FAQ Category: General

You have asked a very good question and one that others may wonder about, too. What exactly is osteoporosis? Simply stated, it is decreased bone density. But that still might not mean anything to you. Does the phrase brittle bones help? Because that is quite literally what osteoporosis is.

To understand this a bit more from a biologic point of view, consider that bone strength comes from two things: bone density and bone quality. Bone density refers to how many bone cells are present in a square inch. That measure also reflects how close together the bone cells are.

But density isn’t the only component of bone strength. There’s also bone quality. Bone quality reflects the health of the bone cells present. Quality of the collagen cells that make up bone, thickness of the bone, and architecture of the bone all make up this entity we call bone quality. Bone quality reflects the condition of the supportive structure of bone.

Bone loss occurs in a predictable fashion with aging. Women are affected more often before men around the time of menopause when the menstrual cycle stops and the woman can no longer get pregnant or give birth to children. A significant reduction in the hormone estrogen at that time contributes to the development of osteoporosis.

But men are also affected — about 10 years later than women as age-related changes cause microarchitectural deterioration. In both men and women, the bone becomes fragile. Fractures can occur without trauma or injury. These are called fragility fractures. The risk of fracture, loss of independence, and even death associated with osteoporosis is what makes the prevention of this condition so important. It’s not just quantity of life; it’s also quality of life that’s at stake.

It’s a good idea to get educated now about this condition. The library is a good place to start. You can also go to the National Osteoporosis Foundation’s (NOF) website (www.nof.org) for more information. Stay in regular contact with your physician. You may need to be monitored to make sure you are getting the results you need. Nonresponse is a fancy way to say you are still losing bone, in danger of fracture, or already had a fracture despite treatment.

Patient compliance (cooperation, following recommended suggestions) with treatment is an important way to ensure success. Lack of compliance is often a hidden risk factor. If you are doing everything you’ve been told to do to stop bone loss but the DXA scan shows continued progression of the disease, then your physician will do some more testing to see if there’s some other reason for the problem. Most people are very successful in turning around the negative effects of osteoporosis and prevent fractures that can be so devastating.

The television commercial you are referring to is for a class of medications called bisphosphonates. These medications help slow down the loss of bone for people who have osteopenia or osteoporosis (brittle bones). Osteopenia means bone density is lower than normal but not osteoporotic yet.

Not everyone has osteopenia or osteoporosis. These conditions tend to develop as we age and especially in women who are postmenopausal. Some people are at greater risk of developing osteoporosis based on their genetics (positive family history for fractures and/or osteoporosis). Others are at increased risk because of lifestyle factors such as tobacco use, excessive intake of caffeine and/or alcohol, and inactivity or lack of exercise.

See your doctor to find out your current risk of osteoporosis and what you need to prevent it. If you are tested and discover your bone mineral density is low enough, you may be a candidate for a bisphosphonate. But early identification and intervention is often possible just by changing your diet, activity level, and taking vitamin supplements including calcium and vitamin D.

First of all, thanks for being willing to volunteer at the hospital. Your service is a very valuable contribution to the care of patients. Many physical therapists, nurses, and doctors got their start in the candy striper department!

Secondly, your reaction to this open wound is very natural. If you ever find there are patients that you would rather not transport, let your supervisor know. There is no shame in that at all! Every one has their own personal comfort zone when it comes to viewing damaged body parts. It is okay to respect and honor what is acceptable for you.

As for the patient, we can only make some educated guesses about what is going on. Severe traumatic fractures with open wounds are at increased risk of infection. The first step in treatment is a procedure called irrigation and debridement. The surgeon cleans the area of any debris and cuts away any dead tissue. Usually the wound can then be closed.

But if there is an infection already present, then the wound may be left open so that wound care can begin. There’s no sense in closing the skin around an infection that would only fester and get worse requiring another surgery to re-open the wound later. All efforts are made to reduce and eliminate the infectious process so that healing and complete recovery can proceed.

If you are comfortable with the patient, you may want to ask him directly what happened or what the long-term treatment plan might be. The answers to these kinds of questions (asked with sensitivity and tact) can often provide you with enough information to better understand why the open wound has not been closed yet.

Implants and hardware used to fix broken bones do show up on x-ray. This is important because of a doctor is working on you, he or she has to know where the hardware is located.

