Falls happen. Fall incidence can increase with disability. Falls in multiple sclerosis (MS) are common and often occur due to motor weakness, imbalance, gait impairment, and not using the adaptive equipment (cane, walker, orthotic) designed to help one ambulate more effectively and safely.
Falls can result in injury. This injury might only be an embarrassment to one’s pride; however, at other times, falls can contribute to more serious problems such as a fractured hip, a head injury, and in the worst case scenario, death. It is therefore important that we take a proactive approach to fall prevention.
The International Multiple Sclerosis Falls Prevention Research Network has examined the roles of various fall prevention rehabilitation programs to learn which might be the most effective in reducing fall risk and falls (click here to read the research). A critical element, in all programs, is that participant improvement in fall risk and fall reduction is primarily achieved in the short term but not sustained over the long term. The reality is that most people's motivation, to continue a program, dramatically "falls off" over time.
Here's a summary of the different types of program settings:
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Traditionally rehabilitation fall programs have been delivered in hospitals or health care settings.
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Benefits: These settings are perceived as safe; have knowledgeable staff; and available support.
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Considerations: Health care settings may have more of a focus on illness rather than wellness; there are also accessibility and logistic issues.
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Home based programs are practical and cost effective. However, there is little comparative analysis in how home based programs compare to rehabilitation programs.
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Benefits: Convenient; exercise techniques can be integrated into home environment and person's daily activities; home environment allows for home modification advice; enhances perceived perception of control and mastery of home environment; exercise program may facilitate greater involvement of family members; cost effective.
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Considerations: Potential risk for injury with unsupervised exercise program; greater risk of caregiver burden.
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There are also education and exercise based programs that can be done away from home.
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Benefits: Interaction with other participants as a motivator for attendance; ongoing engagement to exercise; programs allow participants to challenge themselves; regular access to an exercise facilitator for feedback and support; access to exercise equipment.
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Considerations: Programs may be too far away from home; limited transportation; attendance requirements; time demands; energy expenditure getting to and from the programs
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There are also community setting programs, which are located in venues that are not health focused.
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Benefits: community gyms may be perceived as more socially acceptable and "normal;" convenient access.
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Considerations: Community gyms may be seen as less friendly; people with MS may want to exercise away from the general population.
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Each fall prevention program setting has its strengths and weaknesses. A review of the literature supports that there is little difference in initial program effectiveness (reduction in falls) between the settings; however, maintaining ongoing engagement is a key factor in achieving sustained behavior change.
Maintaining behavior change over the long term is the challenge confronting all fall prevention programs. However, programs that facilitate ongoing use of fall prevention strategies may offer the best long term benefits. Programs with a strong home based focus are much more convenient. However, unless these programs are created to include group interaction (tele-health or online facilities), they provide little opportunity for participants to learn from each other, motivate each other, obtain guidance from an instructor, or use exercise equipment. The most successful fall prevention programs of the future may combine the best features of each program in a mixed setting model.
The aim of any fall prevention program is to most therapeutically target that population's needs and desires for the present and future. With regard to MS, further research is needed that involves people, with MS, becoming involved in the decision making process for fall prevention programs.
