Pelham Physical Medicine - Balance Training and Rehabilitation DO YOU SUFFER FROM DIZZINESS, VERTIGO OR UNSTEADINESS?   Call us: 718 823-3900 Statistics: 70% of patients with vertigo and dizziness are seen by primary care physicians, only 50% are diagnosed. Over 90 million Americans age 17 and older, have experienced a dizziness or balance problem. 20 to 40 percent of adults over 65 who live at home fall each year. The fear of and result of falls are a major cause of nursing home admissions. Balance-related falls account for more than one-half of the accidental deaths in the elderly. Symptoms of Balance Disorders Dizziness / Vertigo Imbalance / Unsteadiness Visual motor disturbances / Nausea Secondary symptoms of ; memory problems, muscular stiffness/imbalance/ weakness, fatigue, headaches and anxiety may be experienced. Leading Injury Etiologies by Age Deaths Due to Injury New York State, 1990 - 1992 Leading Injury Etiologies by Age Hospitalizations Due to Injury New York State, 1990 - 1992 Who Is Behind the Push for PREVENTING Falls? The United States Government Both Houses of Congress introduced essentially the same bill in 2002: The Elderly Fall Prevention Act  The bill notes: Falls are the leading cause of injury deaths among people over 65. 25% of elderly persons who sustain a hip fracture die within one year. Hospital admissions for hip fractures among the elderly have increased from 231,000 admissions in 1988 to 332,000 in 1999.  The number of hip fractures is expected to exceed 500,000 by 2040. The cost to the Medicare and Medicaid programs and society as a whole from falls by elderly persons continues to climb much faster than inflation and population growth.  Direct costs alone will exceed $32 billion in 2020. Medicare   In 2002 Medicare doubled the payments for the CPT Codes associated with vestibular testing and treatment for the prevention of falling among the elderly.  OSHA  OSHA has issued a statement of concern regarding falls in the workplace.  They have indicated prevention of falls will become a major issue for them. American Academy of Orthopedic Surgeons, American Geriatrics Society and British Geriatrics Society All three organizations have issued essentially the same position statement: All patients over 55 should be screened EVERY YEAR for balance problems and the risk of falling. Who Should Be Routinely Screened? Anyone who has a history of falling Anyone 55 years of age or older Anyone who complains of dizziness Anyone expressing a fear of falling Anyone 50 years of age or older who; Is having difficulty adjusting to wearing new glasses, especially bifocals.  Has deteriorating hearing or previously undiagnosed hearing loss which requires treatment or hearing device. What is the Profile for Patients Needing Vestibular Testing ? Anyone who has fallen   or Anyone who has scored at a level of significant risk on a balance screening  and    Through examination and medical history, the balance disorder is determined NOT to be caused by: cardio-vascular conditions cardio-pulmonary conditions diabetic neuropathy peripheral neuropathy adverse effects of medications skeletal injuries / muscular disorders any other nonvestibular”etiology NURSING HOMES  & FALL PREVENTION Each nursing home bed has on average, nationally, 4 falls per year.  If vestibular testing were done, those who are at risk would be given balance retraining and conditioning and likely would  have less falls.  One of the leading causes of death over the age of 75 is a fall. What is Computerized Balance Assessment ? Assessment studies are used to evaluate postural stability both in static and sensory conflict situations. Vision, vestibular function and somatosensation are tested. This is not a diagnostic site of lesion test, but rather provides information  about the patient’s functional abilities. Some responses are related to vestibular dysfunction, but further testing is necessary for a diagnosis. This information is helpful in formulating a specific therapy plan for balance disordered patients. Balance Assessment 97750 Physical Performance Test 10 seconds each, eyes open, eyes closed Perturbed surface, same protocol Balance Assessment Screen ambulatory patients over age 55 Utilize to; monitor therapy progress and documentation, for better compliance Free screening to reach out into the community Click on image to enlarge Diagnostic Component VENG / Calorics InfraRed/Video ENG System provides complete two-channel electro-nystagmography.  The patient simply looks into our Goggle and Ocular Motor Module and all the tests can be performed instantly !  With the most streamlined and user-friendly Windows based software, tests are performed with the fastest station available in the industry today.  State of the art air Atmos calorics are included.  Diagnostic Component VENG How is the Video ENG Test Performed ? The test can be performed in an examination room in less than 45 minutes. Using a light weight goggle outfitted with an Infra Red / Video camera, the horizontal and vertical movements of the eye are displayed, saved and analyzed by the Windows based computer system.  An additional unique feature is the IR pickup to accurately record the horizontal and vertical movements of the head for VOR assessment. Unlike other systems, there is no light bar assembly or calibration required. Click on image to enlarge Click on image to enlarge Click on image to enlarge Click on image to enlarge Click on image to enlarge   Air Calorics VENG TEST RESULTS RECOMMENDATIONS   Click on image to enlarge Therapeutic Component FallTrak is a state -of-the-art, computer-assisted Visual Vestibular Proprioceptive (VVP) Balance Assessment and Training Device that allows for both static and dynamic balance assessment.  Therapists may use the built-in training modes with ease and flexibility.  In addition, the system allows the design of unique, individual training protocols when specific deficits are identified during the test phase. Limit of Stability Click on image to enlarge Click on image to enlarge Falltrak Settings Following Moving Target Click on image to enlarge Following Path Click on image to enlarge REHABILITATION DOCUMENTATION Click on image to enlarge Fall Trak What is Balance Retraining ? Balance retraining involves exercises designed to improve coordination of muscle responses as well as the organization of sensory information for balance control.  OUTCOMES OF THERAPY Benign Positional Vertigo 95% (N=5000 patients) Vestibular neuronitis 75% (N=500 patients) Disequilibrium of Aging 85% (N=200, includes fall reduction) Labyrinthine concussion 90% (dizziness) 75% (imbalance) (N=100 patients) Acoustic neuroma 90% (N=100 patients) Ototoxicity 60% (N=15 patients) CPT & ICD-9 CODES Click on image to enlarge VENG REPORTS Click on image to enlarge Click on image to enlarge RECOMMENDATIONS CHART Click on image to enlarge PERSONAL INJURY & MEDICAL LEGAL Many patients with concussions, whiplashes or the like and have documented Vertigo(Posttraumatic Vertigo), qualify for up to 10% whole person permanent impairment. AMA Guides#5 Criteria for Rating Impairment Due to Vestibular Disorders   Class 2  1%-10% Impairment of the Whole Person-Symptoms or signs of vestibular dysequilibrium present with supporting findings…..and…..activities of daily living can be performed without assistance, except for complex activities (eg. Riding a bicycle) or certain types of demanding activities related to the subject’s work (eg. Walking on girders or scaffolds)         Attorneys-Click on link below.  Print  this simple form to help your clients recieve the proper treatment. Client Questionaire