Stayingvertical Library

Are falls an integral part of your MS experience? They don’t need to be. Are you afraid of falling, and therefore, avoid activities? Do people tell you you’re overestimating your abilities and being unsafe?

According to a recent article in the International Journal of MS Care (Vol 16, Number 4, Winter 2014, p163), “over 70% of older people with MS report moderate to extreme balance problems” and “in a given year, nearly 60% of individuals with MS will experience a fall” (p.161).

While it is unrealistic to avoid all falls, their frequencies can often be greatly reduced. A variety of MS symptoms contribute to falls, and having an understanding of how to better manage specific symptoms will help reduce falls. Examples of symptoms that contribute to falls are fatigue, muscle weakness, spasticity, vision, vertigo, sensory loss, cognition, medication side effects, heat intolerance, bladder urgency, fear of falling and overconfidence. That is a long list! These symptoms obviously can affect many other areas in one’s daily life, and the awareness that they also contribute to falls may not be a primary thought on a person’s mind. To better illustrate, let’s take a look at some of these symptoms and ways to manage fall prevention.

Fatigue is the most common symptom, often the most impairing, and one of the most difficult symptoms of multiple sclerosis to treat. Kalb, Holland, and Giesser (2007) report somewhere between 75 and 90 percent of people with MS complain about fatigue, with a good 50 percent identifying it as the symptom having the greatest impact on their daily lives. Of the many affects on the mind-body fatigue creates, weakness, decreased concentration, and decreased balance increase a person’s risk for falls. Managing fatigue helps lessen symptoms, and thus, lessen possibility of falls. Regular exercise and physical activity help improve endurance, strength, flexibility and balance. Better time management, knowing when fatigue levels are the greatest during the day, will help increase awareness to avoid certain activities during that time and perform when more rested. Be attentive to know when to stop an activity before fatigue hits, and let go of the mentality of “pushing through” to complete a task. The home environment, the organization and amount of clutter, also can have a large energy use impact, and re-locating most frequently used items in kitchen, bathroom, etc., will ease the amount of energy needed to perform a task. One last recommendation: sit to perform more tasks! Save energy; prevent falls.

Muscle Weakness and spasticity can alter how you walk and your balance. They can also make movement more laborious, causing fatigue. Regular exercise can help improve muscle strength and decrease spasticity. However, there is usually a certain amount of both that just is not going away, as it is a direct result of the nerve damage from MS. Bracing and assistive devices can help accommodate muscle weakness and control spasticity. When choosing bracing and/or an assistive device, choose what makes you walk more “normally”. You will then be walking with less effort and with less risk for falling! Using braces and/or an assistive device won’t make you lazy. They will actually allow you to stay more active!

Vision. A person reading this article who has experienced visual changes knows all too well the frustration and interference vision has with balance and falls. Optic neuritis, or inflammation of the optic nerve, is the most common visual disorder with MS. People may experience vision loss, blind spots, decreased color recognition and contrast sensitivity. Walking and navigating spaces with low light or unfamiliarity can be extremely challenging. Nystagmus is tiny repetitive movements of the eye. For some people, it can be so slight that they are not aware of it, but for others, it is significant enough to impair vision, creating nausea and loss of balance. Walking on high pattern carpet, or walking in general, can be a challenge. Double vision, or diplopia, is another visual change, creating blurry vision and seeing one image as two. Ways to better manage these symptoms include good lighting, getting rid of the clutter to have clear walking paths, increasing contrast, such as on stairways to see each step better, eliminate glare, and to use an eye patch (with diplopia) while walking to eliminate seeing double.

Sensory Deficits can be in the form of numbness in your limbs, e.g. in your feet or losing the ability to know where your limb is in space. This can greatly alter your ability to navigate the world. With practice, you can learn to use whatever sensation you do have. You can also learn to use information from your vision and vestibular system to compensate for sensory loss.

Vestibular Deficits refer to difficulty sensing your orientation in space and coordinating your eye and head movement. Using visual and sensory input can help compensate for vestibular deficits. So much so, that when tested objectively, an individual may have dramatically more vestibular impairment than they realize. This deficit is most noticeable when we can’t use our visual or sensory inputs as much, e.g. walking on a thick carpet in the dark. This deficit is also noticeable when it appears that our world is moving, e.g. walking through a moving crowd (similar to the confusion when you are sitting in a parked car and the car next to you suddenly moves, and for that brief moment, you assume that you are the one in motion).

Medications have side effects and the way that each person responds to medications is unique. Don’t underestimate the influence that medications can have on balance, fatigue and concentration. It is important to know all your medications, including supplements. Always keep a list in a purse or wallet and talk to your doctor and/or pharmacist about how they could affect mobility and safety.

It is important to remember that in addition to considering how symptoms are affecting your balance, there are some simple, easy steps to take to manage your home environment to preventing falls. Use of adaptive equipment in the bathroom, clearing clutter, removing throw rugs, railings next to stairs and good lighting are some examples of living smarter. A physical and/or occupational therapist specialize in helping people adapt their homes to make daily living easier, more safe, and independent. Talk to your doctor to explore rehabilitation services.

Getting around in the community poses different challenges. Terrain can be unpredictable and uneven. Crowds and traffic can create a confusion (your visual field is moving). Crowds and traffic can also necessitate quick movements/reflexes that may not be so quick anymore. This may be a time to use a more supportive assistive device (e.g. using a walker even though you get around the house fine without one) to keep you balanced and walking easier and more dependable. You will probably get less fatigued as well. Be creatures of habit whenever possible – take the same path, same intersections to the same store at the same time of day (i.e. when it is least busy). Allow extra time. Arrive early to scheduled events.

Even with making changes and better symptom management, falls still do happen. Knowing what to do if you fall is important in keeping you safe. Do you know how to get up? What method will work best for you? Have your practiced fall recovery? Do you know how to direct others in assisting you or what ‘props’ you might need? If you fall, don’t rush to get up. Give yourself time to allow the ‘adrenaline rush’ to subside so you can think clearly. Assess yourself for injuries. Stay focused when getting up, and rest before continuing your journey. Learn from your mistakes – why did you fall? Could you prevent a similar fall in the future?

Last but not least, have an emergency plan in place, and educate your family and/or friends about your plan and how they can help. At all times, carry a cell phone, especially if you are alone. Even carry it into the bathroom with you. If a fall were to occur, the amount of time saved when getting immediate attention can lessen the potential impact and time needed for recovery. Have important phone numbers programmed into your phone and written in a visible location, such as the kitchen or desk/work area. If someone needs to assist you, contacts are easily retrieved. Also, have an emergency plan in place and written down. Who would you call first? Second? Do you have neighbors that you can count on? These are just a few questions to think about when formulating a plan. Having someone help you to create a plan can make sure all bases in the plan are covered. Medical alert services are widely available in most areas. These services are connected to a mobile phone (app) or are a small device that is worn to alert if a fall has occurred, and an emergency response system then is activated. It is easy to put off making a plan, but if a fall does occur, one will be greatly reassured, more calm and confident to react.

Take charge of your fall risk. Understand what your risk factors are and how to manage them. Remember the goal is to STAY VERTICAL!

References
Kalb, R., Holland, N., Giesser, B. (2007). Multiple Sclerosis for Dummies. Hoboken, NJ: Wiley Publishing, Inc.
Free from Falls Program by the National MS Society
Minimizing Your Risk of Falls – A Guide for People with MS published by the National MS Society

Click here to get even more great tips on this topic by viewing our archived webinar on Staying Vertical: Reduce Risks for Falls.