aide
-Have muscle weakness or decreased sensation in the feet or legs
-Have poor vision
-Recently had a lower extremity surgery
-Feeling dizzy or light headed
-Had a fall within the past few months to a year
-Fearful of falling
-On a ton of medications
Well then this if for you!
Falls...the one thing that everyone is afraid off especially when over the age of 65. Falling is the number one reason for fatal and nonfatal injuries in persons 65 and older. Falls are also the most common cause of traumatic brain injury ¹. According to the CDC (Centers for Disease Control and Prevention), 1 in 4 elderly adults 65+ yrs old fall each year ¹. One in five falls will result in a serious injury such as head trauma or a broken bone ¹. “Over 800,000 people a year are hospitalized due to a fall that resulted in injury of either head trauma or hip fracture. More than 95% of hip fractures are a result of a fall. ¹” In addition, ¹ “every 20 minutes an older adult dies from a fall in the United States”. Yikes!!
Prevention is Better Than a Cure
Some of the things that contribute to falls especially in the elderly population are impaired vision, medication, decreased balance, leg weakness, chronic health conditions and home hazards. The key is figuring out which one or ones are a problem for you so that you may seek help to decrease these risk factors and lower your chances of having a fall.
Problem: Impaired Vision
People with visual deficits such as glaucoma or cataracts are definitely at risk for falls as their visual acuity and depth perception are altered. Lighting can also play a role as if walking out at night or when getting up from bed to walk to use the bathroom; if adequate lighting is not available the visual field will be altered thus increasing risk of falls.
Solution: If you notice you have trouble looking at objects either far or near or often misjudge your step when coming on/off an escalator or stair case, you might have a visual deficit. Get your eyes tested frequently. If you were prescribed glasses, make it your duty to always wear them. Update your glasses if need be. The CDC recommends: “If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are. ²” Also utilize night lights throughout your home to ensure adequate lighting when going to restrooms and always give yourself a few minutes to adjust upon getting up from bed to walk to restroom to ensure your eyes have adjusted from your awaked slumber.
Certain meds have side effects of dizziness, altered mental state, muscle fatigue and sudden drop in blood pressure including but not limited to blood pressure medication, antidepressants, sleeping pills and some pain meds and muscle relaxers. Not to mention if on more than one of these medications the drug interactions can cause issues with gait and balance and increase risk of falling.
Solution: Have your primary care provider look over ALL your medications to screen for the side effects and drug interactions. Report a list of all your medications to your health care providers. It is important to keep all your health care clinicians in the loop with your list of meds because if one prescribes a medication unaware that you are currently taking a drug for a certain condition he/she might end up prescribing you another medication treating the same condition but with more severe side effects when interacting with that drug. Thus putting you at risk for falling. As a Physical Therapist, I ran out out of fingers and toes to count the amount of times I had patients coming in for gait and balance treatment, with a long list of meds to treat similar or exactly the same conditions in which the physicians prescribing these drugs had no clue the patient was already taking Drug XYZ prescribed already from Doctor A. So I can’t emphasize enough the importance of having your healthcare provider monitor the medications you are on and their interaction with other drugs.
Problem: Decreased Balance/ Leg Weakness
If you have had numerous falls in the past, frequently feel unbalanced when walking, often grab onto the nearby person/wall/furniture when walking then you may have a balance impairment. Many factors can play into why someone has decreased balance for example whether or not you may have decreased sensation in your feet due to Diabetes, or have an inner ear issue such as vertigo, or recently had a stroke and have difficulty moving the limbs due to extreme weakness. Decreased mobility/inactivity can also affect balance because when we are inactive our muscles become deconditioned and if the muscles are weak, they will affect our ability to stay upright thus putting us at increase risks for falls. Not to mention if you do trip, the ability for you to catch yourself or to correct your footing is less likely if the muscle strength is not there.
Solution: Consider using a walking aid whether cane or walker. A Physical Therapist can assess you for the proper assistive device needed to give you more stability when walking and can train you on how to properly use the device. Talk to your health care physicians about falls prevention classes or referrals for physical therapy to work on gait and balance training and/or strength conditioning. Also, stay active! You are never too “old” to exercise. The body is made up of many muscles and like the saying goes “use it or lose it”. It doesn’t mean you have to sign up for the next marathon but just keeping moving, maybe even a gentle daily walking program to build up endurance. You can even join a gym! The American Heart Association, AHA, recommends about 30 minutes of moderate intensity exercises at least 5 days a week to improve overall health ³.
