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Addressing the High Risk of Falls in MS

December 14, 2016

Intervention programs that target key modifiable risk factors are vital when attempting to prevent falls in multiple sclerosis (MS) patients. The research done on this topic is relatively new and it is known that much more work needs to be done to improve the prevention strategies.

Because falls in MS patients may lead to potentially life-changing consequences, from physical injury to a fear of falling, diminished physical activity, and social isolation,1 they are “a major problem that requires focused attention,” says Marcia Finlayson, PhD, OT Reg (Ont), OTR, Director of the School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada. And “since falls are multifactorial, solutions need to be multifactorial, as well,” she adds.

Over the last decade, researchers have gained an improved understanding of fall risk factors in persons with MS,” says Jacob J. Sosnoff, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL. “Nearly 50 risk factors...have been found to be associated with falls in persons with MS."

These variables include:

  • Impaired Balance
  • Inability to Dual-Task
  • Reduced Strength/Sensation
  • Reduced Vision

However, there have been strides made in intervention research. Results emerging from these studies suggest that targeted exercises in various settings can reduce fall risk and incidence in people with MS.

A range of research findings on why people with MS fall and how falls can be detected and prevented was shared at the Fifth International Symposium on Gait and Balance in MS, held at the end of 2015 in Portland, Oregon. Among other things findings suggested:

  • Speed when walking and postural transitions be included in fall prevention strategies.
  • Over half of individuals who utilized a wheelchair fell once during a six-month assessment period
  • People using assistive devices should partake in dual-task training and strengthening/balance exercises
  • Training in postural control may improve gait and balance
  • Possible effects of comorbidities should be taken into account during exercise interventions
  • Instilling confidence in walking performance to minimize perceived fall risk may be an important element in rehab

The clinician should play a role in prevention as well, checking in with patients about if and how often they are falling:
“Clinicians should regularly inquire about history of falls with each of their MS clients, says Dr. Finlayson, “and ask about the factors surrounding the fall (e.g. was the person walking and talking at the same time; was the person engaging in an activity that challenged his or her physical abilities; was there an environmental barrier that the person encountered?).” People are often reluctant to report falls because they are embarrassed or are afraid of what will happen as a result, she continues. “Clinicians need to make reporting of falls safe so that appropriate supports can be put in place to reduce their frequency and severity.”