The Ups and Downs of Fall Prevention March 13th, 2018 Presented by: Sanofi Genzyme Genentech Mallinckrodt Pharmaceuticals
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Neurologist and Physical Therapist Portland, OR
Occupational Therapist Lafayette, CO
What is a fall? How common are falls in people with MS? What makes people with MS fall? Preventing falls Home modifications Devices Exercise Q & A
Fall: any unexpected event that results in you ending up on the ground, floor, or any lower surface Near-Fall: losing your balance but managing to stay upright, for example by holding on to something
How many times did you fall today?
106 articles screened (through Jan, 2012) 8 articles (6 quantitative, 2 qualitative) met criteria (MS, prospective or retrospective falls assessment, potential fall risk factors evaluated) 1,929 participants, 1,037 (53.75%) were fallers Gunn et al, Phys Ther 2013;93(4):504-513.
115 articles screened (through Jan, 2013) 15 articles met criteria (MS, 3 prospective and 12 retrospective falls assessment, potential fall risk factors evaluated) 2,452 participants, 1,260 (52%) were fallers Gianni et al, Clin Rehabil 2014;28(7):704-716.
Individual data from studies in 4 countries that prospectively measured falls for 3 months Fall rates, prevalence of fallers and frequent fallers, fall risk factors 537 participants, 1721 falls, 56% were fallers, 37% were frequent fallers (2 or more falls) Nilsagard et al. Mult Scler J 2014;June 16.
LOTS!! Most Do you? Have you been injured by a fall? What can be done?
Poor balance Distractions Tripping over things Getting too hot Using a cane
Intrinsic Factors Physical Factors Medications Extrinsic Factors Social/life-style Environment Intrinsic factors Extrinsic factors
Type of fall risk factor Demographic Physiologic Behavioral Cognitive Specific fall risk factors Progressive MS Longer MS duration?male gender Age Impaired balance Greater disability (EDSS) Slower walking Use of a mobility aid Impaired cognition executive function, verbal memory
Progressive MS Is this because of greater disability? Is this because it s difficult to adapt to constant change? Use of a mobility aid Is this just a marker for fall risk or disability? Does this reflect imbalance, challenge of dual tasking, challenge of device selection Would a mobility aid program help?
Injuries Fear of falling Reduced activity Reduced social participation Reduced quality of Life
1. Exercise With a trainer/pt Home based exercise and education Group exercise and education 2. Orthotics/braces Correct foot drop 3. Adaptive equipment Assistive device training 4. Modify your environment 5. Planning and Awareness 6. Accommodate for cognitive challenges 7. Communication
Significant increase in Activitiesspecific Balance Confidence scale Significant improvement in Berg Balance Scale
Significant improvement in confidence regarding falls compared to pre-program (p <.05) Significant decrease in concern of falling compared to pre-program (p <.05) Significant decrease in activity curtailment (p <.05) 35% decrease in reporting of activity curtailment due to fear of falling Significant decrease in falls in the past 6 months compared to pre (p <.05; chi square)
Cattaneo et al., 2007 1 month fall duration
Nilsagard et al., 2014
64 participants, unilateral foot drop, progressive MS Oddstock dropped foot simulator vs. PT Falls during 18 week investigation Esnouf et al., 2010
Six weekly 40-minute 1-on-1 sessions Device selection Device fitting Device use training Fewer fallers More walking Less sitting
Bathroom equipment raised commodes grab bars shower chairs tub transfer benches hand held sprayers grippy tape on tub/shower floors foot scrubbers
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) Utilize rolling surfaces in the kitchen to move items between surfaces Use a chair in the garden to reach low heights without bending forward as much
Consider floor types and thresholds (remove floppy throw rugs!) Grab bars and railings can go in more places than bathrooms and stairwells! Consider the position and heights of your furniture 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 halfway) Install ramps if needed Bed rails come in handy
Contrast grip tape on steps Wear polarized sunglasses if it is too bright Light up walkways, stairways and dark areas Night lights Motion sensors Light up toilet Decrease clutter and obstacles on the floor
Consider the time of day and when you function best Medication timing Consider crowds Lighting during different times of day Morning and afternoon temperatures Planning and visualizing the steps prior to executing challenging tasks (e.g. transferring to the shower or getting up the stairs) Journaling or recording falls and successful events! What did you do differently this time? What would you change next time? Schedule toilet breaks to avoid urgency and rushing
Help Attention & concentration Perform one thing at a time-don t multitask! Eliminate environmental distractions Help Memory, Organization, & Problem Solving Help Visual/Spatial Organization Decrease clutter! Plan ahead; ask assistance; delegate Self honesty-too much to think about? Simplify Set self up for success! If prone to get lost, ask another to be with you Minimize distractions
Communicate with the people around you (family, friends, coworkers etc.) Explain what would help prevent you from falling (Maybe your kids will start picking up their shoes?) Ask for help if you need it! If someone is helping you with a transfer count it out together!
People with MS fall often These falls have significant adverse consequences Injuries Reduced confidence Reduced activities Many factors contribute to fall risk Poor balance Distractions Visual and cognitive challenges Can you reduce fall frequency and severity? Careful evaluation of your fall risk factors Exercise to improve balance Devices to compensate Modifying your environment Plan and be aware Communicate
FREE FROM FALLS A comprehensive fall prevention program https://www.nationalmssociety.org/resource s-support/library-education-programs/free- From-Falls nationalmssociety.org
MS Awareness Month: Join Us in Celebrating Support Partners We re working with Biogen and others to celebrate the support heroes who help the community rise above MS Join the #MySupportHero conversation! Post photos, video or words of appreciation on social media using the hashtag Share posts containing the official #MySupportHero flower Change your social media profile picture Visit AboveMS.com for more information Note: Biogen is not involved with content unrelated to #MySupportHero on Can Do MS s website and social media pages.
MS Path 2 Care An initiative to empower people affected by MS to be active partners in their healthcare experience. Visit www.mspath2care.com to learn more about the importance of shared decision making in MS care, and to hear important tips directly from people living with MS, their support partners, and MS specialists. MS Path 2 Care is brought to you in partnership with: SAUS.MS.18.01.0305
Cognitive Challenges and MS: What You Need to Know April 10, 2018 Presented by: Sanofi Genzyme Genentech Mallinckrodt Pharmaceuticals
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