For Overall Cardiovascular Health:
At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150
At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity
Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.
Problem: Chronic Health issues
Patients with comorbidities and chronic illness such as Diabetes, Arthritis, Heart Disease, COPD, Parkinsonism, Multiple Sclerosis, Alzheimer’s, history of stroke, and etc are at increased risk to falls due to the general weakness, impaired muscle tone, reduced sense of position in relation to gravity, altered mental state, decreased cardiovascular endurance and decreased oxygenation.
Solution: Follow up with health care provider regarding treatment interventions and exercise regimens to ensure optimal functioning despite health conditions. Routinely check blood pressure if feeling lightheaded, check glucose levels, use assistive device of need be for conditions that can impact gait and take prescribed meds at routine time of the day.
Problem: Home hazards
As we often like to think we are the most safe in our homes, that is not always the case. Clutter can lead to tripping and falling. Incorrect placement of furniture may narrow spaces and increase risk for falling. Throw rugs and small pets are very easy to trip over or get your walking aides caught up over. Poor lighting can affect your visual field and depth perception. Cracked stairs and loose carpet, lack of or shaky railing can also increase your risk of falling. The bathroom can become a complete nightmare without grab bars or a shower stool. High kitchen cupboards may prove difficult to reach and can lead to a safety issue if you are constantly trying to climb up onto the counter. Step stools are helpful but if unsteady can be very dangerous.
Solution: Remove the clutter from your home. Wires, stacks of books, that step stool you refuse to place under the table or in a closet can all lead to clutter and increase risk of falling. Furniture placement is also essential making sure everything is strategically placed so that you are able to maneuver around your home without sliding through the corners or stumbling around your furniture. Even more so, if you use an aide whether cane or walker to move around; it can easily get caught in the clutter causing you to misstep and fall down. Get rid of or properly secure throw rugs to the floor especially if you notice the ends curling upwards.
Be mindful of pets when walking about in your home; they love to lay near your feet. As lovable as they are, they are very easy to trip over if not paying attention!
Be mindful of steps especially if you already had visual issues. Depth perception and busy colors can really impact the way we see our stairs. Also if living in an older home make sure the railing is secure and if steps are slanted revealing wear and tear, maybe time to revamp as this can all lead to falls. Make sure to hold onto railing when ascending or descending stairs and be aware of foot placement to ensure you don’t misplace your feet at the edge. You may even consider installing rails on both sides if need be for safety. Don’t forget having a step stool in the kitchen can be very helpful. Ensure the step stool is leveled before using.
Grab bars and/or shower stool are also neat for bathrooms especially in showers where it tends to get slippery. May even consider anti-slip bath mats. Also grab bars near the toilet as to assist with transfers on and off.
Lighting is essential in both daytime and especially at night. Broken bulbs?? Replace it! Make sure your home always has adequate light to ensure that you can see where you are going especially at night time walking down hallways to get a glass of water or use the bathroom. Night lights tend to come in handy for that or if you are feeling fancy, motion sensor lights can also do the trick. Also make sure there is adequate light over staircases. Is the light switch only at the bottom or top of the staircase? You may need both to ensure safety.
“Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Oct. 2016, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/index.html.
“Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
American Heart Association Recommendations for Physical Activity in Adults. (2017, December 14). Retrieved July 23, 2018, from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.W1Ydo-gvxD8
Yoshida, Sachiyo. “A Global Report of Falls Prevention: Epidemiology of Falls.” Retrieved July 24, 2018 Http://Www.who.int/Ageing/Projects/1.Epidemiology%20of%20falls%20in%20older%20age.Pdf
Picture retrieved from
What Is BPPV?
BPPV-Benign Paroxysmal Positional Vertigo is the most common vestibular disorder that causes a false sense of room spinning dizziness. This issue is due to the disruption of the crystals in your inner ear. This occurs when the otoconia (calcium carbonate crystals) get dislodged from the utricle, where they are normally embedded, and migrate into one or more of the 3 semicircular canals also known as “canalithiasis” ¹. During head movement, the free floating otoconia crystals shift disrupting the normal fluid movement in the semicircular canals thus causing the brain to send signals of false movement in relation to gravity ¹. The information perceived by the brain does not match what the eyes are seeing and what the body muscles are doing nor what the other ear is sensing therefore causing the person to feel an imbalance or false sense of spinning ¹.
What Causes BPPV to Happen?
