Columns

2008.08.13 Help, I've fallen and my shoe doesn't really car

on . Posted in Nowhere Road

By RICH FOLEY

I can’t say for sure that it’s the perfect headline, but a recent banner in an Ohio daily trumpeting “Smart shoes may prevent falls” did get my attention. I’m just having some trouble believing the claims for the  new “iShoe” insole.

The Associated Press story describes the insole as containing a variety of sensors designed to tell how well a person is balancing. A doctor is then supposed to be able to interpret the information and, if needed, send the patient to a specialist in advance of a fall.

The device was developed by a graduate student working in an intern position at NASA who thinks research into helping astronauts keep their balance in no-gravity environments can transfer into helping the elderly stay upright here on Earth.

Erez Lieberman, the man responsible for the iShoe, says a fall is preceded by numerous warnings, similar to high cholesterol and high blood pressure being early warnings suggesting a future heart attack. “You gradually get worse and worse at balancing,” said Lieberman, adding “If you know the problem is there, you can start addressing the problem.”

That all sounds good, but is making the elderly wear insoles containing various sensors really the answer? The iShoe works by recording how pressure is distributed by the feet of patients with balance problems, comparing it to the pressure patterns of those with normal balance, and determining if a person needs special help.

But how many falls are caused by reasons that wouldn’t be measured by the insole? Ice, potholes, banana peels, or a newly waxed floor are all factors that could cause a person to fall, none of which the insole would detect. And how about stepping into a puddle of water? Would you simply short out your iShoe? Or would it give your foot a shock you wouldn’t soon forget?

On the happy side, the iShoe can send out a warning if its wearer falls, just like in those old television commercials. Instead of having to make an emergency call yourself, however, your iShoe will make the call for you. “Help, my owner has fallen and she can’t get up!”

I can joke about the idea, but it’s really a serious matter. According to The National Osteoporosis Foundation, 24% of all hip fracture patients over the age of 50 die within a year of the fracture. That’s enough to make anyone afraid of falling. In fact, maybe it would be safer just to sit on the couch.

But is the iShoe really going to be of any help? You can have all the information in the world about someone’s balance problems, but will that guarantee that they won’t fall?

Lieberman compared having balance information to having advanced warnings for people prone to a heart attack. But lots of people who know they have bad cholesterol or blood pressure numbers still have heart attacks. Knowledge doesn’t always mean power in the medical field. Sometimes, it just means higher health care costs without an expectation of a payoff.

Not everyone agrees with me on this. The story quotes a Dr. Robert Lindsay, who is a trustee at the osteoporosis foundation, as saying, “If they have a sensor that can detect differences in balance, it is fairly easy to train the elderly, using physical therapy, to improve their balance.”

 OK, doctor, but if a sensor is needed to tell the person that their balance is bad, how serious is it, really? If you can’t tell that your balance is getting worse by just doing your everyday activities, is it bad enough to worry about?

 I suppose you could come up with all sorts of little devices to detect potential health problems. Perhaps a little monitor to measure the loud noises you’re subjected to, to officially explain your hearing loss. Or a ultraviolet ray detector to record your sun exposure, perfect for those who don’t understand that it was staying outside all day without skin protection that caused that sunburn.

 There used to be an old doctor joke, something like “If it hurts when you do that, then don’t do that.” Some things people should be able to figure out for themselves. And they shouldn’t need a shoe with sensors to tell them if their balance is all right. Not falling always worked for me.

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