Cutting Through the Chaos: Creating Effective Frameworks for Complex Patients

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist Owner: Healthy Aging Physical Therapy

If you’ve ever worked with, or been, a patient who seems to have more going on that meets the eye, you know how challenging it can be. Fortunately, these are also often the most rewarding patients - and, most importantly, the ones who need us most.

At Healthy Aging Physical Therapy, our team specializes in exactly that: caring for complex patients—people with multiple diagnoses, long medical histories, and functional challenges who often feel like no one knows where to start. They’re the ones who have seen five other therapists, have a dozen specialists, and still feel stuck.

Why Our Patients Are So Complex

When you’re in physical or occupational therapy school, you learn about impairments in isolation.

• A hip fracture? You study how to rebuild strength and balance.

• A cardiac patient? You learn to monitor vitals and improve endurance.

• A neurological condition? You focus on motor control, coordination, and safety.

But real-world patients with geriatric, neurologic, and complex medical needs don’t fit in tidy boxes. The people we serve are living with multiple comorbidities, often taking many medications, and facing social and emotional challenges that go far beyond their diagnosis list.

For example, many of our patients with Parkinson’s disease also experience osteoarthritis, chronic pain, memory loss, anxiety, and depression - and often have a partner who is also aging and managing their own medical issues to boot. Similarly, a patient referred for “hip fracture” is rarely just an orthopedic case. The fracture may have resulted from a fall, which stemmed from a combination of weakness, balance impairments, cardiac symptoms, and home safety challenges. Many live alone, with limited support and a history of sedentary behavior.

It’s no wonder that walking into these homes for an evaluation can feel overwhelming, even for seasoned clinicians.

Many of these individuals have already been discharged from other settings because progress stalled, the situation was too complicated, or insurance coverage ran out. Over time, we’ve become the go-to practice for these patients—the ones other providers refer when they aren’t sure what else to do. In many cases, we become the last stop—the “hail Mary” for patients who are exhausted from circling through the healthcare system.

So, how do we help?

Our Framework for Treating Complex Patients

Through experience and teamwork, we’ve developed a simple, realistic framework that helps our clinicians navigate these challenging situations - one that keeps both patient and therapist grounded, hopeful, and effective.

Whether you’re a therapist reading this, a patient with a complex background, or a caregiver trying to support a loved one, I hope these strategies help you cut through the chaos and find a starting point that leads to progress.

1. Focus on What Matters Most and Not Everything at Once

When faced with a dozen problems, it’s natural to want to fix them all. But that’s a recipe for overwhelm, and, inevitably, an ineffective therapeutic approach.

Instead, we teach our therapists to start by asking:

“What are the top one or two things we can help with right now that will most improve this person’s quality of life, safety, and independence?”

Sometimes that means addressing strength, balance, or mobility. Other times, it’s about helping the patient move again after weeks (or months) of fear and inactivity. Sedentary behavior, whether from pain, fear, or fatigue, triggers a cascade of physical and emotional decline and often, interrupting this cycle can be an important first step. Even small steps toward safe, confident movement can change everything. Sometimes, a compensatory approach is the right starting point: helping a patient obtain the proper wheelchair, walker, or other durable medical equipment to restore access to their home and community.

Time after time, we’ve learned that small wins matter. They build trust, confidence, and momentum - all critical ingredients for rapport and long-term success.

2. Layer in Support

We remind our team (and ourselves) that we can’t fix everything - and that’s okay. Somethings aren’t ‘fixable’ and other things are outside of our scope and capabilities.

Our role is to make a meaningful difference where we can, while also building a web of support around the patient to provide support for ‘the other things’. That often means:

• Connecting patients with mental health providers when mood disorders or anxiety is a barrier

• Coordinating with care team physicians and pharmacists to address medication-related issues

• Referring our patients to trusted home health aides, elder services, or aging life-care specialists

• Providing resources for community programs, support groups, and case managers

It’s not about doing it all ourselves - it’s about building the right team around each patient, one layer at a time.

3. Collaboration Is Key

When you work with a Healthy Aging therapist, you may only see one person walk through your door—but behind that therapist is an entire network of expertise.

Our team includes specialists in neurology, orthopedics, geriatrics, vestibular therapy, and cardiopulmonary rehab. We collaborate behind the scenes through discussion boards, case consults, and joint visits - bringing fresh ideas, new eyes and diverse perspectives to every complex case. Sometimes that collaboration means I’ll step in for a Complex Case Visit, working alongside the treating therapist to strategize solutions. Other times, the team shares insights online, helping each other troubleshoot mobility challenges, medication effects, or behavioral barriers.

