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Evaluate the sensory component of balance.   Peripheral nerve impairment and inner ear disorders can cause unsteadiness and dizziness that can lead to a fall.  

  1. •Conduct a pin-prick test on soles of feet to screen a patient for peripheral nerve loss.

  2. •Ask your patient if they have vision loss or have been experiencing dizziness. 

  3. •Observe performance on a Romberg and foam test in your office.

  4. •First, ask your patient to stand on the floor with feet close together and eyes closed.  If unsteady, this may indicate impaired peripheral nerve function - or possibly a central nervous system based cause for balance impairment. 

  5. •Second, ask your patient to stand on a piece of foam with feet close together eyes open and eyes closed. If unsteady with eyes open, this may indicate a vision impairment.  If unsteady with eyes closed, this may indicate a hypo-functioning inner ear.

  6. •Rehabilitation is recommended for patients who have peripheral nerve loss, history of dizziness recently or increased sway during any part of Romberg testing. 

Sit to Stand performance has been linked to fall risk, balance and lower body strength.  Evaluate the strength component of balance.  Ask your patient to stand up from a chair - if possible, without the use of their hands.   Rehabilitation is recommended for patients who need their hands (on chair or their legs) to stand up, rock to stand up or are unable to stand.  Very slow sit to stand speed and need for hands is linked to a need for assistive device.  If your patient is unable to stand without physical assistance, consider likelihood of strength recovery and consider and order for rehabilitation, environmental assessment for safety at home, and need for 24-hour assistance.

Physician Guide Further Evaluation of Fall Risk

FALL RISK AND STRENGTH: 

FALL RISK AND SENSORY LOSS:

  1. 1.Perkins BA, Olaleye D, Zinman B, Bril V. Simple Screening Tests for Peripheral Neuropathy in the Diabetes Clinic. Diabetes Care. 2001;24(2):250-256.

  2. 2.Hansson EE, Månsson N, Ringsberg KA, Håkansson A. Falls among dizzy patients in primary healthcare: an intervention study with control group. Int J Rehabil Res. 2008;31(1):51-7.

  3. 3.Kulmala J, Viljanen A, Sipilä S, et al. Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Age Ageing. 2009;38(2):162-7.

  4. 4.Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol. 2002;88(3):1097-118.

  5. 5.Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986;66(10):1548-50.

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