Along with ringing in the New Year, January is sure to bring plenty of snow and ice! The onset of slippery conditions can cause an increase in incidences of falls. Though the majority of falls only result in mild injuries such as muscle soreness or bruising, approximately 10% of falls result in a trip to the emergency department. Some falls may be unavoidable, but being informed of the risks and actively making changes can reduce the risk of falling. With 30-65% of people with brain injuries reporting balance deficits at some point during recover, it is especially important for survivors to be aware of the facts that make them more susceptible to falling. Factors to Consider: Are you over 65 years old? Approximately 1 out of 4 people over the age of 65 experience a fall every year, with falls being the leading cause of injuries in this population. Do you take multiple medications? Individual medications or interactions between multiple medications may cause an increase in risk of falling. Researchers have found that certain classes of medications including sedatives and antidepressants may contribute to increased falls risk. If you notice an increase in falls with the start of a new medication, be sure to contact your physician. Have you fallen more than once in the last year? Previous falls are an indicator of an increased likelihood for subsequent falls. If you have previously fallen it is very important to take preventative measures to avoid reoccurring falls. Do you have vision deficits? Vision is an important component of balance, and having vision deficits significantly increase the risk of falls. Blurred vision, double vision, and other visual impairments are common after a brain injury; therefore, it is important to follow up with your optometrist or ophthalmologist if you suspect any changes in your vision. They may make changes to your eye glasses or refer you to an occupational therapist for vision therapy. Do you have impaired sensation in your legs? It is common to experience decreased sensation or proprioception, the perception of movement and positioning of our body, following a brain injury or due to other chronic conditions such as diabetes and peripheral neuropathy. This can cause individuals to trip on objects or lose their balance. Are you depressed? Studies have shown a correlation in increased falls with depression likely due to cognitive, sensory, and motor changes that may occur with brain injuries. Consider talking to your physician, social worker, or counselor if you believe you are experiencing depression. Do you experience dizziness? Dizziness can be a symptom of many conditions including damage to the vestibular system, changes in vision, medication symptoms, or other medical conditions. If you are experiencing dizziness it is advised to consult with your physician. They may refer you to an Ear Nose and Throat Specialist, ophthalmologist or to a vestibular physical therapist depending on the cause. Are you mostly inactive? A decrease in activity can lead to poor cardiovascular endurance and flexibility, as well as weakened muscles, which can increase your risk for falls. Ask your physician if you are able to participate in a regular exercise program, and consider consulting a physical therapist or another expert for a custom exercise program to meet your needs and goals. Do you experience incontinence?Incontinence is associated with an increase in falls due to impulsive and unsafe behavior occurring when a sudden urge to urinate occurs. Depending on the type of incontinence and the severity, different techniques such as utilizing caregiver assistance, bed pans, pads, or Kegels may be appropriate. A pelvic floor specialist can aid with decreasing episodes of incontinence. If you answered yes to any of these questions, you might be at an increased risk for falling. Many brain injury survivors may have answered yes to many of the above questions; because of this, individuals who have experienced a brain injury have a significant increased risk of falling. Although some risk factors such as age are out of our control, many others may be modified to reduce your risk. If you believe you or a loved one is at an increased risk for falling, there are some simple modifications that can be made to decrease the risk:

• Remove tripping hazards such as rugs or uneven thresholds in your home
• If you use an assistive device, make sure you are using it correctly
• Wear supportive shoes with a rubber sole to prevent shuffling feet and slipping.
• Use night lights in order to increase visibility at night. Alert systems can be used for individuals requiring more assistance.
• Shovel snow and apply salt to reduce the risk of slippery sidewalks

These tips can reduce your likelihood of falling and incurring an injury. If you have notice any recent changes or have questions regarding your balance, please contact your physician. References

• Kallin, Kristina, et al. "Predisposing and precipitating factors for falls among older people in residential care." Public health 116.5 (2002): 263-271.
• Lord, Stephen R., Hylton B. Menz, and Catherine Sherrington. "Home environment risk factors for falls in older people and the efficacy of home modifications." Age and ageing 35.suppl_2 (2006): ii55-ii59.
• Peterson, Michelle, and Brian D. Greenwald. "Balance problems after traumatic brain injury." Archives of physical medicine and rehabilitation 96.2 (2015): 379-380.
• Thurman, David J., Judy A. Stevens, and Jaya K. Rao. "Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology 70.6 (2008): 473-479.
• Woolcott, John C., et al. "Meta-analysis of the impact of 9 medication classes on falls in elderly persons." Archives of internal medicine 169.21 (2009): 1952-1960.

Emily Wolf, PT, DPT Physical Therapist, The Lighthouse Neurological Rehabilitation Center

Emily graduated from Arcadia University with a Doctorate of Physical Therapy. Her academic focus was primarily on treatment of adolescents and adults post-concussion. She has been practicing as a physical therapist at The Lighthouse Neurological Rehabilitation Center in Kingsley, Michigan since 2017.