That culture of teamwork is one of our greatest strengths—and one of the biggest reasons I feel our patients make progress where others have stalled.

4. Think Long-Term

Complex patients rarely fit neatly into a six-week plan of care. Their needs evolve, new issues arise, and maintaining stability often becomes the goal as much as improvement.

That’s why we emphasize continuity - treating each patient as someone we’ll likely know for years. When a patient is ready to discharge, we make sure:

• A comprehensive post-discharge home program is in place

• The patient has been connected with the appropriate community and medical supports

• We have established a clear plan for future follow-up

For many, we transition them into a Maintenance Plan of Care under Medicare Part B, or into our Wellness programssuch as Wellness365, where they continue to receive guided exercise and ongoing support to prevent decline.

Because our ultimate goal isn’t just short term rehab - it’s recovery and resilience.

What This Means for Patients and Families

If you’re a patient, caregiver, or family member feeling frustrated that “no one knows how to help,” please know: you’re not alone, and your situation isn’t hopeless.

Working with complex conditions takes time, teamwork, and the right perspective. The most important first step is finding professionals who know how to cut through the chaos—and, most importantly, who see you as a person first, not just a list of diagnoses.

That the heart of what we do at Healthy Aging Physical Therapy.

Don’t Fall this Fall! Your Guide to Preventing Falls and Staying Strong

As the leaves begin to fall, let’s talk about a more serious kind of fall - one that affects 1 in 4 older adults each year. Of those, 1 in 5 results in serious injury, including broken bones and head trauma. Even more concerning: once someone experiences a fall, their risk of falling again doubles.

But here’s the good news - falls are not an inevitable part of aging. There are proven, evidence-based strategies that can help reduce fall risk, improve confidence, and even teach people how to fall more safely when accidents happen. And Healthy Aging Physical Therapy is here to help you or your loved ones put those strategies into action.

CDC STEADI Initiative and Fall Prevention

According to the CDC’s STEADI Initiative (Stopping Elderly Accidents, Deaths and Injuries), the key pillars of fall prevention include:

• Screening for fall risk using tools like the Timed Up and Go (TUG) or 4-Stage Balance Test

• Strengthening and balance training that’s appropriate for age and ability

• Medication review and management

• Vision and vestibular assessment

• Home safety modifications

• Education on what to do in the event of a fall

[Source: CDC STEADI Program – https://www.cdc.gov/steadi/]

At Healthy Aging Physical Therapy, we’ve structured our programs around this proven framework to deliver the most effective strategies for fall prevention. Keep reading to learn how we put each pillar into practice.

Screening for Fall Risk

During our therapy evaluations, our licensed physical and occupational therapists conduct standardized, evidence-based fall risk screens, using tools like:

• Timed Up and Go (TUG)

• 4-Stage Balance Test

• 5 Times Sit to Stand

• Berg Balance Scale

• Backwards Walking Speed

• Gait speed analysis

These assessments help us identify your current fall risk level, evaluate your balance and mobility, and guide the creation of a personalized plan of care. At Healthy Aging, we believe knowledge is power—so we don’t just give you a score, we help you understand what it means. Using age- and gender-based normative values and clinically validated cut-off scores, we compare your results to your peers and determine what they indicate about your individual fall risk. From there, we build a care plan that addresses specific areas of deficit and set clear, measurable goals. These goals allow us to track progress, ensure what we're doing is effective, and pivot when needed to keep you moving forward safely.

Strengthening and Balance Programs

Strength and balance are woven into nearly everything we do here at Healthy Aging Physical Therapy, because we know just how critical they are to aging well. Every Physical Therapy and Occupational Therapy plan of care we create includes targeted interventions to build strength, improve balance, and reduce fall risk. But we also go above and beyond traditional therapy by offering extended support through our Wellness365 program, where specially trained personal trainers work with older adults to maintain and build strength long after therapy ends. For those who enjoy the energy of group fitness, we offer evidence-based classes like Strong and STEADI, which blends balance training, reactive strategies, and floor recovery skills, and Fit & Fearless, our adaptive martial arts program that teaches safe falling techniques and improves agility and body control. Whether you’re just getting started or continuing your wellness journey, our strength and balance programs provide the foundation for safer, more confident movement.

