Fall circumstances, consequences, assessments, and interventions to manage fall risk among individuals living with spinal cord injury

Recurrent falls

Among nonambulatory individuals with SCI, Jorgensen et al. reported that men experienced recurrent falls (more than one fall) 3.1 times more often than women within a year. This finding could be explained by the difference in how men and women manage risk. As age increases, the odds of falling more than once among nonambulatory individuals with SCI decreased. The increased odds of falling among younger adults may be due to activity level and involvement in activities in the workplace that increase exposure to more potential fall situations than older adults ( ).

Between 30% and 41% of nonambulatory individuals had recurrent falls within a 6- to 12-month period ( ). Recurrent falls were also reported 14% more often among individuals with greater functional mobility independence, likely because more mobile individuals can engage in more intense physical activity and are therefore more likely to fall ( ).

Most ambulatory individuals with SCI report falling more than once ( ). Within a 6- to 12-month period, 28%–68% of ambulatory individuals with SCI experienced multiple falls ( ). Jorgensen et al. reported that individuals who could recover by themselves following a fall experienced 4.7 times more recurrent falls than those who could not get up by themselves. The increased frequency could be related to increased confidence in the ability to recover from a fall among those who are able to recover independently. Increased confidence may result in taking greater risks and exposure to more situations that lead to a fall ( ).

Biological risk factors

Biological contributors of falls among both ambulatory and nonambulatory individuals living with SCI include many factors. The most common contributors include muscle weakness, loss of balance, spasticity, and muscle spasms ( ; ; ; ). Lower levels of functional mobility have also been linked to an increased risk of falling ( ). However, Nelson et al. found that persons with more function are also at greater risk because they have a greater exposure to situations where falls may occur, making them more likely to engage in risk-taking behaviors ( ). Other biological factors that may increase the risk of falls summarized by Khan et al. include: male sex (wheelchair users only), an increased number of comorbidities, trunk weakness, fatigue, walking asymmetry, shorter duration since sustaining SCI, narcolepsy, and reduced sensation ( ). Age can also be a risk factor. Among 94 participants, individuals who reported a high frequency of falls were significantly younger. This may be because these individuals are more active and have greater levels of enthusiasm and energy ( ). In addition, reports of pain in the 2 months prior to the fall can affect the performance of activities of daily living and increase fall risk ( ). Studies have also revealed that individuals living with incomplete spinal cord injury, injuries in which partial sensation and/or motor function persists below the level of injury, experience significantly more falls than individuals with complete injuries ( ).

Behavioral risk factors

In a systematic review and meta-analysis, Khan et al. found that the most commonly reported behavioral attributions associated with falls included inattention or distraction, ambulation, fear of falling, a history of previous falls, and not using the safety features of a wheelchair or walking aid ( ). Risk-taking behaviors are also associated with falls ( ), which is theorized to be the reason why men are three times more likely to fall than women ( ). Nelson et al. also found alcohol abuse increased the risk of falls as well as the use of a shorter wheelchair. A shorter wheelchair allows for greater maneuverability; however, the design makes the chair less stable overall ( ). Finally, individuals with a lower quality of life were found to fall more frequently ( ).

Environmental risk factors

Environmental contributors to falls exist both within and outside the home. Hazards such as railings, stairs, heavy doors, and slippery floors are identified as increasing the risk of falls ( ). Among nonambulatory individuals, Sung et al. reported that the bathroom was the most common location for falls to occur, and 43% of falls were associated with pushing or driving the wheelchair on rough surfaces ( ). Forslund et al. found that 65% of falls occurred indoors, and 47% of falls occurred between the hours of 9 AM and 6 PM ( ).