As for metal detectors, if all you have are screws, nails or plates, chances are they won’t be detected by airport security detectors, although it does happen from time to time. Implants, such as for the knee or hip, tend to be detected more often. According to the American Association of Orthopedic Surgeons, in one study, all hip replacements were detected and 90 percent of total knee replacements were detected.

If you’re concerned about being stopped at the airport, it might be best to carry a doctor’s note describing the type of implant or hardware you have in your body. It’s not a guarantee that there won’t be any problems, but it might help clear the path.

There are several reasons why someone may have a leg length difference. Some people are born with dislocated hips congenital dislocated hip and this can affect leg length. Some people develop infections in their hip, which can cause shortening. Tumors in the leg may need to be removed, shortening the bone somewhat. A break earlier in life may not have healed properly; the bones may be malaligned, with one end slightly overlapping the other. Scoliosis that is severe (curvature of the spine) could result in a leg length difference, as can other disorders of the spine or muscles.

Traditionally, shoes are built up to accommodate the longer leg. As you say, this limits the type of shoe that women can wear because it has to be able to support the higher lift. However, there is a way to adjust the shoes so that they are changed, cut down, to accommodate the shorter leg, instead.

Researchers describe the procedure as follows:

Find a pair of shoes with a thick sole. They were very popular in the 1970s and are coming back again. They’re not quite platform shoes, but they are thicker. Make sure the sole is a type of material that can be cut, rubber is the most common. Brace the shoe in a vice at the toe after you have protected the toe with a covering, so it doesn’t get scratched up. Mark how low you want the shoe to be, drawing a line along the sole of the shoe. Using a serrated knife, cut the rest of the sole off. You’ll have to remove the shoe from the vice after you get half way down.

Once you’re done, rinse off the debris and, using a Dremel tool, you can engrave ridges like the other shoe, to provide traction.

This technique can be done on any shoe with the right sole, including sandals and open toes.

Doctors, as with all humans, do make mistakes from time to time. When a surgeon makes a mistake, the results can be devastating. As a result, surgeries have strict protocols and regimens geared towards avoiding mistakes as much as possible.

Computers and scanning equipment, such as computed tomography scans, are being used in hospital operating rooms and are becoming more common place, depending on the type of surgery being done. In some cases, scanning isn’t necessary. However, some surgeries, such as repairing spines by inserting hardware, scanning is providing a good extra tool for surgeons to be sure that what they are implanting is going into the proper place and in the proper way.

Doctors are always trying to find ways to make surgery safer and more accurate, resulting in better outcomes all around. One way doctors are improving their results is by using technology that has already been used in other areas of medicine. For quite a while, portable x-rays have been used in operating rooms when they were necessary. Now, surgeons are beginning to include tests such as computed tomography imaging (CT scans) to see what is going on inside the patient.

A study that was recently done looking at the use of CT scans in back surgery, found that adding the scans only added an average of 14 minutes to the procedures. Considering how successful the surgeries were, the researchers felt that the added time was beneficial and not dangerous for the patients.

There is no doubt that racial and ethnic inequalities exist in the health care system. Studies have repeatedly shown that given equal disease, equal treatment gives equal results. But minorities don’t receive equal care. And the picture has not improved over the last 20 years.

A recent review of the literature in this area of research showed that minorities are less likely to receive specialty care and more likely to experience delays in diagnosis and treatment compared with the white (caucasian) adult population. Minorities are less likely to receive screening or preventive care, so the diagnosis is made later. A delayed diagnosis often means more advanced disease and more painful symptoms.

You are not imagining what you have seen and/or experienced. Even with higher level education and skill with the English language, there is a tendency for health care providers to still judge people based on race/ethnicity.

Social scientists have called for an increased focus on education to turn this around. They say there three ways to approach this problem: through the patient, the provider, and the health care system. Educating health care providers may be one approach. If providers can be taught to assess and treat everyone the same, outcomes may improve. Evidence-based treatment guidelines for pain associated with different causes are needed to help providers give the care that patients need.

Availability and affordability of medical care must be addressed through health care reform. Money is needed to fund pain research with a goal of providing practical health care policies around the treatment of minorities. Public health must include a focus on the well-documented causes and results of racial and ethnic disparities in the treatment (or lack of treatment) of pain and other health care problems.