There is no known exact cause as to why this happens but research has shown that risk factors that may influence the occurrence of BPPV are: direct trauma to the head, prolong periods of inverted head positions, inner ear infections or diseases, migraines, reduced blood flow, sickness causing prolonged periods of lying in bed and or inactivity, and one’s preferred sleep position ¹.
Am I Making This Up? Is BPPV all in My Head? Why Me?
You are not alone nor are you going crazy! BPPV has an estimated incidence of 107 people per 100,000 per year ¹. BPPV has a recurrence rate of about 15% per year with a high of 56% ² of individuals having a recurrence of BPPV. It is more prevalent in people 50 and older and more likely prevalent amongst females ³. At least 20% of patients that have symptoms of dizziness are diagnosed with BPPV by their physician ². Other symptoms that can also occur due to this condition other than the routine nausea, room spinning dizziness and vomiting are high levels of anxiety, frustration, anger, fatigue and depression. It is completely normal to feel helpless and frustrated and depressed when dealing with BPPV due to the functional limitations that occur as a result of this condition but please seek counselling if symptoms worsen as the emotional component can actually make the symptoms persist.
Who Do I See if I Think I Have BPPV?
After visiting your family doctor or general practitioner and upon diagnosis of BPPV, you may be referred to a more specialized physician for treatment or further assessment such as an Audiologist, ENT (Ear Nose and Throat Doctor), and/or Physical Therapist (specifically trained to rehab patients with vestibular disorders) ¹. Beware that not all Doctors are familiar with vestibular rehabilitation and may fail to refer you to a Physical Therapist for treatment, which has been proven highly effective for recovery, so don’t be afraid to bring up the idea of seeing a Physical Therapist for treatment to your doctor if have been diagnosed with BPPV.
How is BPPV Diagnosed?
BPPV is diagnosed through symptom clustering and checking the semicircular canals via the Dix Hallpike and Supine Horizontal (Roll) tests. During your assessment your Physical Therapist may ask you question in regards to positions and whether or not they tend to elicit your symptoms. BPPV is commonly triggered by activities such as getting in and out of bed, rolling over in bed, tipping the head back to look up, bending over forward, and quick head movements ¹ (i.e turning your head when someone calls your name). After collecting a list of activity provokers, the Therapist and/or other healthcare professional trained in vestibular assessment will perform the Dix Hallpike [Figure 1] ⁴ to check for loose floating otoconia in the posterior semicircular canals which tend to be the most common area of BPPV.
The Supine Horizontal test will also be performed to assess the horizontal canals for BPPV. Positive test is the presence of rapid eye movement whether torsional or up or down beating on the side that is tested which is noted as “nystagmus”. The rapid eye movement is triggered when the free floating otoconia is moving in the canal and should last in short duration under 30 seconds ¹. This can last longer if the otoconia are stuck to the cupula (organ in inner ear that senses spatial orientation) instead of free floating in the canals which is called cupulolithiasis, another form of BPPV where the rapid eye movement nystagmus will occur as long as the patient is held within the testing position. Since the otoconia are stuck on the cupula, the brain perceives constant input of movement therefore causing constant nystagmus when in the tested position but symptoms should subside once taken out of the tested position with head in neutral positioning in relation to gravity. In addition, a series of visual and vestibular test will also be performed to rule out other pathologies.
Figure 1: Dix Hallpike
[Picture retrieved from http://epomedicine.com/clinical-medicine/vestibular-examination-dix-hallpike-maneuver-for-bppv
Ahhhh Yes! The Good Part: How is BPPV Treated?
Upon assessment and determining whether or not it is canalithiasis or cupulolithiasis and determining which canal is affected. The Physical Therapist will perform evidence based highly effective corrective maneuvers to clear the crystals from the canal. The maneuvers utilize head on body movement along with gravity to transfer the crystals back into their rightful place in the inner ear. One of the maneuvers that can be performed is called the Epley maneuver [Figure 2] ⁵ or also known as the Canal Repositioning Maneuver which is performed to clear the otoconia out from the posterior semicircular canal. This maneuver can also be self performed for the individual to treat at home ONLY IF your Therapist recommends it, however, caution should be
taken because if performed wrong can make symptoms worse. The maneuver that can be used to clear the crystals in the horizontal/lateral canals is called the Lempert Roll Maneuver or “BBQ roll’. Both maneuvers can be modified for patients that may have neck injuries or postural deformities that may affect their ability to get into some positions. If the therapist suspect cupulolithiasis, then he/she will perform the Liberatory Maneuver which incorporates rapid head movement to dislodge the crystals from the cupula.
