Each year, millions of older people—those 65 and older—fall. In fact, one out of three older persons fall each year, but less than half tell their doctor
.
One fall causes the chances of falling again to double
Falls Are Serious and Costly
- One out of five falls causes a serious injury such as broken bones or head injury.1, 2
- Each year, 2.5 million older people are treated in emergency departments for fall injuries.3
- Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.3
- Each year at least 250,000 older people are hospitalized for hip fractures.3
- More than 95% of hip fractures are caused by falling sideways.2, 3
- Falls are the most common cause of traumatic brain injuries (TBI). 3
- Adjusted for inflation, the direct medical costs for fall injuries are $34 billion annually.3 Hospital costs account for two-thirds of the total.
What Can Occur After a Fall?
While many falls do not cause injuries, one out of five falls results in a broken bone or a head injury.1, 2, 3 These injuries can make it difficult for a person to sustain balance for normal movement, perform everyday activities, and maintain independent living.
- Falls can cause broken bones, such as a fracture of the wrist, arm, ankle, and hip.
- Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head may unknowingly be left with a concussion or TBI. They are then at a much higher risk for a more serious or permanent injury.
- Many persons who fall, even if they are not seriously injured, develop a fear of falling. When a person is less active, they become weaker and this increases their chances of falling.
Organizing the Evidence to Evaluate Risk Based on Fall Etiology
Morse 4 has identified three types of falls in the acute care setting:
1.) Anticipated physiological falls. These are falls that occur in patients who are identified as “fall-prone,” based on identified risk factors (e.g., unstable gait, history of falling). Morse reported that anticipated falls are the most common (78 percent of falls), although a more recent report suggests that this type of fall only accounts for 34 to 38 percent of falls in hospitalized patients.
2.) Unanticipated physiologic falls. These are falls that are attributed to physiologic causes, but occurrence of the condition could not be predicted (e.g., seizures, fainting).
3.) Accidental falls. Slipping, tripping, or having a mishap often causes accidental falls. Morse indicated that accidental falls are less common, but a more recent report suggests that accidental falls account for 45 percent of falls in acute care.
Fall risk assessment currently is based solely on the clinical judgment of the health care professional (subjective) or with the use of a tool/questionnaire. Studies have been shown this to vary widely with the experience level of the clinician, and overall, it has been shown to have an accuracy of 35 percent.4 An objective clinical tool is needed. The PRT NeurOpTrek™ is such a system.
NeurOpTrekTM is the trade name for a state-of-the-art instrument to evaluate neuro-visual processing dysfunction affecting balance and posture following a neurological event, sports related injury (such as concussion) or simple dysfunction occurring due to aging.
There is no known direct competitive instrument to the NeurOpTrek™. The instrument will pioneer a major expansion in diagnosis and treatment of balance/posture dysfunction. It is patented and evidence based. Research has proven that dysfunction within the spatial or ambient visual process relative to the sensorimotor system will cause a shift in the concept of the visual midline causing Visual Midline Shift Syndrome (VMSS). 5, 6 This shift in the visual midline reinforces postural imbalance and can also be responsible for abnormal postural tone (spasticity in muscles), dizziness and vertigo.
For example, when a person incurs a hemiparesis from a CVA or TBI, it has been reported that the person will lean away from the affected side complicating rehabilitation efforts. Research has proven that the weight shift is due to a dysfunction between the bi-modal visual process and the sensorimotor system causing a shift in the visual midline away from the affected side. This visual midline shift then reinforces the lack of weight bearing on the affected side.
Fall risk assessment currently is based solely on the clinical judgment of the health care professional (subjective) or with the use of a tool/questionnaire. Studies have been shown this to vary widely with the experience level of the clinician, and overall, it has been shown to have an accuracy of 35 percent. An objective clinical tool is needed. The PRT NeurOpTrek™ is such a system.
Medicare is making the RoF a priority due to the numbers involved.1 There are many different codes for evaluating RoF by different health care professionals. Information is not readily available on the impact of these new programs as Medicare has only published usage data through 2013 and this program was only begun due to the Affordable Care Act. The main point is that the number and expense to the system caused by falls has made Medicare aware of the problem and seeking a solution. This is an excellent environment for the launch of the NeurOpTrek™.
PRT proposes two instruments for this. The first instrument, NeurOpTrek™, will be an advanced system that will separate out the visual versus the motor/proprioceptive aspects of the RoF. The NeurOpTrek™ will determine a starting prescription of yoked prisms for neurologically challenged persons. This instrument will also have EMR capabilities similar to the model discussed in the previous paragraph. NeurOpTrekTM will provide the position (axis) and the amount of the yoked prism prescription for the clinician to prescribe. The prescription will be automatically included in the EMR data for the clinician to utilize. Eventually, posture analysis with the NeurOpTrek™ will determine where PRT’s PBs bands shall be placed to improve posture caused by the motor/proprioceptive problems. Follow-up testing will show the changes in gait from training and therapy and will offer new recommendations for prisms and PBs bands. The second instrument, RoF Analyzer will be discussed in the second-generation instruments found later in this plan.
The NeurOpTrek™ market will be for those professionals directly involved in the neuro-rehabilitation field such as for hospitals, clinics and offices where optometrists, physicians, physical and occupational therapists provide treatment and therapy. Concerning optometrists, Neuro-Optometric Rehabilitation is an emerging specialty within the profession.
Treatment through yoked prisms has documented that the visual midline can be shifted back to center thereby enabling weight bearing on the affected side and increased potentials through rehabilitation. In addition, Visual Midline Shift Syndrome has been clinically found to have increased prevalence with the aging population and related to falls and injury. NeurOpTrekTM will provide a means of assessment and treatment thereby reducing falls and injury.
A working prototype has been developed which includes a mat with pressure sensitive devices to record Center of Mass as well as Center of Pressure together with Vector Forces allow software to evaluate imbalances in balance and posture (Figure 5). Published peer reviewed research by Dr. Padula in the journal, NeuroRehabilitation, has proven that the NeurOpTrek instrument was able to determine the amount of yoked prisms needed to rebalance the bi-modal visual process affecting preconscious organization of the visual midline in relation to the sensorimotor system. 6
Not only will the instrument document the imbalance through quantitative assessment using state-of-the-art software and video, but also the software will be designed to determine the exact axis and amount of yoked prism to be prescribed for the patient (Figure 6).
The advantage operate NeurOpTrek. It also will eliminate the need for extensive time-dependent trial and error testing by the clinician to learn about bi-modal visual processing and organization of vision related to balance and posture.
Figure 2. Instability in posture & balance demonstrated by Center of Mass (COM)
& Center of Pressure (C).
Figure 3. Improvement in posture and balance through use of yoked prisms is demonstrated by immediate change in the COM and the COP.