Changes of functional ability in patients with spinal cord injury with and without falls during 6 months after discharge

• Published in: Physical therapy 2014-05, Vol.94 (5), p.675-681
• Main Authors: Wannapakhe, Jirabhorn, Arayawichanon, Preeda, Saengsuwan, Jiamjit, Amatachaya, Sugalya
• Format: Article
• Language: English
• Subjects: Accidental Falls; Adult; Care and treatment; Exercise Test; Female; Humans; Male; Middle Aged; Older people; Physiological research; Postural Balance - physiology; Prospective Studies; Recovery of function; Rehabilitation; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Studies; Time Factors; Walking; Walking - physiology
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20130260

Ambulatory patients with spinal cord injury (SCI) encounter a high risk of falls. However, most of the fall data in the literature were subjectively reported, without evidence to confirm the functional ability of those with and without falls. The purpose of this study was to prospectively evaluate changes in functional ability relating to falls in participants with SCI who fell and those who did not fall during the 6-month period after discharge. A 6-month prospective design was used in the study. Fifty independent ambulatory participants with SCI were assessed for their functional ability using the Timed "Up & Go" Test, 10-Meter Walk Test, Berg Balance Scale, and Six-Minute Walk Test (6MWT) prior to discharge and 6 months afterward. After discharge, the participants' fall data were monitored monthly to categorize them into faller (≥1 fall in 6 months) and nonfaller (no fall) groups. Twenty-seven participants (54%) fell, and their baseline functional abilities were obviously lower than those who did not fall. After 6 months, the functional ability of these participants showed significant improvement for every test, whereas those who did not fall demonstrated a significant improvement only for the 6MWT. After adjusting for the baseline data, the functional ability at 6 months showed no significant differences between the groups. The study did not monitor physical activities of the participants during the follow-up period. The findings on fear of falling were subjectively reported by the participants. Participants with SCI are commonly characterized as being active and enthusiastic, which may drive their physical activities. However, sensorimotor impairments following SCI hinder their ability to move safely, particularly in those with more functional deterioration. Therefore, greater functional improvement is accompanied by a higher risk of falls. Because falls can induce serious consequences, rehabilitation professionals may need to seek strategies to improve safety issues during movement for these patients, particularly in their own environments.