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

Falls are a common concern among individuals living with Spinal Cord Injury (SCI) that can result in significant consequences. In a 6- to 12-month period, 34%-82% of ambulatory individuals and 31%-73% of nonambulatory individuals living with SCI experience at least one fall. Between 28% and 68% of ambulatory and 30% and 41% of nonambulatory individuals will experience recurrent falls. The circumstances associated with falls vary widely and can be categorized as biological, behavioral, social/economic, and environmental in nature. Due to differences in mobility, the circumstances associated with falls among ambulatory and nonambulatory individuals are diverse; however, some of the most common circumstances include falls due to the influence of muscle weakness or spasticity and inattention or distraction. In addition, falls occurred both inside and outside of the home and were more common among individuals who were working or studying. Falls can result in significant consequences, including physical injuries, such as bruising, fractures, or head injuries. In addition, individuals living with SCI commonly develop a fear of falling that can limit engagement in desired activities in the home and community. To effectively manage fall risk, appropriate evaluation methods are needed. Several methods including objective clinical measures, subjective self-reports, and photo-elicitation techniques have been used to assess fall risk in this population. Additional research however is needed to effectively assess fall risk among both ambulatory and nonambulatory individuals living with SCI. Finally, few intervention studies have been conducted to effectively manage fall risk. Although additional research is needed to understand how to effectively manage fall risk, several intervention studies have been performed to manage some of the most common circumstances associated with falls, including poor transfer skills, impaired seated balance, and impaired ambulation.