Falls in independent ambulatory patients with spinal cord injury: incidence, associated factors and levels of ability

Abstract

Study Design: A 6-month retrospective study. Objectives: To investigate incidence and factors associated with falls in independent ambulatory patients with spinal cord injury (SCI), and to compare levels of ability in those with and without a history of falls. Setting: A tertiary rehabilitation center and community hospitals. Methods:Seventy-seven independent ambulatory subjects with SCI were interviewed for fall data during 6 months before participation in the study. Subjects were also assessed for their functional ability using the timed up and go test (TUGT) and the 6-min walk test (6MinWT). Results: Twenty-six subjects (34%) reported falls during 6 months (range 1-6 times). After falls, two subjects required medical attention due to wrist joint fracture and back pain. Walking without a walking device significantly increased the risk of fall, whereas using a walker significantly reduced the risk of fall (Po0.05). Moreover, faller subjects showed significantly better levels of ability than the non-faller subjects (Po0.005 for the TUGT and Po0.05 for the 6MinWT).Conclusion: Approximately one-third of the independent ambulatory subjects with SCI experienced falls. Notably, faller subjects had better functional ability than the non-faller subjects. Thus, apart from emphasizing the ability to walk independently, rehabilitation professionals may need to seek strategies that improve balance and safety.

Ability of obstacle crossing is not associated with falls in independent ambulatory patients with spinal cord injury

“…However, the nonsignificant differences of functional ability between the groups may reflect the influence of not only intrinsic but also extrinsic factors or external causes on fall risk of the participants. 2,3,[5][6][7] Although the falls occurred mostly due to stumbling over an obstacle, failures on obstacle crossing showed no significant correlation to the fall data ( Table 5). The findings may be associated with conditions of the obstacle-crossing tests and the actual environments when the participants fell after discharge.…”

“…A fall was defined as an unplanned or unexpected event that occurred during the performance of an activity while standing or walking, or changing postures, and resulted in a person coming into contact with the ground or other lower supporting surface. [2][3][4][5][6] …”

“…The average time required over the three trials was recorded. 5,6,11,12 Five times sit-to-stand test. The test is sensitive and responsive to assess lower-extremity motor strength (LEMS), sensorimotor integration and balance control.…”

“…After completing the tests, participants received a fall diary sheet 5,6 to make a daily record of the fall data at home. The researcher (WP) telephoned the participants every month for 6 months to ask about the fall data.…”

“…Therefore, these patients encounter a high risk of falls and subsequent injuries (39-75% of the patients fell during 5-12 months), and most falls occur during walking, frequently due to tripping over an obstacle. [1][2][3][4][5][6] Currently, there is only little evidence on obstacle crossing in patients with SCI. Amatachaya et al 7 found that 44% of independent ambulatory participants with SCI (n = 34) failed to walk over small obstacles.…”