Figure 2: Epley Maneuver
[Picture retrieved from https://athenatech.us/epley-maneuver-diagram/epley-maneuver-diagram-unique-check-your-balance]
Benign Paroxysmal Positional Vertigo (BPPV). (2018, January 26). Retrieved July 10, 2018, from https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
2. Pérez P, e. (2018). Recurrence of benign paroxysmal positional vertigo. - PubMed -
NCBI. [online] Ncbi.nlm.nih.gov. Accessed July 11, 2018, Available at:
3. Patient.info. (2018). Benign Paroxysmal Positional Vertigo; BPPV information. Patient.
[online] [Accessed July 16. 2018]. Available at:
4. Vestibular examination : Dix-Hallpike Maneuver for BPPV. (2014, August 27). Retrieved
July 12, 2018, from
5. Athenatech.us. (2018). Epley Maneuver Diagram Unique Check Your Balance - Diagram
Inspiration. [online] [Accessed 16 Jul. 2018].Available at: https://athenatech.us/epley-maneuver-diagram/epley-maneuver-diagram-unique-check-your-balance
Our Patients come from Round Rock, Austin, Pflugerville, Westlake, Cedar Park, Lakeway, Steiner Ranch, Hyde Park, Tarrytown, Lago Vista, Leander and Georgetown.
When is the right time to think about a Cochlear Implant?
For people with hearing loss, hearing aids are a great option to gain access to speech and communicate with those around you. But for some, hearing aids are not enough. Some people have too great of a hearing loss that even a hearing aid cannot help. For those people, cochlear implants are possible option.
Most people on the street are familiar with hearing aids. However, many people have likely never heard of a cochlear implant. So what is it? A cochlear implant is a surgical prosthetic to help someone with severe to profound hearing loss. These devices are composed of two parts- an internal and external unit.
The external unit contains a transmitter, microphones, and a speech processor. The microphone and speech processor are housed inside of a device that is similar to a behind-the-ear hearing aid. A cable connects the processor and microphone to the transmitter that attaches to the outside of your head via magnet. The microphone picks up sounds and sends it the speech processor that analyzes and digitizes the signal before sending it to the transmitter.
The internal unit is comprised of an electrode array and a receiver. The receiver is located under the skin on the temporal bone. The electrode array is located within the cochlea, or the organ of hearing. The receiver collects the signal sent from the transmitter and converts it to an electrical pulse. This pulse is then sent to the electrode array which then directly stimulates the auditory nerve. This signal then travels the length of the auditory system up the brain where it is processed as sound.
Now surgery may seem scary, but for some, a cochlear implant is a good option to regain functional hearing again.
Who is a candidate for a cochlear implant?
- Have a moderate to profound hearing loss in both ears
- Get little to no benefit from hearing aids
- Have no medical contra-indications that would put them at risk during a surgery
- Is psychologically ready to undergo the time commitment required with a cochlear implant
- Have a severe to profound hearing loss in both ears
- Get little to no benefit from hearing aids
- Have no contra-indications that put them at risk for surgery
- Have familial and educational support that will emphisize the development of auditory skills
What is the process for getting a cochlear implant?
A potential cochlear implant candidate should talk with their ear, nose, and throat surgeon and their audiologist. From there, the audiologist would perform a candidacy evaluation. This candidacy appointment is completed in the best aided condition, meaning the individual would wear his or her hearing aids for the testing. FDA guidelines must be met that shows the individual is not getting functional benefit from amplification. Once approved for the implant, the individual will undergo a medical exam, imaging studies, and a psychological exam. After the child or adult is determined to be a candidate, he or she will undergo implantation surgery.
Now a cochlear implant is no walk in the park. Even after getting an implant and “turning it on,” an extensive amount of follow ups must occur to appropriately program this device. Also, practice on the patient’s part must occur that includes at home listening exercises to retrain your brain how to accept an auditory signal again. It can be frustrating at times because progress can be slow.
However, with appropriate follow up and effort on the patient’s part, cochlear implants can allow individuals to rejoin the hearing world again! So do you think you are ready to talk about cochlear implants?
For more information contact the Hearing & Balance Center of Austin at Great Hills ENT at (512) 258-2300.
Why Can't I Undestand the Television Clearly?
Living with Hearing Loss and Hearing Aids
Well, this is a very good question, and unfortunately not one with a super easy answer. If you have hearing loss or hearing aids you are already behind the 8 ball, and this has to be the #1 complaint my patient's have and always makes the Top 5 things people in Austin want to hear clearly.
