Christine Bowers is 18 years old and carries a cane.
As a student at Chicago’s Moody Bible Institute, she often finds herself in crowded corridors. She uses the cane as much to alert those around her that she has mobility difficulties as she does for support. Seeing the cane, other students give her a bit more room as they hurry through the halls.
In January 2016, doctors removed a cavernous malformation — a tangle of blood vessels — from deep within Bowers’ brain.
“It paralyzed my left side,” she says as her physical therapist straps her into a complex harness in a large room filled with equipment at the Shirley Ryan AbilityLab — formerly the Rehabilitation Institute of Chicago.
Now, she says, “I’m working on preventing a fall.”
Under the supervision of Ashley Bobich, her physical therapist, Bowers, who one day hopes to teach English abroad, is walking on the KineAssist MX, a computerized treadmill with a robotic arm and harness at the back. The metal arm allows people freedom of motion but catches them if they stumble.
Falls are one of life’s great overlooked perils. We fear terror attacks, shark bites, Ebola outbreaks and other minutely remote dangers. Yet nearly half a million people each year die worldwide after falling. Falls are the second-leading cause of death by injury, after car accidents. In the United States, falls cause 32,000 fatalities a year — more than four times the number caused by drowning or fires combined. Nearly three times as many people die in this country after falling than are murdered by firearms.
And more people go to emergency rooms after falling than from any other form of mishap, according to the federal Centers for Disease Control and Prevention — nearly triple the rate due to car accidents.
Any fall, even a tumble out of bed, can change life profoundly, taking someone from robust health to grave disability in less than a second. Falling can cause fractures and even injuries to internal organs, the brain and spinal cord.
“Anybody can fall,” says Dr. Elliot J. Roth, medical director of the patient recovery unit at the AbilityLab. “And most of the traumatic brain injury patients and spinal cord injury patients we see had no previous disability.”
People fall in different ways. They can trip or slip when walking. They lose consciousness and collapse or are sent tumbling by vertigo. Something supposedly solid gives way. They leap from high places.
However it happens, gravity takes hold, and a brief, violent drama begins. And like any drama, every fall has a beginning, middle and end.
“We can think of falls as having three stages: initiation, descent and impact,” says Dr. Stephen Robinovitch, a professor in the School of Engineering Science and Department of Biomedical Physiology and Kinesiology at Simon Fraser University in British Columbia, Canada. “Most research in the area of falls relates to ‘balance maintenance’ — how we perform activities such as standing, walking and transferring without losing balance.”
By “transferring,” he means changing from one state to another: from walking to stopping, or lying in a bed to standing, or standing to sitting.
“We have found that falls among older adults in long-term care are just as likely to occur during standing and transferring as during walking,” says Robinovitch, who installed cameras in a pair of Canadian nursing homes and analyzed 227 falls over three years.
Research into falling, gait and balance has increased tremendously over the past two decades. Advances in technology improve our understanding of how and why people fall offer possibilities to mitigate the severity of falls and improve medicine’s ability to treat those who have hurt themselves falling.
In general, elderly people are prone to falls because they are subject to illnesses that affect their cognition, coordination, agility and strength.
“Almost anything that goes wrong with your brain or your muscles or joints is going to affect your balance,” says Fay Horak, professor of neurology at Oregon Health & Science University.
Fall injuries are the leading cause of death in people over 60, according to Horak. About 30 percent of those 65 and older living in senior residences fall every year. For those 80 and older, that rises to 50 percent. A third of those falls lead to injury, according to the CDC, with 5 percent of those resulting in serious injury, which can be expensive: The average fall resulting in hospitalization costs $34,294.
Old people tend to fall and break their hips. In contrast, young people fall and break their wrists because they are able to get their hands out faster before they hit the ground.
Given the tremendous cost to individuals and society of falls, and the increasing knowledge of how and why they occur, what can people do to prevent falls? And can they do anything to lessen harm in the split second after start to fall? A few tips:
• Prepare your environment.
Secure loose rugs, or get rid of them. Make sure the tops and bottoms of stairs are lit. Clean up spills immediately. Install safety bars in showers, and treat slick surfaces such as smooth marble floors with anti-slip coatings. In the wintertime, clear ice outside your home, and put down salt.
• Fall-proof your routine.
Watch where you are going. Don’t walk while reading or using your cell phone. Always hold handrails — most people using stairways do not. Don’t text and walk, don’t have your hands in your pockets as this reduces your ability to regain your balance when you stumble. Remember that your balance can be thrown off by a heavy suitcase, backpack or bag.
• Improve your gear.
Wear good shoes with treads. On ice, wear cleats — you can buy inexpensive soles with metal studs that slip over your shoes. Don’t wear high heels — or at least have a pair of flats for walking between locations. Get a hearing aid if you need one. Wear a helmet when bicycling, skiing and skateboarding. Use a cane or walker if necessary. Hike with a walking stick.
• Prepare your body.
Lower-body strength is important for recovering from slips, upper-body strength for surviving falls. Martial arts training can help you learn how to fall. Drugs and alcohol are obviously a factor in falls, as is sleep apnea. Maintain a balanced diet to support bone density and muscle strength. If you feel lightheaded or faint, sit down immediately. Don’t worry about the social graces. You can get back up once you’ve established you are not going to lose consciousness.
Understandably, some elderly people fear falling so much that they don’t even want to think about it.
“People should know they could improve their balance with practice, even if have a neurological problem,” Horak says.
These strategies are all things you can do before you fall. What happens once you start to fall? If you are falling, first protect your head — 37 percent of the elderly falling in a study by Robinovitch hit their heads, particularly during falls forward. Fight trainers and parachute jump coaches encourage people to try not to fall straightforward or backward. The key is to roll and try to let the fleshy side parts of your body absorb the impact.
“You want to reach back for the floor with your hands,” says Chuck Coyl, a professional fight director who has worked with many stage organizations, including the Lyric Opera of Chicago, describing how he tells actors to fall on stage. “Distribute the weight on the calf, thigh, into the glutes, rolling on the outside of your leg, as opposed to falling straight back.”
Most importantly, even if you have fallen, do not be afraid of falls.
Christine Bowers has fallen several times, and those falls made her very skittish about walking, a serious problem in the rehabilitation of those who have fallen.
Bobich agrees: “It’s huge. Fear of falling puts us at risk for falling.”
“Falls often cause fear of falling, and fear of falling often causes fear of walking, and fear of walking often causes abnormal or inadequate walking,” says Roth.
One challenge of rehabilitation is to not only increase physical capacity but also to build patient confidence.
“We’ve been doing what’s called perturbation training, where I pick a change in the treadmill speed,” Bobich says. “She’s walking along, I hit the button, and the treadmill speeds up on her, and she has to react. Her biggest fear was slipping on ice, so I said, ‘You know what? I have a really great way to train that.’ ”
The treadmill hums while Bobich speeds it up and slows it down. Bowers, her right hand clasping her paralyzed left, struggles to maintain her balance.
“You’re getting better at this,” Bobich tells her. “You’re getting way better.”
This is a condensed version of an article published by the Wellcome Trust, the largest medical charity in the world, on its Mosaic Science website, published here under a Creative Commons license.