Fall Risk in Older Adult with Chemotherapy-Induced Peripheral Neuropathy
A 72-year-old woman with stage II ovarian cancer is receiving paclitaxel/carboplatin. She has grade 2 peripheral neuropathy with decreased vibration sense and proprioception in her feet, and reports two falls in the past month. She lives alone and wants to remain independent. Her Berg Balance Scale score is 45/56, and Timed Up and Go is 14 seconds. She has no other significant medical history. Her oncologist is concerned about fall risk and asks for a PT evaluation.
1. What are the key examination findings that indicate fall risk, and what further assessments would you perform?
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Key findings: two falls in past month, grade 2 neuropathy, decreased vibration and proprioception, Berg Balance 45/56 (below 45 indicates increased fall risk), TUG 14 seconds (≥13.5 sec indicates fall risk). Further assessments: Romberg test, single-leg stance, 5-times sit-to-stand, Functional Reach Test, and assessment of home environment. Also screen for orthostatic hypotension and vision problems.
2. Design a multifactorial intervention to reduce her fall risk, including exercise, environmental modification, and education.
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Exercise: Balance training (e.g., tandem stance, weight shifting, Tai Chi) 2-3 times per week; progressive resistance training for lower extremities; gait training with emphasis on proprioceptive input (e.g., walking on different surfaces). Environmental: Home safety evaluation-remove throw rugs, improve lighting, install grab bars in bathroom, use nightlights. Education: Teach safe falling techniques, use of assistive device (cane or walker) if needed, foot care (proper footwear, daily inspection), and to rise slowly from sitting. Refer to ophthalmology and podiatry if needed. Coordinate with oncologist about neuropathy management (e.g., duloxetine). Monitor progress with Berg and TUG every 4 weeks.