Medication Review and Management

While we don’t prescribe or manage medications directly, our therapists play an important role in identifying potential medication-related fall risks. During every evaluation, we review your current medication list and screen for drugs that may contribute to dizziness, fatigue, or low blood pressure—such as sedatives, antihypertensives, and certain pain medications. When we identify red flags, we collaborate with your physician, nurse practitioner, or pharmacist to recommend a formal medication review or suggest adjustments that may reduce your risk of falling.

Vision and Vestibular Assessment

Our Vestibular Therapy services are provided by clinicians specially trained to treat conditions such as BPPV, vestibular hypofunction, and motion sensitivity. Addressing these issues can significantly improve stability, reduce dizziness, and restore confidence in movement, particularly during sudden turns, head movements, or nighttime activities when balance is most challenged. In addition to vestibular care, we also consider vision as an important piece of the fall prevention puzzle. While we don’t provide eye exams, we screen for vision impairments during PT and OT sessions and refer to optometry or ophthalmology when needed. We also help patients address visual-vestibular integration challenges and provide guidance on modifying the home environment to better accommodate vision changes. Want to learn more? Check out our Vestibular and Dizziness page here.

Home Safety Assessment and Modification

At Healthy Aging Physical Therapy, home safety is an essential part of every plan of care. Our Physical and Occupational Therapists assess your living environment during therapy visits to identify potential fall hazards and barriers to independence. We evaluate factors such as flooring, lighting, stairways, bathroom access, and furniture layout, and we provide tailored recommendations to improve safety and function. When modifications are needed, we help coordinate referrals to trusted professionals who can install grab bars, ramps, railings, and other accessibility features. For those seeking a more in-depth evaluation, either in conjunction with therapy or on its own, we also offer our Home Assessment & Resource Program (HARP). This program provides a focused, expert evaluation of your home environment with personalized safety recommendations and resource navigation to support aging-in-place confidently and safely.

Fall Preparedness Education

At Healthy Aging Physical Therapy, we also believe fall preparedness is just as important as fall prevention—because even with the best strategies in place, accidents can still happen. That’s why our therapists receive advanced training in fall preparedness education, including safe falling techniques, floor recovery strategies, and how to respond if a fall occurs. We routinely make getting on and off the floor a core part of therapy, recognizing that this essential skill is often overlooked in traditional rehab settings. Whether someone is learning to recover independently after a fall or safely call for help when needed, our goal is to build both skill and confidence. For those who want to go even deeper, our Fit & Fearless program offers a supportive group environment where participants practice safe landing techniques, controlled descents, and reactive balance drills inspired by adaptive martial arts. It's an empowering, innovative approach to fall preparedness that helps older adults feel strong, capable, and ready for whatever life throws their way.

Movement Matters: Helping Loved Ones with Dementia Stay Active

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

June is Alzheimer’s & Brain Awareness Month - making it an ideal time to spotlight how purposeful movement can slow physical decline, curb agitation, and brighten the day for people living with dementia.

The Hidden Cost of Inactivity in Dementia

• Faster loss of strength, endurance, and mobility.
  People with dementia experience significantly steeper declines in muscle power, balance, gait speed, and overall endurance than their cognitively healthy peers. A 2017 systematic review found that targeted exercise can reverse many of these losses, highlighting just how much ground inactivity can cost them.

• A 2-3 fold higher fall risk.
  Up to 60–80% of individuals with dementia fall each year, double (or more) the rate seen in age-matched adults without cognitive impairment.

• More than “just weak legs.”
  Neurologic changes in the brain affect depth perception, spatial awareness, and dual-tasking, making tripping over obstacles or misjudging doorways far more likely, even in familiar environments.

Why Activity Often Fades

Research into barriers paints a clear picture:

• Low motivation and apathy.
  Dementia frequently dampens initiative, so even engaging in even once-loved hobbies may need an extra nudge.

• Safety worries - both real and perceived.
  Fear of falls, wandering, or behavioral changes can make caregivers over-cautious, unintentionally encouraging more sitting and inactivity.

• Limited guidance or support.
  When caregivers lack time, know-how, or resources, structured movement sessions often become a low priority when so many other caregiving needs exist.