Non-white racial groups suffer from more than just a lack of housing, employment, and justice in the criminal system. They also receive unequal health care. In a recent review of pain management, researchers found that there are some serious health care inequalities among minority groups

Whether it’s acute pain, chronic pain, cancer pain, arthritis pain, or pain after surgery, it is clear that all people are not treated alike when it comes to pain management. Take for example, care in the emergency room. It is often the case that Hispanic and African American patients are not given any pain medication for broken bones. This is true for Hispanics even when English is their main language and they have adequate health insurance. When it comes to the treatment of disabling pain from headaches or back problems, minorities are less likely to be given opioid (narcotic) medications.

Studies assessing control of postoperative pain report varied results. There may be a trend for better postop pain control in a descending order: Caucasians are offered the highest dose of opioids, then blacks, Hispanics, and Asian Americans last with the lowest dose for the same level of pain. And there’s been some data to show that this is true even when other factors are equal such as insurance coverage, type of surgical procedure, and number of days in the hospital.

It’s very possible that your observations are accurate. But what to do about it can be a complex and challenging problem. The first step may be to express your concerns to your supervisor. Bringing it to the attention of the management staff may not result in an immediate change but it’s a place to start.

You are not alone — osteoarthritis is the number one cause of pain and disability in older adults around the world. Areas affected most often include the hip and knee, but other joints such as the spine, shoulders, elbows, wrists, and ankles can be affected. Small joints of the hands can also cause pain, stiffness, and loss of motion and function from osteoarthritis.

With so many adults affected, health care providers have tried to conduct research and report results in an organized way that includes evidence-based treatment guidelines. Current practice guidelines published by the Osteoarthritis Research Society International (OARSI) no one single treatment approach was recommended. Using a combination of drug therapies along with other conservative (nonoperative) approaches was preferred and most effective for the majority of patients.

The bottom-line is to find a cost-effective way to reduce pain and manage other symptoms that accompany osteoarthritis. The more patients understand the disease, the better able they are to manage their own condition. So patient education is a key component of any successful treatment program.

Finding ways to take pressure off the affected joints is a central feature of any successful program. For some patients, this means some lifestyle modifications, exercise, weight loss, and using supportive devices when needed. Studies show that combining exercise with weight loss works much better than just exercise or just weight loss alone.

The three treatment approaches used most successfully include drug therapy, physical therapy, and surgery. At different times in your disease process, you may find one more helpful than the others. Finding the right combination of treatment approaches for each phase can take some time but is well worth it in terms of relieving pain and improving function.

Your primary care physician can get your started with some education and self-management techniques. A referral to a physical therapist and/or an orthopedic surgeon may be needed. A team approach combining the knowledge and efforts of all three disciplines along with nutrition counseling for weight loss (if needed) can be very effective.

Degenerative arthritis (also known as osteoarthritis) often affects the hips and/or knees in aging adults. Having good medical care whether from a physician, nurse, or physical therapist is important. Each one has something to offer that can ease your pain, improve your symptoms, and increase your functional abilities. All of those are important in maintaining your independence.

Physicians can offer a wide range of pharmacologic (drug therapy) and surgical treatment options. Many patients start out taking a simple pain reliever such as Tylenol and doing just fine for quite a while. Adding physical therapy early on can also provide some insurance against future disability.

Physical therapy can be very helpful in getting a patient headed in the right direction. The therapist can get you set up with an individual program that works best for your situation and personal preferences. The therapist can provide exercises to help with strengthening muscles that support and offload the joints. If necessary, weight loss can be accomplished using exercise without aggravating joints and increasing pain and stiffness. The therapist can provide a postural assessment and advice or suggestions about ways to improve posture to reduce stress on the joints.

The therapist may advise changes in footwear or sleeping habits that help manage symptoms. In some cases, the therapist has a role in providing appropriate braces insoles or walking aids to help improve patient function. When symptoms are at their worst, modalities such as heat or electrical stimulation may be used to get control of symptoms before moving forward with the rest of the program.

Sometimes family members who are health care providers prefer that their loved ones see someone beside themselves for care. Staying objective about the best way to treat a condition isn’t always easy when it’s someone you love. Your grandson may be trying to look out for your best interests by getting another expert’s advice and counsel.

You can also talk with your physician about what he or she thinks might be best for you at this time. Seeking medical help may relieve your grandson’s worry about you and won’t hurt you — in fact, it will probably prove to be very helpful in the long run.

