Evaluating Intrinsic Fall Risk Factors After Incomplete Spinal Cord Injury: Distinguishing Fallers From Nonfallers

Abstract

Objective To determine whether performance on measures of lower extremity muscle strength, sensory function, postural control, gait speed, and balance self-efficacy could distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury or disease (SCI/D). Design Prospective cohort study. Setting Community. Participants Individuals (N=26; 6 female, aged 58.9±18.2y) with motor incomplete SCI/D (American Spinal Injury Association Impairment Scale rating C [n=5] or D [n=21]) participated. Participants were 7.5±9.1 years post injury. Seventeen participants experienced traumatic causes of spinal cord injury. Main Outcome Measures Participants completed laboratory-based and clinical measures of postural control, gait speed, balance self-efficacy, and lower extremity strength, as well as proprioception and cutaneous pressure sensitivity. Participants were then followed for up to 1 year to track falls using a survey. The survey queried the circumstances and consequences of each fall. If a participant’s number of falls equaled or exceeded the median number of falls experience by all participants, they were classified a faller. Results Median follow-up duration was 362 days and median time to first fall was 60.5 days. Fifteen participants were classified as fallers. Most falls occurred during the morning or afternoon (81%), at home (75%), and while walking (47%). The following laboratory-based and clinical measures distinguished fallers from nonfallers ( P <.05): measures of lower extremity strength, cutaneous pressure sensitivity, walking speed, and center of pressure velocity in the mediolateral direction. Conclusions There are laboratory-based and clinical measures that can prospectively distinguish fallers from nonfallers among ambulatory individuals with spinal cord injury. These findings may assist clinicians when evaluating their patients’ fall risk.

Comparing the causes, circumstances and consequences of falls across mobility statuses among individuals with spinal cord injury: A secondary analysis

“…Time to first fall: Since participants may have experienced more than one fall, which is not an independent event, time to first fall (from the date of the baseline interview to the date of the first fall) was used. 36 Time to first fall was reported using median, interquartile range (IQR) and then compared across the three groups using a Kaplan-Meier analysis. Participants who did not experience a fall during the tracking period are represented as censored events.…”

“…Participants who did not experience a fall during the tracking period are represented as censored events. 36 Time to first fall has been used to compare fall data, including risk, among individuals with SCI 36 , 37 and has been used as an outcome measure to determine success of fall reduction interventions. 38 , 39…”

A qualitative photo-elicitation study exploring the impact of falls and fall risk on individuals with subacute spinal cord injury

“…The circumstances surrounding falls among the SCI/D population have been well described in recent years [ 3 ], with circumstances varying with mobility status [ 4 , 5 ]. Compared to wheelchair users with SCI/D, those who walk have a higher incidence proportion of falls [ 1 ] and experience the majority of their falls when walking or completing activities in standing [ 4 , 6 , 7 ]. Similarly, the physical, psychological and social consequences of falling and living with a high fall risk after SCI/D have been described [ 3 , 6 , 8 – 11 ].…”

Risk Factors Associated With Falls and Fall-Related Injuries Among Wheelchair Users With Spinal Cord Injury

“…Compared with ambulatory individuals with SCI among whom performance-based measures have shown ability to differentiate between fallers and nonfallers, 36 , 37 performance-based measures such as balance measures including the Function in Sitting Test, Trunk Control Test, or TAI were not found to be associated with falls and fall-related injuries among nonambulatory individuals with SCI. This might be because of the lack of sensitivity of clinical performance-based measures used for nonambulatory individuals.…”

“…Specifically, the subanalysis of fall-related injuries was performed with a small number of fallers. When comparing the literature on fall predictors among nonambulatory individuals with SCI to the existing literature on ambulatory individuals 36 , 37 or individuals with other neurologic diseases, 41 , 42 it becomes evident that further research with a bigger sample size is required to provide more robust findings. Another limitation is that our analyses were based on self-reported and retrospective fall data.…”