The Upside of Movement: Small Steps, Big Impact

Despite the challenges, the benefits of regular movement are powerful. Studies link even modest activity to:

• Reduced agitation and anxiety

• Improved mood and quality of life

• Better executive function and attention span

The World Health Organization and Alzheimer’s Disease International recommend that older adults, including those with dementia, aim for:

• At least 150 minutes of moderate-intensity aerobic activity per week (e.g., brisk walking, dancing, cycling)

• Muscle-strengthening activities 2 or more days per week

• Balance and mobility-focused exercises at least 3 days per week, especially for those with a history of falls or unsteadiness

But here’s the most important part:
These goals don’t need to be met all at once. Even 10-minute bouts of movement count. A short daily walk, chair yoga, or marching in place while brushing teeth can build into meaningful progress over time.

And remember—something is always better than nothing. Consistency and routine matter far more than intensity.

My Top 3 Tips to Get Your Loved One Moving

1. Make It Part of the Routine

• Same time, every time.
  Repetition breeds familiarity, and familiarity feels safe. A short walk after breakfast or gentle seated exercises during nightly news on TV can become as automatic as brushing teeth.

• Leave visual “clues.”
  Place sneakers by the dining chair or set out resistance bands where they’ll be noticed. Then cue your loved one with a calm, confident “Time for our walk!”

2. Make It Meaningful

Movement can be easier, and more enjoyable, when it feels like a meaningful activity, rather than a workout. The best way to help a loved one with dementia get active? Choose activities that connect with who they are and what they’ve always loved to do.

Tie movement to personal identity and past routines:

• Gardener?
  Keep a raised-bed planter or container garden ready to go. Practice squatting or sit-to-stand movements while pulling weeds, watering plants, or sorting seed packets.

• Make household chores a team effort.
  Turn household chores into movement moments. Fold towels together while standing, carry a light basket across the room, or reach to hang clothes on a low rack or line. Involve them in safe cleaning tasks like dusting, wiping counters, or organizing drawers. These repetitive tasks offer built-in structure and gentle physical activity.

• Dancer or music fan?
  Put on their favorite music from high school or early adulthood. March in place, sway side to side, or tap feet to the beat. Even seated, this can raise the heart rate and lift the mood.

• Involve the family pets.
  Take short walks with the family dog, brush the cat, or pretend to care for a stuffed animal if pets aren't available. Caring for something else often sparks a natural desire to move.

• Crafter or artist?
  Set up a workspace that encourages posture shifts—standing to cut fabric, reaching to gather supplies, or walking to display finished pieces.

Bonus Tip: Use exercise time to engage. Talking is a great form of ‘dual-tasking’ and dual-tasking is a powerful way to improve balance. Reminisce while you move. Play cognitive games like eye-spy or categories. Ask questions about the world around you - see if they can count the passing cars or recall facts about your neighbors as you walk by.

3. Try a Group Fitness Class

• Community programs, like local strength and balance classes, add social interaction and gentle accountability.

For locals, Healthy Aging PT’s Strong and STEADI sessions blend fall-prevention drills with upbeat music and expert guidance. Ask your senior center for recommendations or check our calendar.

When to Call in for Backup

Encouraging safe, consistent movement isn’t always easy, especially when dementia is involved. You might find that your loved one resists participation, struggles to follow instructions, or becomes overwhelmed by too many choices. That’s completely normal - and it's exactly where we come in.

At Healthy Aging Physical Therapy, our licensed Physical and Occupational Therapists and certified personal trainers are experienced in working with older adults living with cognitive impairment. We understand how to blend clinical expertise with patience, creativity, and compassion.

Here’s how our Therapy and Wellness365 teams can help:

• Comprehensive Assessment
  We evaluate strength, mobility, balance, and fall risk while considering cognitive status, emotional state, and home environment. This helps us determine what’s safe, what’s realistic, and what’s meaningful.

• Personalized Movement Prescription
  One-size-fits-all exercise plans don’t work, especially in dementia care. We’ll create a tailored program that matches your loved one’s current abilities and interests, focusing on what they can do and building from there.

• Cognitive-Aware Coaching
  We train family members and paid caregivers in practical strategies: how to cue movement clearly, how to redirect attention when needed, and how to create daily routines that support success without stress.

• Progress Monitoring & Support
  Our team can check in regularly to adjust the plan, troubleshoot challenges, and provide encouragement. Even small wins, like standing up more easily or walking an extra lap around the kitchen, can be incredibly meaningful.

If your loved one is struggling with inactivity, mood changes, falls, or increasing dependence, it may be time to bring in professional support.

We’re here when you’re ready.
Call us at (617) 398-4508 or visit our website to request:

• A Medicare-covered Physical or Occupational Therapy Evaluation, or

• A private Wellness365 Personal Training session for continued fitness and support after therapy ends.

