Life with MS

Have you fallen in the last year? If you have MS, you probably have. As a physician who cares for people with MS, most of my patients tell me they have trouble with their balance, and often fall and injure themselves. It is estimated that more than 75 percent of people with MS have difficulty with their balance. About one half have fallen once in the past six months, and about one third have fallen many times each month. Also, more than half of people with MS have been injured by a fall. Understanding why people with MS fall and what you can do to minimize your risk of falling is important to your safety.
 
Why people with MS fall
 
As with so many aspects of MS, we don’t know for sure why people with MS fall, but we do have some good leads, and the reason probably isn’t the same for everyone. MS can cause many complications that interfere with balance and that increase risk for falls. One way to look at fall risk factors is to divide them into two types – intrinsic fall risk factors, which are things about you that make you more likely to fall, and extrinsic fall risk factors, which are things about the world outside you that make you more likely to fall. 
 
Common intrinsic fall risk factors for people with MS are reduced sensation or weakness in the legs and poor vision (including reduced visual acuity, depth perception, contrast perception, poor color vision, and double vision). People with MS also often have problems with walking or movement control. Many develop an abnormal gait and use a cane, crutch, or other device to help them walk.
 
Although all of these may be associated with imbalance and falls, research suggests that the most common cause of imbalance in people with MS is not being able to feel where their feet are. If you don’t know where your feet are, it’s difficult to adjust quickly enough when your balance is challenged. This can happen if you slip or trip, land your foot unevenly, or someone accidentally bumps into you. If you don’t adjust your position quickly when your balance is challenged, your body weight will shift too far over and you are likely to fall. 
 
Extrinsic risk factors for falls in people with MS include unsafe shoes, such as those with high heels, slip-ons, or shoes with little grip or poor support. Slippery or uneven floors and poor lighting at home or in the community can add to the instability. Taking too many medications, or any medication that affects thinking and alertness, is also associated with an increased risk of falling. 
 
Preventing falls
 
Fortunately, there are many things you can do that may help reduce your risk of falling. First, remember to tell your health care provider that you are falling or having problems with your balance so he or she can offer suggestions and help ascertain why you fall.  
 
Do you have poor feeling in your legs? Are your legs weak? Do you know you feel off balance but you’re not sure why? Exercises may improve your balance and prevent falls. An exercise program designed to address your specific problems is likely to be the best. A physical therapist can get you started on a program that challenges your balance in a safe environment and that optimizes your ability to use the sensation, balance, and strength you do have to prevent falls. Physical therapy may also help improve your gait or help you choose to use a cane or other assistive device.
 
Community-based exercise programs are another great way to improve your balance. T’ai Chi, a type of exercise done while standing that involves slow flowing continuous movement between body positions, can reduce falls and has been shown to improve balance in people with MS.
 
And finally, a vision check will help eliminate any ocular irregularities that might be contributing to falls. 
 
As for reducing the extrinsic fall risk factors, if you are taking four or more medications, ask your health care provider if you really need to be taking all of them. (But, don’t stop taking any without asking your provider first.)  Look at your shoes. Do they provide adequate support? Are they stable enough? Will the ones you chose for today work for all the things you might do today? Could you bring a more “sensible” pair with you? And lastly, look around your home.  Are there cords or rugs that could trip you? Uneven paving? Would better lighting inside or outside, in the day or night, help?
 
Do your best to prevent falls. That ounce of prevention is worth pounds of cure.
 
Dr. Cameron is a neurologist and physical therapist. She is currently a Multiple Sclerosis fellow in the Department of Neurology at Oregon Health and Science University and at the Portland VA Medical Center. As an MS fellow, Dr. Cameron provides clinical care to people with MS and related disorders, is involved with a number of clinical trials of treatments for people with MS, and is developing her own research on balance and falls in people with MS.
 
(Last reviewed 2/2010)