The use of electric eels to treat chronic pain is a very old idea that may indeed seem barbaric. According to stone carvings, it was probably used thousands of years ago. Fish that emit electric currents were applied to people to treat headaches and arthritis pain. A more modern version of this kind of treatment is called neurostimulation. Neurostimulation involves the application of electric current near or along the nerve pathways causing the pain.

Today, the electrical stimulation is applied in a more technological fashion — but it still amounts to sending an electric impulse either to or through the spinal nerves, spinal cord, or brain. The idea is to override the pain messages that seem to have gotten stuck in the on setting. The idea of neurostimulation is currently in use for conditions like migraine headaches, back pain, post-operative pain, phantom limb pain after limb amputation, and even angina that won’t go away.

How is it applied? There are several different by which electrical stimulation can be delivered. The first and easiest method is called peripheral nerve stimulation (PNS). Flat, surface electrodes (square, round, or rectangular shaped) are placed over the skin over the area of pain or near the affected nerve. A small handheld device is connected to the electrodes that can be set to deliver low-level electrical impulses through the electrodes. The little box can be attached to a belt for ease of use.

A second method is called percutaneous implantation. The peripheral nerve stimulator is actually placed under the skin. This works best for patients with low back, head, neck, and/or facial pain because the implant can get close to the spinal nerve roots causing the problem.

When peripheral nerve stimulation doesn’t work, then spinal cord stimulation is considered. Spinal cord stimulation is used most often for severe, constant back or limb pain that isn’t relieved by any other means (e.g., medications, peripheral nerve stimulation, physical therapy, nerve blocks). The unit is implanted into the spinal canal where it can relay electrical impulses to the brain through the spinal cord.

A third method directly to the brain is called motor cortex stimulation or deep brain stimulation depending on where the implant is located. These implantable devices generate a low-voltage electrical pulse that blocks the brain’s ability to perceive and register pain. These units are battery powered and have multiple settings that allow the patient to choose different intensities, patterns, and duration of stimulation. They can even be turned off and back on to vary the input and try to override or fool the brain.

The problem of chronic pain has led scientists and researchers around the world to look for any and every way to help patients with this problem. The use of electric eels may have a brief rebirth in some parts of the world. But it’s likely that neurostimulation using the same principles will remain the preferred choice for delivering electrical impulses with the idea of stopping the brain’s perception of pain.

Fibromyalgia syndrome (FMS) is a chronic pain problem with widespread tender points and muscle pain throughout the body. Most patients with fibromyalgia also list many other symptoms that seem to be part of this condition. Those symptoms range from depression to fatigue to decreased sexual function and difficulty sleeping. Finding one treatment to alleviate all of the many symptoms isn’t always possible. Sometimes finding ANY treatment that helps seems impossible.

But studies show there are some treatment modalities that seem to help no matter how severe the condition. One of those is exercise. But the question is: what type of exercise is best? How long should the person perform those exercises each day? And how long before you can stop exercising and just take it easy?

None of those questions has been solved completely but we have some information that might help. Aerobic exercise (getting your heart rate up to a target rate) has been shown effective, but it is also fatiguing. And since many people suffer from fatigue linked with fibromyalgia, it’s difficult to get up and go when you have no energy.

Stretching and relaxation techniques help some, but not all folks with this disorder. One area of exercise that has just come under investigation is the Pilates physical fitness system. Pilates has become synonymous with core training but it is much more than that. For those of you who have never taken a Pilates class, it is a form of exercise that focuses on the core postural muscles of the trunk and abdomen.

Pilates exercises teach awareness of breath and alignment of the spine. They are designed to strengthen the deep torso muscles and protect the back from injury. Breathing is coordinated with movement with a general goal of improved flexibility and health. The developer of this physical fitness system was Joseph Pilates from Germany. He died in 1967 before seeing the tremendous success of his program.

In a recent study from Turkey, women following a supervised 12-week program of Pilates training three times a week were compared with an equal number of women who performed a home program of stretching and relaxation (the control group). All women in the study had been diagnosed with fibromyalgia but no other serious health problems.

After 12 weeks, the Pilates group had significantly better results in terms of pain and function compared with the control group. The results didn’t last, though. By the end of six months’ time, the Pilates group was back to the same level of pain, fatigue, and disability as the control group.