Let’s work together to keep your loved one strong, steady, and engaged - every step of the way.

“You Actually Care”: Why Soft Skills are the Key to Effective Therapy

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

The other day, a patient’s spouse looked at me, and said incredulously:

“It’s like you really understand her and actually care. You’re not just going through the motions.”

I instantly teared up, because I’m a giant crybaby, but it really got me thinking.

I do care. And the fact that he said it with such surprise broke my heart. Because while it felt so natural to me, to him, this wasn’t the norm — and that’s is a problem!

It also reminded me that what we are doing is different—and it’s working! This is exactly what I want every patient and family to feel when they work with us at Healthy Aging Physical Therapy. And it’s why I’ve built our practice, intentionally, to protect and promote what I think is the number one differentiator in great care: effective soft skills.

The Problem: A System That Strips Away the Human Side of Health Care

In today’s healthcare system, connection is rare. You go to your MD and they are typing more than they talk. The visit is often less than 15 minutes. There’s little to no time to ask questions. Patients rarely feel truly heard.

In many outpatient therapy clinics, time with your therapist is limited. You might spend 15-30 minutes with your clinician, but the rest of your session is with an aide or tech, often in an open gym, surrounded by other patients. While the shared gym environment is motivating for some, it can make it difficult for others to be open or vulnerable.

Home care should feel more personal, but even that has become transactional. With nursing shortages, therapists are being asked to address issues beyond their scope. Visits are often 30-40 minutes at the most, and a large portion is spent on answering multiple-choice questions for Medicare and making sure those are complete to ensure payment. 

Please know, none of this is said to slight any of these healthcare providers — clinicians are, by and large, well-meaning individuals working under extremely challenging conditions. Rather, these are symptoms of a systemic issue. Financial and administrative burdens, staffing challenges, and healthcare inequity are strangling our system. And while clinicians struggle to get through the day, the ones truly suffering are our patients.

The Solution: Shifting to Model That Puts the Care back in Healthcare

When I started seeing patients under the Healthy Aging model, something shifted for me. I had spent years in settings where I felt I had to  rush through the "subjective" portion of an eval, get through the history in 10 minutes or less so I could move on to the "real" work: strength testing, range of motion and outcome measures.

But once I gave myself permission to slow down and listen, my evaluations transformed. It started taking me 30, or, sometimes more, minutes to get through my subjective - not because I was inefficient, but because I let myself get curious. And the more curious I became, the more I learned. Learning more about my patients helped me design better plans for their care. And I found that as my relationships grew stronger, their outcomes got better.

I needed that time to get to know my patients beyond their past medical history and med lists. I wanted to know more than just their goals, but about their lives:

• Tell me about your home. Have you lived here a while? Did you raise your family here? Is it important to you to age in place? Have you looked into supported living settings or do you want more information?

• Who helps you day to day? Do you have family, friends, caregivers involved in your life — or need help finding more support? What needs feel unmet?

• Tell me about your grandkids and your pets, your church groups and what you do in the community. How do you spend your days?

• How are you feeling — not just physically, but emotionally? Are you in a place where you can focus on therapy, or are there other issues that need to be addressed first?

• How is your sleep? Appetite? Hydration? Do you have access to healthy food?

• How do you feel about exercise? Love it? Hate it? Have you had PT before? Was it helpful? What gets in your way of being more active?

These questions aren't luxuries. They are essential. They help me develop a plan that reflects who they are, where they are, and what matters most to each of them.

That single shift, from checking boxes to checking in, changed everything.

Structuring a Practice Centered on Soft Skills

It wasn’t enough for me to work this way. I wanted our whole practice to reflect this approach. That meant building a structure that not only allows for soft skills, but rewards them. How do we do this?  From hiring to training to the way we structure our sessions, compassionate, patient-centered care is the foundation and everything stems from there.

• We hire for heart, not for accolades. When I interview a prospective therapist or personal trainer, I’m not looking for specialty certifications, or awards on their resume. I’m looking for the people that care. Therapists and trainers that care about the work they do, the patients they work with and the colleagues they work beside. I’m always on the lookout for someone that has something special to give, who wants to learn more, and collaborate with their peers.  

• We book our visits for a full hour.  After years of rushing around in home care, I didn’t want to feel rushed anymore. Our patients deserve better. They need time at the beginning to talk and settle in, and time at the end to wrap up, reflect and make a plan for the next week. After treating this way for five years now, I can’t even imagine going back to a shorter visit. 

