Balance Center aims to prevent falls

Hospital considers wellness part of mission

While Robert Wood Johnson (RWJ) University Hospital Hamilton (NJ) is as committed as any other facility to provide quality care for its inpatients, the leaders of the hospital believe their responsibility to the well-being of local residents extends far beyond its four walls.

In fact, RWJ has made a substantial investment to demonstrate that commitment, building an 86,000-square-foot Center for Health & Wellness. The newest program in the center is called a Balance Center, targeted at preventing falls, which, according to the National Center for Injury Prevention and Control, are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma among adults 65 years and older.

The Balance Center provides diagnostic and rehabilitation services for individuals with a history of falls, inner ear disturbance, Meniere's disease, stroke, head trauma or vestibular (inner ear) disorders.

"Over 90 million people in the U.S. have experienced dizziness or balance problems," notes Michael Long, PT, MS, MBA, executive director of ambulatory care. "In the community we noticed that a lot of people were asking for information on how to prevent falls; our audiologist received a call asking if we performed VNG [videonystagmography, which identifies the root of a balance problem] studies, and physicians had asked if there was somewhere they could send patients who have balance problems."

All well and good, but shouldn't a hospital be concerned more with patients who have problems, rather than those who might develop them?

"We want to keep people out of the ED," says Long. "Our mission is to promote the health and wellness of the community."

By pre-screening individuals in the community, he continues, "we can predict fall risk. Our hope is that with these screenings we can get to them before they have falls and keep them out of the hospital."

VNG is core service

When a patient comes to the center, "The first thing that is done is the VNG test," says Jason Homowitz, PT, MS, MBA, the program's clinical supervisor. "Based on the test, the audiologist will create a summary of findings, and physical therapy will cater a balance program for the patient."

The physical therapist will perform a fall track assessment, which involves having the patient stand on a diagnostic board and focus on a grid. "It measures body sway based on responses with the eyes open and closed, while standing on both a rigid and on a perturbed surface," Homowitz explains.

The "cure," he continues, consists mainly of vestibular therapy, which works by having the patient perform motions that are intended to make them dizzy, while at the same time requiring them to focus on their body position and coordination. This helps the brain compensate for lost balance more quickly.

While such therapy would clearly mitigate the chance of these individuals falling should they ever be admitted to RWJ, Long is quick to point out that the staff in the hospital are not relying entirely on the new program to identify these at-risk individuals. "There are now two ways the hospital works to identify patients at risk for falls," he explains. "Part of the standard nursing assessment is that they grade the patient on whether or not they may be a fall risk. If they are, they are identified as such throughout their stay. Then, whenever a patient comes to rehab we do a kinetic balance test, to make sure they are not a fall risk as well."