& Continuing Education Courses
Sponsored by: Jordan Hearing and Balance, LLC South Jordan Utah
Lynn S. Alvord PhD
Additional Information Tests for Falling
Alvord Falls Screening Examination
The word “screening” in the Alvord examination is somewhat a misnomer, it actually constituting a comprehensive falls risk examination aimed at finding the “main cause(s)” of the patient’s falls. The examination looks at all body systems potentially causing falls plus the other major falls risk factors. The Alvord Falls Screening Examination is outlined in the author’s text, Falls Assessment and Prevention (Alvord, LS, Plural Publishing, 2008). The elements assessed include a physical examination of systems plus a comprehensive list of most of the known falls risk factors.
The Alvord Falls Screening Examination includes the following:
Medications that might predispose to falls
Presence of Vertigo symptoms
History of knees giving out
Vision 20/50 or worse, corrected
Dementia, depression, risky habits (rushing, carrying on stairs, etc.)
Near falls when turning the body or head
Falls after first standing, standing on soft surfaces or standing with eyes closed
Irregular pulse or palpitations or other heart disease
Stroke, Parkinsons or other disorder affecting movements
Dix-Hallpike (or BPPV symptoms)
Reduced strength or feeling
“Up and go” test
Other obvious risk factors (deformities, etc.)
Failure on any one of the above factors or history features constitutes “fail”. A major advantage of the Alvord Falls Screening Examination is that it provides the key patient factors that can be worked on either medically, behaviorally or with therapy. Knowing the “main” cause(s) is key to remediation, rather than labeling the falls disorder “multifactorial”.
What helps prevent falls?
The most direct way of preventing falls is to find some main medical cause(s) and treat it. Many fallers, however, are not capable of being “cured” and instead, methods must be utilized to prevent falls in other ways. Bed alarms in hospitals, bracelets to identify those at high risk of falling, bed rails, a light on in the bathroom with the door partly open, etc., are some measures that have helped. The Veterans Administration significantly reduced falls in their hospitals by leaving the bathroom door ajar with the light on, having a table at the bedside which gives the patient something to hold onto, and when necessary, a pad at the bedside so that if a fall occurs, injury is less likely. This latter method, however, seems dangerous because standing on a soft surface predisposes many people to fall.
For outpatients, balance therapy in the form of vestibular therapy, if appropriate, or general balance training if a non-vestibular case, often bears fruit for improving balance. Tai Chi, for example, has been shown in National Institute of Health analyses of various studies to improve balance and help prevent falls. Our clinic utilizes Tai Chi as well as group therapy sessions which teach falls prevention concepts and train attendees on the proper performance of various exercises.
In summary, my experience is that finding the “main cause” and working on that one is the most effective. Simply calling it “multifactorial” is doing a disservice to the patient because usually there is a main cause, the improvement of which will stop the falls. This usually requires a thorough “falls examination” which assesses all possible body systems causing falls (see Alvord Falls Screening Examination below). Without such a complete assessment, one or more abnormalities may be discovered upon which the blame for the falls are placed. We all like to believe the disorder in our own area of expertise is the culprit.