• Our clinicians are paid for time, not for productivity. If one of our therapists spends an hour and a half with a patient, they are paid for an hour and a half of their time - even if half of that was dealing with a non-billable need. It happens! This frees our therapists to be present and focused and without worrying about productivity quotas or time crunches.

• I train each of our therapists to evaluate with intention. When someone joins our practice they accompany me on an evaluation before going out on their own. I model what I teach, and have systems in place to help guide them in asking the important questions. I can’t tell you how many times I finish an evaluation and a patient or their family says to me ‘I’ve had a lot of PT, and no one has ever asked me these kinds of things.’ This is how I know I’m on the right track. And when a patient feels seen and understood, they are more willing to do the work.  

• We lead with our core values. They’re printed on the first page of our patient booklets, woven into our orientation, and reflected in how we speak, act, and show up for care.

  Healthy Aging Therapists are:

• Patient Centered + Holistic

• Empathetic + Compassionate

• Collaborative + Approachable

• Fitness-Forward + Functional

• Evidence-Based + Education-Focused

And our mission statement says it all:

Healthy Aging Physical Therapy delivers specialized outpatient-at-home physical therapy, occupational therapy, and wellness services to support optimal aging for older adults, individuals with Parkinson's Disease, and those with complex medical needs. Our unique in-home model reduces barriers to access, is driven by patient-centered goals, emphasizes education, and embraces a holistic, whole-health approach. We believe in movement as medicine, that every body has the ability to improve, and that above all else, kindness matters..

5 Soft Skill Tips for Therapists Who Want to Provide Better Care

If you’re a therapist reading this and thinking, "I want that, too!" here are my top 5 tips to improve your own soft skills and get better results:

1. Take the time to talk, even if it takes time away from something else.

Taking that extra time not only at evaluation, but at each session, to engage, ask, and listen will pay dividends in patient engagement, motivation, and success. So what if you didn’t get to complete that Berg today or see how they did on the stairs. You’re in it for the long game and not everything needs to be accomplished on day one - you can always get to it next session. That time spent talking isn't wasted - it's essential.

2. Don't write off the "hard" ones - they are the ones that need your care the most.

Frustrated by your ‘unmotivated/unwilling’ patient? Don't just write them off as lacking potential, being non-compliant or unwilling to participate. These are the ones to DOUBLE DOWN ON. Really dig in - get curious! Why are they struggling to participate or follow through? Are they anxious, overwhelmed, or confused? Are there cultural barriers or limiting beliefs?  What do they care about? How can you change your approach to meet their needs? Do you need to consider layering other support services to approach their case in a more multidisciplinary way? Are your goals reasonable or do they need to be more accommodative and realistic for this situation? Everyone has potential - sometimes you just need to look a little deeper, try a different approach or add in the additional support they need to thrive.

3. Be ready to modify your game plan.

Our patients are not robots - and rehabilitation is not linear. You need to be able to walk in the door, assuming things may not go as planned. The days your patient is painful, stressed or anxious are not the days you are going to get everything done. You need to be flexible and prepared to pivot. This is a skill learned through experience, and I do think it’s one of the hardest things for a student or new grad to understand right off the bat. My advice is to talk with your patient first before making the plan for the day, guide them towards the best choices during your session instead of telling them what you are going to do, and have goals, not plans, for each session.

4. Ask questions, at every visit.

And I’m not talking about ‘How is your pain on a 0-10 or did you do your Home Exercises?’ Read up on motivational interviewing and adapt your questions to your patient’s capability. Looking to get a sense of perceived rate of exertion? Wondering if your balance challenge was hard enough? Yes, there are a million validated pain scales and exertional scales out there, but honestly, who wants to be given a piece of paper with 20 numbers and colors and smiley faces every time they do a new exercise. It’s okay to keep it simple and just ask how it felt - “Was that easy, medium or hard?” “Could you handle another set or need a break?” “How could we make this harder? Want to try closing your eyes or a different surface?”  Let your patient make the choices (Bonus - it’s better for neuroplasticity!) - "Anything you want to focus on today?" “We’ve got 15 minutes left - would you rather get outside for a walk or try this new game I brought?” Ask questions that focus on the wins - “What went well this week?” “Tell me one thing you can/will/want to do this week to work towards your goals?” Questions keep your patient engaged and keep you focused on what they truly need.