So we know that although exercise works, it’s a management tool, not a cure. Until a cure is found, it’s good to know that there are things you can do for yourself. Exercise is one of them. If you haven’t tried Pilates, look for a program near you. With over 14,000 certified Pilates instructors in the United States, it is quickly becoming available everywhere.

Pilates exercise training isn’t just for the fit and able. Many people with a wide range of problems have given it a try and found it both do-able and enjoyable. Pilates is named after Joseph Pilates, the man who first developed this technique for dancers and other performing artists. The design of the pogram was to encourage the use of the mind to control muscles.

In fact, Pilates and his wife who helped him develop this technique called it ontrology at first. They believed that using the mind to control core postural muscles would provide support for the spine and improve spinal alignment. Pilates exercises also teach awareness of breath and strengthen the trunk and abdominal muscles.

Studies have been done looking at the effect (and safety) of Pilates for a variety of conditions such as scoliosis, low back pain, impaired balance, and impaired posture. There has even been a recent study on women with fibromyalgia using Pilates to control pain and improve function and quality of life.

The results of that study showed that Pilates provided effective and safe short-term results — more so than following a program of stretching and relaxation. Pilates has a built-in feature that avoids putting excess demand on muscles, which is important in a syndrome like fibromyalgia that is characterized by muscle fatigue. With less pain and better physical function, the women reported an improved quality of life.

Finding a program like Pilates that doesn’t make fatigue worse is a boon for individuals with fibromyalgia. Pilates belief that this fitness program strengthened body and mind may prove to be as effective as a combined exercise and cognitive-behavioral program. With such positive results, folks with fibromyalgia who also suffer from low energy and chronic fatigue may be more likely to continue exercising using Pilates in order to maintain those benefits.

Lap belts used to be the only type of car restraint we had when restraints were first installed in cars. Then, over time, researchers learned that the impact of a crash could propel your upper body forward at such a speed and force, that the lap belt could cause harm, although it still kept you in your seat, preventing you from flying through the windshield.

When this became known, manufacturers began installing three-point restraints (seat belts with chest straps) in the front seats, but they kept using lap belts in the back, thinking that the back seat drivers were safer than those in the front. This was proven to be false, so they began putting the three-point restraints in all seats of their vehicles.

Lap belts still exist because there are still older cars on the road that either can’t be retrofitted or the owner’s choose not to. However, drivers and passengers are safer if they wear three-point restraints and should be encouraged to do so.

There is a wide range of mental health problems that involve frequent visits to the doctor, emergency department, or other health care provider. Not all are the same or have the same underlying risk factors or cause.

In the case of true hypochondriasis, the affected individual is preoccupied (even obsessed) by the belief that he or she has a serious health problem. This belief continues even after a medical doctor has ruled out any serious pathology. The extent of the problem can be so great that the patient becomes delusional.

Hypochondriasis develops in the adult years — usually early on during the 20s and 30s. Men are affected as often as women. And most of these folks have a previous history of other psychiatric or mental health disorders such as an anxiety, panic, or obsessive-compulsive disorder. These problems may have been present during childhood and/or the teen years but unrecognized or undiagnosed.

Psychologic help is now available for people with hypochondriasis. A specific type of treatment called cognitive-behavioral therapy or CBT helps patients identify and then alter their dysfunctional beliefs. They learn how to change their health-seeking patterns of behavior. The psychologist will also help them with any anxiety or mood disorders as part of the program.

You can help as a family by encouraging your sister to seek help with this problem. Most people affected by hypochondriasis know they struggle with irrational thoughts and chronic worry about their health. They are often very open to suggestions and perhaps even relieved when someone else suggests seeing a psychologist would be acceptable. A trip to her primary care physician first may be in order if adequate medical testing has not been done to rule out true organic disease.

There’s no doubt that the brain, psyche, or conscious and subconsious thoughts and beliefs can affect how the body (soma) feels. More than ever, scientists are finding ways to measure the mind-body connection and even direct treatment toward what have been called psychosomatic complaints.

Today, the transfer of mental and emotional stress into physical symptoms is referred to as a somatoform disorder. Muscle, joint, back, and headache pain are the most common symptoms, but other symptoms can include gastrointestinal (nausea, loss of appetite, constipation), neurologic (numbness, tingling, paralysis) and sexual dysfunction. A common feature of somatoform disorders is symptom amplification — a heightened awareness of symptoms or symptoms blown out of proportion.

