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Conference Explores Why Some People with MS Fall Down and How to Prevent It

January 5, 2016

Summary
  • Nearly 100 clinicians, researchers, engineers and others from around the world gathered in Portland, Oregon in September for the 5th International Symposium on Gait and Balance in MS.
  • This year’s meeting focused specifically on falls in people with MS – how often people with MS fall, why they fall, and how to prevent falls. Presenters included several researchers supported by the National MS Society.
  • The presentations summaries (abstracts) from the meeting are posted online in the International Journal of MS Care (2015;17(6):301–302).
 
Background: A common effect of MS is difficulty walking due to a variety of factors including balance problems.  Because of mobility challenges and other symptoms, people with MS may be at significant risk for falls and the potentially life-changing consequences of fall-related injuries.  This is particularly significant since people with MS are at greater risk than the general population for osteoporosis. Studies have shown that approximately half of middle-aged and older individuals with MS experience at least one fall over a six-month period.
 
The Meeting:
Nearly 100 clinicians, researchers, engineers and others from around the world gathered in Portland, Oregon in September for the 5th International Symposium on Gait and Balance in MS. This annual conference is convened by the Oregon Health & Science University MS Center and the MS Center of Excellence West at the VA Portland Health Care System.
 
This year’s meeting focused specifically on falls in people with MS – how often people with MS fall, why they fall, how to detect falls, and how to prevent them. Here are a few highlights:
  • M. Wang and colleagues (Oregon Health & Science University) explored why, while assistive devices such as canes are intended to improve walking and prevent falls, studies show that use is associated with increased falls in people with MS. Reviewing the literature, the team found that using assistive devices increases the attentional demands of walking, so “multi-task” training may reduce falls. Also, some devices may increase energy demands more than others, increasing fatigue that may then increase the risk of falls. Using devices that require less energy expenditure could minimize fall risk.
  • Brett Fling, PhD, Fay Horak, and colleagues (Oregon Health & Science University) found that although some people with MS had significant deficits in postural control compared with people without MS, they were equally able to improve, and this ability correlated with activity in certain areas of the brain. This study demonstrates that postural training may strengthen gait and balance and reduce falls in people with MS. Read more about Dr. Fling’s research, funded by the Society.
  • Jordan Craig, Jessie Huisinga, PhD (University of Kansas Medical Center) and colleagues, are using wireless sensors that are useful for assessing gait and balance. Using these sensors, her team showed that patterns of foot and trunk acceleration during walking occurred differently in people with MS than in people without the disease. Exploring these differences further may yield important information on why people fall. Watch a video on Dr. Huisinga’s Society-funded research.
  • Alicia Flach, PT, DPT, NCS, and colleagues (St. Louis University) evaluated nearly 100 people with MS using the Timed Up and Go Test (measuring the time that a person takes to rise from a chair, walk 10 feet, turn around, walk back to the chair, and sit down). The results showed that people who walked and turned more slowly were at higher risk for falls, indicating that prevention strategies should seek to increase speed in those areas.
  • Laura Rice, PhD, Jacob Sosnoff, PhD (University of Illinois at Urbana-Champaign) and colleagues looked at falls in people with MS in wheelchairs (most studies focus on people who are ambulatory) and found that more than half had fallen in the past six months. The results call for special attention to preventing falls  in this segment of people affected by MS. Read more about Dr. Sosnoff’s research, which is funded by the Society through special funds from the Illinois Lottery.
  • Jaime Zelaya, PhD, and colleagues (Oregon Health & Science University) reported that people with MS below age 50 who reported urinary incontinence with urgency were significantly more likely to experience recurrent falls in the following 3 months; further research may determine whether treating bladder problems can reduce falls.  
  • Denise Nowack, RDN (formerly of the National MS Society) presented information about the comprehensive falls prevention program, “Free from Falls.” This program significantly improved confidence, decreased falls, concern of falling, and activity curtailment, in a pilot study of 19 sites nationwide. Nearly 70% of more than 100 participants are now engaged in a regular exercise program and nearly 40% are using mobility devices more effectively.
 
The presentation summaries (abstracts)  from the meeting are posted online in the International Journal of MS Care (2015;17(6):301–302).
 
Next Steps: This meeting highlighted an urgent area of MS rehabilitation research – finding solutions to prevent potentially disabling falls. Drs. Sosnoff and Marcia Finlayson - a Society grantee who has been a leader in the field of falls prevention research – have joined with others to create the International MS Falls Prevention Research Network, which includes MS rehabilitation researchers from the U.S., Ireland, Italy, and the United Kingdom. The goal of this group is to work together to maximize falls prevention research efforts, and they have already begun to publish recommendations on how to advance research and treatment programs.
 
Read more about walking difficulties and how to minimize them, including details about the Society’s comprehensive falls prevention program, “Free from Falls.”

About Multiple Sclerosis

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Symptoms range from numbness and tingling to blindness and paralysis. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted, but advances in research and treatment are leading to better understanding and moving us closer to a world free of MS. Most people with MS are diagnosed between the ages of 20 and 50, with at least two to three times more women than men being diagnosed with the disease. MS affects more than 2.3 million people worldwide.

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