5. Put the CARE back in your Care Plan.

We all got into this field for the right intentions, but too often, corporate healthcare, big hospitals and practices that prioritize profit over people slowly take this from us. We’re pushed to be more outcome driven, instead of more caring, more efficient instead of empathetic - and this inevitably leads to burnout. If you work somewhere and you feel like your ability to care (not just ‘provide care’)  is being stifled, change it. Advocate for a better model. Leave if you need to. Or build something new. Don’t settle for the status quo and remember why you chose this career and take the steps you need to find joy in it again.  Bring back the care back to healthcare. Make soft skills the standard, not the exception.

Dizzy? Don’t Wait. Why Early Treatment for Dizziness MATTERS.

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, AIB-VRC

Owner: Healthy Aging Physical Therapy

I’ve been meaning to write this for a while.

As a physical therapist, I’ve met so many patients - especially older adults - who are frustrated, scared, and worn out from trying to get help for their dizziness. Many have already been to the ER or seen their primary care doctor. They’ve had bloodwork, imaging, and hours spent waiting, only to leave with a discharge summary (and costly bill…) that says "vertigo" and a prescription for meclizine (which, by the way, is often the worst thing you can do for vertigo!). 

Dizziness can be hard to describe, hard to diagnose, and hard to treat without the right tools. And most healthcare providers, despite their best intentions, do not have the training to effectively treat dizziness. Causes of dizziness in older adults can range from simple ‘plumming’ issues like Benign Paroxysmal Positional Vertigo (BPPV) to complex, multifactorial dizziness that can really limit an individual's ability to live their lives the way they want to and can lead to a cascade of other problems, both physical and emotional, down the road. Fortunately, truly dangerous causes of vertigo are actually pretty rare, and vestibular therapists like myself are trained to screen for them - and can do so, right at home. 

Last week, I completed an advanced Vestibular Rehabilitation course through the University of Pittsburgh’s Department of Physical Therapy - a detailed update on the science of dizziness, its causes, and effective treatments. It gave me the final nudge to write this, because the truth is:

Dizziness is common - but TREATABLE!

What is the Most Common Cause of Dizziness?

You may be surprised to learn that one of the most common causes of dizziness in older adults is BPPV (benign paroxysmal positional vertigo) - and it’s often misdiagnosed or missed altogether.

In fact:

• Dizziness is one of the top 3 reasons older adults seek emergency care.

• It accounts for ~10% of all ER visits in people over 65.

• Approximately 40% of dizziness in older adults can be attributed to BPPV - and many go undiagnosed for years.

BPPV is caused by tiny calcium carbonate crystals in your inner ear - called otoconia - that get dislodged and move into the wrong part of your vestibular system. This sends confusing signals to your brain, causing that awful spinning sensation when you move your head a certain way.

But here’s the key:
BPPV is both benign and highly treatable. (Really  - it’s in the name!)

Using a gentle series of head movements called canalith repositioning maneuvers, we can move the crystals back to where they belong, most often in just 1 or 2 sessions.

What If It’s Not BPPV?

That’s okay too. Vestibular therapists are trained to assess and treat a wide range of dizziness causes - including vestibular hypofunction, central dizziness, post-concussion syndrome, cervicogenic dizziness, and more.

Treatment often includes a combination of:

• Vestibular exercises designed to retrain the brain and inner ear to work together again. These may include gaze stabilization exercises (teaching your eyes to stay steady while your head moves), habituation exercises (gradual exposure to movements that trigger symptoms to reduce sensitivity), and substitution strategies that help your body use other senses like vision or proprioception to compensate for balance loss.

• Balance training that challenges your body safely to improve stability, confidence, and coordination. This may include:

• Standing on uneven surfaces

• Practicing turning or head movements during walking

• Dual-task activities to mimic real-world situations (like walking while talking or carrying something)

• Education is one of the most powerful parts of therapy. As vestibular specialists, we help you:

• Understand why you're dizzy

• Identify what makes your symptoms worse

• Learn how to gradually return to daily activities

• Build confidence to move again (because the fear of dizziness can often be just as limiting as the dizziness itself)

We also spend time helping you avoid common pitfalls - like over-relying on meclizine or stopping movement altogether, which can actually make symptoms worse over time.

We don’t just guess - we test.
Using clinical tools and evidence-based screening, we assess your vestibular system, visual tracking, balance strategies, gait, and postural control. From there, we create a personalized plan that meets your needs and goals.

Vestibular rehabilitation therapy (VRT) is the gold standard for managing most non-life-threatening vestibular disorders, and it has strong research support behind it.

Isn’t Dizziness Just a Normal Part of Getting Older?