How does television process speech signal?
In a perfect world the entire signal would be processed and come out your television's speakers. But we don't live in that world. A normal human ear at birth can hear between 20-20,000 Hz. That is a very broad range. When we test hearing we look at 250- 8,000 Hz because that is the range in which all of the parts of speech fall. Vowels are in the lower frequencies, giving volume to what we hear. While the higher frequencies are the endings of words, or high frequency consonants. Think /s/, /t/, /p/, /sh/, /ch/ sounds. A high frequency hearing loss will affect the clarity of sound and not so much the volume. When you think about it, even reducing the range to 250- 8,000 Hz is still a pretty big range, so we have to cut it down further.
Now, in order for an auditory signal to go from Point A (broadcast station, satellite, server) to Point B (your living room T.V.) at some point it has to travel along an electrical cord. In the U.S our electrical outlets are 110v, 120 Hz with 15 amp of resistance. So, the signal has to travel at a multiple of 60Hz. Telecommunications standardly cut out everything above 2,500 Hz. Poof, gone. That would be most of the consonants that tell us the difference between "tear," "care," "fare," "pair," & "share." Couple that with an English accent from British programming or dramatic sound effects (which are low frequency heavy) and we have a recipe for disaster on the undertanding front.
Will hearing aids help me understand the television better?
Yes. Will it be perfect, no. Will the overall volume decrease? Yes. Please remember, a hearing aid is a therapy tool. It is the cornerstone of an amplification SYSTEM. Albiet the most important, but if you still aren't hearing the television as clearly as you would like but everyting else sounds better, it might be time to look at an assistive listening device. Most hearing aid manufacturers have a device that will transmit television signal directly into your hearing aid(s).
Why are some television channels louder than others?
Quite simply, it is based on average age of viewing demographic. Certain stations are louder. For example, PBS, HGTV, Food Network, TCM and network television tend to be louder (from personal experience) than Comedy Central, TBS, USA, and TNT. My husband is always asking me if I have my ears in after I've been watching say The Big Bang Theory marathon on TBS and he changes the channel to network TV. The volume goes up and he instantly has to turn things down. I usually have him set the volume to where he can hear it and then instruct him to hit the "back" button. And 9 times out of 10 he has to turn it up too. For added measure I'll then point out that YES I am wearing my ears. I'll admit, I still use closed captions from time to time.
At the end of the day, if you are constantly having difficulty understanding speech on the television, at home or in noise it is a good idea to have a baseline audiogram. Believe it or not, they are actually used for more than selling hearing aids. Chances are, if you're having that much trouble, you are missing out on a lot more than just Downton Abbey.
Paige Peterson, AuD, PhD
Discover some easy steps you can take to protect your hearing.
According to the Hearing Loss Association of America, about 20 percent of Americans have some form of hearing loss (that’s about 48 million people!). By the time someone reaches the ages of 65, one in three have hearing loss. While hearing loss does often happen as we age, there are many other factors that can affect our hearing. Here are some helpful ways to protect your hearing for years to come courtesy of your audiologists at Hearing & Balance Center of Austin.
Listen to Music Safely
If you wear headphones to listen to music it’s a good idea to listen to the music at 60 percent of its maximum volume for no more than one hour a day. Listening to music at high volumes, while fun, can certainly damage your ears. If you find that you can’t hear sounds around you while listening to music then the music is much too loud. Same rule applies if others can hear your music blasting from your headphones.
As you can probably already imagine, being exposed to loud noises for long periods of time can damage your hearing (think concerts, festivals and racecar events). Make sure to bring earplugs with you and take 10-minute breaks away from the sound whenever you can.
Prevent Occupational Hazards
While those working on construction sites and factories used to experience a lot of trouble with their hearing, safety regulations have been put in place to protect workers’ hearing. However, you should make sure you are still using the proper equipment and hearing protection at all times. If you are concerned about your hearing while at work talk to your boss about ways to keep everyone safer.
Be Aware of Your Hearing
It’s important to always be on the lookout for any changes to your hearing. Do you notice that it’s becoming more and more difficult to hear those around you? Do you find that you have to keep turning the volume up on the TV or radio just to hear it? Do you ask people to repeat themselves often? If you are noticing changes then it’s time to see your Hearing & Balance Center of Austin audiologists for a hearing evaluation.
If you have questions about hearing loss or are having difficulty understanding those around you then it’s time you called your audiologist in Austin, TX today to find out the extent of your hearing loss and what can be done to treat it. Start being part of the conversation again.
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