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Archive for Sunday, May 26, 2002

VA’s center develops tools to aid those prone to falls

May 26, 2002

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— A group of medical detectives has set up shop at an abandoned supermarket in a gutted strip mall.

There, on the desolate site, sits the Patient Safety Center, a complex of laboratories, evaluation rooms and exam rooms crowded into the corner of the grocery store at the crossroads of two bustling Tampa arteries.

Behind a modest glass door entry, doctors, nurses, therapists, researchers, consultants and biomechanical engineers are developing tools to help elderly patients avoid falls and other accidents.

Among their tools is a 200-pound mannequin named Eric that researchers use to test equipment for those who are bedridden or use a wheelchair. With Eric's help, researchers can eliminate the danger of strangulation for patients restrained in bed.

For people over age 65, falls are the leading cause of injury deaths. More than 11 million elderly in the United States fall each year one in three senior citizens.

The Centers for Disease Control and Prevention says about 40 percent of all nursing home admissions are due to falls.

At least 95 percent of hip fractures nationally are caused by falls. Half of the older adults hospitalized for hip fractures never return home or live independently again. And because the population is aging, hip fractures are likely to increase dramatically in the next few decades.

Betty Choyce Sheehan, a 76-year-old Air Force veteran from Lakeland, had two bad falls in 1998 and 1999. She suffered concussions, damaged her knees, hurt her arms, broke her glasses and smashed her face.

The women's clinic at the James A. Haley Veterans Hospital referred her to a balance and gait program.

At the Patient Safety Center, which was built by the Veterans Administration, physical therapists use a computer-controlled balance machine that creates an unsteady, high-risk environment to pinpoint what makes some people prone to falls.

Safely strapped into a harness, Sheehan stands on a floor plate, encased in a three-sided, boxlike enclosure. The therapist controls the movement of both the floor plate and enclosure. Results tell the therapist what a patient relies upon for balance.

Sheehan said she kept falling backward when she first got on the machine, but by the end she was balancing herself quite nicely. She said she learned she was throwing herself off by using her shoulders instead of her hips to keep her balance.

"I used to go out thinking, 'Where am I going to fall today?"' Sheehan said. "Now, when I go out for a walk, I don't think about it at all. I improved greatly."

Although tests can be done without the machine, it provides quick answers, leaves less to interpretation and measures progress.

The center began at the veteran's hospital in 1999 with two staff members working in trailers and various buildings. As the program grew, so did the staff to 103 people, with 63 working full time and the demand for space.

Only last year did the center come together under one roof.

"We're thrilled to be in the produce section of Winn-Dixie," quipped Audrey Nelson, director of the center.

In one lab down the corridor, Eric is in a hospital bed. The mannequin has movable arms and legs that mimic real patient movement and help scientists develop less stressful techniques for both patient and caregiver. Also, Eric has injection sites and sensors that measure skin pressure to keep bedsores from forming.

As Eric's position or bedsheet is changed, researchers are determining when there's risk of injury to him as he's turned from side to side or left in one position too long.

They look at the risk to the clinician as he lifts Eric or bends over the bed. Testing is done on patient handling equipment, such as body slings for transferring the disabled between bed and wheelchair.

Scientists are trying to improve safety for a person in bed with arm, leg or vest restraints and trying to prevent serious injury or death to a patient who gets his head stuck between bars in a bed rail.

An engineering lab is charged with building rehabilitative equipment using computer-aided design technology.

Besides patient comfort and safety, the center is concerned with patient dignity. Dignity monitors track how long the mannequin is exposed while a caregiver bathes him or changes dressing. Researchers want to find alternatives for the same chore minimizing exposure time.

The VA has funded three other centers nationally, in Cincinnati, Boston and Palo Alto, Calif. Nelson expects innovations from the Patient Safety Center eventually to become the standard in the health care industry.

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