Somatoform disorders include a number of different problems all placed in this one category. These include somatization disorder, conversion disorder, hypochondriasis, body dysmorphic disorder, and factitious disorder. The lack of any evidence that there’s anything physically wrong to explain these disorders has led some experts to suggest dropping somatoform disorders as a real diagnosis.

But other experts in the field of psychiatry and psychology recommend taking a closer look at these disorders and finding ways to diagnose them more accurately and specifically. That way, treatment can be directed more toward the individual’s needs, rather than applying a generalized management approach that doesn’t really benefit the patient. The goals of treatment include reducing emergency department and doctor visits (thereby also reducing costs), improving physical symptoms even if psychologic distress remains unchanged, and/or improving function even if physical symptoms are not relieved.

See your family doctor or an orthopedic surgeon as soon as possible. Most people think bone density loss leading to osteoporosis (weak, brittle bones) is a woman’s disease. But men can develop osteoporosis, too — just later in life than women. And the effects can be just as devastating.

Osteoporosis occurs when more bone cells die than are replaced by new, healthy bone cells. This process of tearing down old bone cells and building up new ones is called bone remodeling. Unfortunately, with age (and for women, a loss of the hormone estrogen), bone remodeling slows down or becomes lopsided with too many old cells and not enough new ones.

Your physician will check for any hormonal abnormalities that can affect bone and prescribe medications that can restore a correct chemical balance. Usually some blood tests are needed to check this out. If your husband (or you!) are a candidate for one of the antiresorptive drugs called bisphosphonates like Boniva or Fosamax, then your doctor will prescribe those for you. Your doctor will also do a risk factor assessment to look for any other risk factors that might increase the chances for developing osteoporosis.

A plan of vitamin and mineral supplementation along with exercise and lifestyle changes is important. Taking calcium with vitamin D, getting some sun exposure (an excellent source of vitamin D), and quitting smoking (or other tobacco use) is a good place to start. A lifestyle of daily exercise to challenge balance, build strength, and stimulate bone growth is essential all the days of our lives.

A heel scan is a good place to start but your physician will likely want to measure your bone density using a more specialized X-ray test called Dual X-ray Absorptiometry (DXA scan). Another useful test is the FRAX Risk Assessment Tool put out by the World Health Organization (WHO). This tool calculates your 10-year risk of fracture. You can even access this tool on-line yourself, but you’ll need the results of your DXA scan to complete the calculations (http://www.shef.ac.uk/FRAX). These tests are recommended for women aged 65 and older, men 70 and older, and anyone over 50 who has significant risk factors for osteoporosis.

Don’t put off the decision to see your doctor. A fall leading to a fracture can be avoided with a simple but comprehensive prevention program. You should both get tested and begin taking steps toward improved bone health and falls prevention.

Therapists are trained in assessing both the patient and the environment (including the home) for things that can increase the risk of falls. Falls prevention has been proven to work — studies have shown a significant decrease in the number of falls older adults take with just some simple changes around the house.

The therapist will look for areas of poor lighting, clusters of electrical cords or wires, and point out any issues with flooring that can be a problem. For example, loose carpet, throw rugs, or slippery floor surfaces can be deadly in terms of tripping up a senior with even mild loss of balance or vision.

Stairs without railings, bathrooms without grab bars, and sometimes even those otherwise helpful walkers and canes can be a problem. These are all things you might be able to look for yourself, but a professional who does this for a living will often see potential problems that the patient or family just takes for granted as an everyday part of life.

The therapist can also perform an assessment of strength, balance, range of motion, and flexibility — all important ingredients in staying upright and more importantly, regaining balancing without falling down when posture is challenged.

The therapist will talk to the person who is limping, stumbling, and/or not using a cane or walker when one is needed. Being afraid of looking old while using an assistive device is a real concern for many older adults. But the statistics show that the greater risk is a fall leading to death. A little, friendly persuasion from the therapist may go a lot further than family members suggesting Mom or Dad use a cane or walker.

Fear of falling (and more especially a fear of not being able to get up) often leads to long periods of sitting, and that adds to the risk of falls. Fear of falling while getting in and out of the tub or shower can result in poor hygiene, which is a general health risk factor of its own.

This is just a partial list of the ways a home and personal patient assessment by a physical therapist can help prevent falls and keep our seniors independent for as long as possible.