"Falls
Prevention"
Written by
Tessa Jupp RN from the talk by Jega PT for the Post Polio Network of WA
CENTRE of BALANCE
Jega highlighted that we are more likely to fall if we lose our centre
of gravity. This is even more important for
polios as this is often changed by the imbalances of muscles due to polio and
its affect on the skeletal frame as well as the affect it has on the muscle
power we need to recover our balance if we trip or become momentarily
unbalanced.
Uneven muscle pull in polios can cause any or all of - kyphosis
(hunchback), scoliosis (sideways twist at any level) or lordosis
(exaggerated forward displacement of the lower spine).
Sway back can occur with poor muscle tone and strength due to
polio where balance is maintained by using tendons and ligaments instead to
keep the body upright. They were not
designed for this additional stress and can collapse, tear or become unreliable
with age. Balance is precarious.
Flat back can also occur with spinal fusion or arthritis stiffening the spinal
joints thus losing the flexibility to maintain balance compounded by a
permanent forward tilt.
Slouched posture, seated or standing from weak trunk muscles can
result in permanent kyphosis with reduced respiratory capacity and
abdominal space and the need for additional postural support which may include
surgical corsets or a rigid body brace.
This too results in less flexibility to respond to disturbances in
centre of gravity.
Pain
stops muscles from working as it is the normal brake to stop dangerous
situations in the body. Sudden pain at an
inopportune moment can also leave us precarious to falls.
Other postural abnormalities are also possible depending on the residual
effects of polio, making it crucial that polios take even greater care to
prevent falls.
FEET
Our base of support is the area between our 2 feet whether standing or
seated. This can also be a concern when
attempting to stand from a seated position with weak muscles.
1. If we have feet that are 2 different sizes
due to polio, that can affect the security of our base of support.
2. Wearing shoes that are the same size
and stuffing the toes of the smaller foot is dangerous because the brain is
dependent on feedback from the whole foot and no feedback is given by stuffed
toes! Get the right size for each foot. Subsidy through Orthotic Dept or try the
Polio Shoe Bank.
3. Paralysis or weakness of feet muscles
will affect the way we walk, the way the heel or foot hits the ground, we push
off for each step, footdrop and whether we are lifting high enough to clear the
ground without tripping over our feet.
4. Swollen feet, common in polios because
of less muscle power to push fluid back to the heart, delays the signals sent
to the brain about how we are walking.
Swelling has an adverse effect on nerves, stretching them and depleting
the nerve message ability to send feedback to the brain.
5. Cold intolerance and other conditions
common in polios like poor circulation, diabetes, smoking, peripheral
neuropathy, will all alter skin sensation thus changing feedback to the brain
and also slow muscle reaction time.
6. Wearing calipers, masks sensation
response and also impedes the normal pump action of muscle to enhance
circulation, resulting in increased swelling, rigidity and slowed reaction time
to correct momentary imbalances.
7. Fatigue, loss of muscle power and
endurance can impede the ability of polios to move and thus unbalance us. Polios report that when tired “My
foot sticks to the floor.” or
“I kept walking but my foot didn’t come
with me!”
or
“My knee/ankle joint gave way with no
warning!”
EYESIGHT and HEARING
We orientate ourselves in space by our vision. Being able to see a horizon helps to
keep us upright. When other senses
don’t work as well we become more dependent on those that still
work. Sound location of noises
around us, helps us to know where we are in relation to other things. If we are more deaf in one ear we
become disorientated and sudden movements to hear better may unbalance us.
Worsening eyesight, poor light or trying to get out of bed at night
in the dark or without glasses is a recipe for disaster.
MOBILITY AIDS
If you have to lean on a walking stick or crutch for
support you need to move on to more support.
These simple aids just slow your walking down to give you more time to react. They will not save you from falling. Get properly fitted and checked regularly by
a professional in this area. Make sure
your shoes are properly fitted too.
Get good advice. Off-shelf
orthosis are no good for polios. Make to
measure.
Beware of the effects of medications, emotional and family
stresses, fatigue. As we age we can not
split attention as when we were younger.
Concentrate on how you move.
TIPS from BRENDA
LAKE PT
Our Brenda had some extra TIPS from her own experience
with falls to add.
1. It only takes ONE fall to fracture
something!
2. Concentrate on walking, Don’t be distracted. You are at greater risk of falling if you
have to think about the act of walking.
3. Don’t walk too close to anything. Always leave enough space for the
individuality of the way you walk. Some
of us sway one way or both. Some have to
swing a leg to carry it through. We may
need more shoulder room or more leg room.
4. Do use available furniture, walls, doorways
etc to steady yourself and keep your balance.
Lean on someone or something if available to keep your balance and save
energy. Use your environment to keep
safe.
5. Be aware of snags and pitfalls in your
everyday home environment. It only takes
a water spill or a small object like a dropped pea or toy to unbalance
you. Keep the floors clean and hazard
free, including cords, mats, newly washed or polished floors, frayed carpet,
brooms left out.
6. Don’t carry heavy loads or loads that
you can’t see over the top of to watch the ground or your feet.
7. Watch where you are putting your feet by
continually scanning the ground ahead of where you place your feet.
8. Always “pick-up” your feet so
that you don’t trip over your toes, especially with foot drop or shoes a
bit too big.
9. Make sure your shoes are firmly attached to
your feet.
10. Keep a wider base that you walk on to steady
your balance but not too wide.
11. Keep a light on so that you can see where you
are going, especially at night if going to the toilet.
12. When you first stand up, get your balance,
wait till you are steady before starting to walk off.
13. Don’t try to change direction without
first stopping.
14. Don’t attempt steep slopes or uneven
path without help
15. Don’t walk in strong wind, it can
really blow you over