One of the most harmful misconceptions I hear from patients is they brush off dizziness as part of aging, or are told by well-meaning healthcare providers to simply drink more water.  But dizziness is not a normal part of aging, and when it goes untreated, it can trigger a cascade of issues that affect nearly every aspect of a person’s health. People often start avoiding certain movements or situations that provoke symptoms, which leads to reduced physical activity, progressive muscle weakness, and worsening balance. This in turn increases the risk of falls, leads to  social withdrawal, and contributes to emotional challenges like anxiety and depression.

In fact, dizziness and anxiety are closely linked; research shows that the brain regions responsible for balance and emotional regulation are deeply connected. So yes, while dizziness can make you feel anxious, anxiety can actually make you feel dizzy! It’s a real, bi-directional cycle that many people find themselves stuck inW.

That’s why early treatment is so critical. A 2023 study of over 800,000 adults found that individuals who received physical therapy within three months of reporting dizziness were 86% less likely to fall in the following year. That’s an extraordinary impact, and a clear message that getting help early matters. Don’t wait to see if it goes away. There’s effective treatment available, and it can make all the difference.

The Benefits of At-Home Vestibular Care

When you're experiencing dizziness, just getting to a clinic can feel overwhelming, dangerous or impossible. You may be facing challenges like driving, navigating stairs, fatigue, or simply not having someone available to accompany you. BPPV treatment may leave you feeling dizzy for an hour or so after they are complete, so getting home from the clinic may be an unexpected challenge as well.  That’s why we bring expert vestibular care directly to you. At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation—a safe, effective, and personalized approach that addresses dizziness, vertigo, and balance issues in the comfort of your own home. Our team includes certified vestibular and concussion specialists, Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist,  and Jessie Jamieson, PTA, both trained through the American Institute of Balance. When dizziness is your primary concern, you’ll be evaluated by one of our vestibular-trained clinicians to ensure an accurate diagnosis and targeted treatment plan from the start.

You may also receive care by a member of our larger, collaborative team of physical and occupational therapists who have  advanced training in fall prevention, Parkinson’s Disease, orthopedic rehabilitation, chronic pain, arthritis, and post-injury recovery. That means you won’t just be treated for your dizziness - you’ll be cared for as a whole person. With at-home vestibular care from a specialized and holistic team, you can feel secure knowing you're in good hands every step of the way.

Ready to Get Steady?

Dizziness doesn't have to take away your confidence, your safety, or your ability to live life on your terms. With the right treatment, delivered by a specialized team in the comfort of your own home, you can get back to doing the things you love without the fear of falling.

At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation covered by Medicare Part B, BCBS and most Medicare Advantage Plans. That means you get the same expert care you'd receive in a clinic, without ever having to leave home. From your first evaluation to personalized vestibular and balance therapy, you’ll be supported every step of the way by a team who understands the unique needs of older adults.

To request a Vestibular Therapy Consultation, you can:

📞 Call us at (617) 398 - 4508
📠 Ask your doctor to fax us referral to (781) 262 3337
🌐 Or click the button below to register as a new patient and we’ll call you from there to schedule your appointment.

References

• Marmor et al. (2023). Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US.
   JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2023.2840

• Pauwels et al. (2023). Gait and Falls in BPPV: A Systematic Review and Meta-analysis.
   J Neurol Phys Ther. https://doi.org/10.1097/NPT.0000000000000438

• Dunlap et al. (2021). Fear Avoidance Beliefs and Disability in Vestibular Disorders.
   Phys Ther. https://doi.org/10.1093/ptj/pzab147

• Metz & Bryce (2024). Including BPPV Screening in Falls Clinics.
   J Laryngol Otol. https://doi.org/10.1017/S0022215123002049

• Agrawal et al. (2009). Vestibular Dysfunction and Fall Risk in US Adults.
   Arch Intern Med. https://doi.org/10.1001/archinternmed.2009.66

• McDonnell MN & Hillier SL. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.
   Cochrane Database Syst Rev. (1):CD005397.
   https://doi.org/10.1002/14651858.CD005397.pub4

• Bhattacharyya N et al. (2008). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (BPPV).
   Otolaryngol Head Neck Surg.
   https://doi.org/10.1016/j.otohns.2008.08.022

• Oghalai JS et al. (2000). The Dizziness Handicap Inventory: BPPV and Older Adults.
   Otolaryngol Head Neck Surg.
   (Referenced for prevalence data; original article not available online, but frequently cited in clinical literature)