When I was in college (and I assume it’s not changed too much) there was typically a point in time where you needed to decide if you wanted to join a fraternity or not. There were a lot of discussions about this in the first few weeks of each school year, with underclassmen asking the older students what they thought about joining a fraternity. These discussions were usually pretty short because joining a fraternity is either is a natural part of going to college for you, or it makes no sense whatsoever. There are not many people sitting on that fence. I was well on the side of the fence that did not understand the attraction of joining a fraternity (not that there is anything wrong with it). Little did I know that 25 years later, I would become a FRAT boy. This FRAT stands for Fall Risk Assessment Team, and this boy is sporting gray hair and wrinkles. FRAT is the term I use to describe the multi-disciplinary team that provides comprehensive assessment and management of the patient at risk for falling.
The multi-disciplinary approach to evaluating and treating the unsteady patient allows for the blending of specialties. Because normal balance is dependent on multiple input systems, it can be difficult for the patient or referring physician to be clear on which specialist should be consulted. Balance problems may not be the result of a single, identifiable pathology, but rather a combination of sub-clinical pathologies. In addition, balance requires the harmonious integration of all the incoming information at the level of the brainstem and cerebellum. Each member of the FRAT must be proficient in their area of specialty, and communicate with other specialists on the team. A comprehensive evaluation for the risk of falls may include a medical examination by a related specialist (typically Otolaryngology or Neurology), an Audiologist, and a Physical Therapist.
The team approach for staffing a balance clinic has numerous advantages. The patient receives the benefit of seeing several specialists, at one site, on one day. Typically, the entry point at a balance clinic will involve some type of screening(s) to determine what specialists and what examinations may be most helpful to address the patient’s complaints. This screening examination can be performed by any member of the team who has been trained and is experienced in taking a case history and performing screening examinations. The team members have the benefit of interacting with other team members to discuss their findings and how these findings may relate to a final diagnosis. The payers (a third party or the patient) benefit from cost savings related to reduced duplication of services, faster diagnosis and treatment leading to less time lost from work and improved likelihood of effective treatment.
An often overlooked member of the falls risk assessment team is the primary care physician (PCP). There should be an ongoing dialogue between the PCP and the FRAT. The FRAT should provide a steady flow of information and tools to assist the PCP in screening for appropriate referral, and in techniques to most effectively manage risk factors identified during the assessment. The PCP should provide feedback to the FRAT regarding perceived value of the information obtained from the comprehensive assessment.
Next week we will review the role of the Physical Therapist as part of the FRAT.