The Ups and Downs of Fall Prevention
Do you have MS? Do you fall? Do you wonder if you fall more than other people without MS? Do you want to know what to do to prevent falling? This article summarizes what we know about how many people with MS fall, the many possible causes of falls in people with MS, and provides tips and suggestions for things you can do to reduce the risk of falling.
How common are falls in people with MS?
Most people with MS fall, and many fall frequently. Research shows that:
- Around 50-60% or more of people with MS fall at least once every 3 months
- Around 30-35% of people with MS fall multiple times every 3 months
- Some people with MS fall multiple times/day
Although most falls in people with MS don’t cause severe injuries, some do. Falling also often reduces a person’s confidence and this leads to them avoiding activities that feel too risky, sometimes leading to isolation and limited engagement in meaningful activities. Everyone would certainly prefer not to fall.
Risk factors for falls in people with MS
Although we don’t know what causes each fall in each person with MS, there are some common factors that seem to put people at greater risk. People who have had MS for longer and those with progressive MS are more likely to fall. Those with more disability overall, and particularly those with worse balance, slower walking, and more cognitive problems, are more likely to fall. And, the most consistently found risk factor for falls is that people who use a walking aide, such as a cane or a walker, particularly if they are a new user of a walking aide, are also more likely to fall.
What you can do to prevent falls
Fortunately, there are many things you can do to help reduce your risk for falling. These include:
- Using the correct walking aid the right way
- Evidence suggests that working with a physical therapist to select the right walking aid, fit the walking aid correctly, and then practice using it, can help prevent falls.
- Adapting your activities
- Exercising to improve your balance
- Using adaptive equipment
- Bathroom equipment (e.g. raised commodes, grab bars, shower chairs, tub transfer benches, hand held sprayers, grippy tape on tub/shower floors)
- Reachers are great for gathering items in hard to reach places (better than a step stool or crawling on the floor!)
- Walker trays or walker bags (avoid holding items while using your walking aid with the same hand)
- Making environmental modifications and adaptations
- Consider floor types and thresholds (remove floppy throw rugs!)
- Grab bars and railings can go in more places than bathrooms and stairwells!
- Decrease clutter and obstacles on the floor
- Improve lighting and contrast
- Consider the setup of your furniture (space available for movement between furniture or height of your bed)
- Place items in easy to reach places to prevent risky reaching or climbing
- Have areas to rest if needed (e.g.. A chair on your stairwell landing to rest half way)
- Use a chair in the garden to reach low heights without bending forward as much
- Install ramps if needed
- Use high contrast textured tape on stairs or steps if you have visual difficulties
- Light up walkways, stairways and dark areas (night lights and motion sensors are great to have)
- Planning and improving awareness
- Consider the time of day and when you function best (maybe you do best right after taking spasticity medications. Maybe your pain medication causes more confusion or decreased balance. Plan to go out when places are less crowded or have better lighting. Maybe you will garden when the temperature more tolerable for you in the early mornings or later in the afternoon to avoid extreme heat.
- Planning and visualizing the steps prior to executing challenging tasks (e.g. transferring to the shower or getting up the stairs with plan).
- Journaling or recording falls and successful events! What did you do differently this time? What would you change next time? Since memory can be a challenge it's good to write these things down. (e.g. Were you rushing to the bathroom? Maybe a toileting schedule would help prevent urgency and the need to rush.)
- Communicate with the people around you (family, friends, coworkers etc.)
- Explain what would help prevent you from falling. (Maybe your kids will start putting their shoes away to help prevent falls)
- Ask for help if you need it!
Exercises to improve your balance
Various exercises can help improve your balance. In general, these exercises are performed in standing and challenge your balance in various ways. They can involve narrowing your base of support by bringing your feet closer together or standing on one foot, shifting your center of gravity by reaching or leaning, or reducing the amount of input you get by closing your eyes or standing on an uneven surface. Most people will do best if they get some help to set up an exercise program that is both safe and has enough challenge that you improve. This is usually best provided by a physical therapist, although sometimes the right trainer or other exercise specialist will do a good job too.
Unfortunately, for most people, falling is part of living with MS but there are things you can do to prevent falls. You can improve your safety, health, independence and your overall quality of life by taking these suggestions and implementing them in your daily life. Don't let gravity defy you, defy gravity!