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Multiple Sclerosis Centers of Excellence

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Staying Upright: Avoiding Falls

Michelle Cameron, MD, PT, MCR

MS affects different parts of the brain or spinal cord in different people, causing somewhat different problems for each person. Many people with MS have poor balance and are at risk for falling. Research is helping scientists find out why this happens and how to help people with MS fall less often.

Imbalance is one of the most common symptoms of MS. People with MS often say they feel off balance and researchers have found three main types of balance problems in people with MS. First, when people with MS stand still, they sway more than people without MS. They also increase this swaying more than expected when they close their eyes or reduce their base of support by standing on one leg or with their feet together. Second, when leaning, reaching, or stepping, people with MS cannot go as far or move as quickly as people without MS. Third, people with MS have difficulty maintaining their balance if they are pushed or pulled.

Imbalance can lead to falls. People with MS fall frequently and often fall badly enough to be injured. More than 50% of people with MS fall at least once in six months and around 30% fall twice or more. Some people with MS are so afraid of falling that they stop being active to avoid falls. People with MS also say they fall more if they try to pay attention to too many things at once or if they are fatigued or overheated.

Scientists are trying to develop effective treatments to improve balance and prevent falls in people with MS. These treatments generally are not medications. The treatments include exercises, home and activity modification, education, and sometimes a device such as a brace, cane, or walker. Exercising in a standing position with gradually increasing balance challenges, such as Tai Chi, can be particularly helpful for improving balance. Modifications to prevent falls include minimizing distractions while walking and removing hazards. Avoid standing or walking when doing difficult mental tasks. Go to the store at less busy times and remove rugs and cords you could trip over at home. Education about fall risk will help you make good decisions. And, using a cane or hiking poles, well-fitting shoes, and/or a leg brace may give you the extra support you need to stay safe and avoid falling. We are currently studying if walking aid (cane, poles, crutches, or walker) selection, fitting, and education by a physical therapist helps prevent falls in people with MS who use walking aids.

More research is needed to know what works best, but for now, people with MS should get help from their doctor and a physical therapist to choose the strategies most likely to improve their balance and reduce their risk of falling.