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Falling Over

Hampstead Heath this morning was beautiful but treacherous and all of a sudden, as is usual with such things, I fell over on the ice. One minute I was walking along chatting and the next minute I was on my bottom as my wrist, forearm, shoulder and buttock took a bash. I slid sideways fast in the fall, thereby distributing the blow to several parts of my body and reducing its impact, entirely by luck. So I escaped joining the legions of people who, over the UK Christmas festivities, suffered a fall as the weather managed to concoct a particularly tricky combination of sub-zero temperatures and sharp showers.

The increasing and continual ageing of the populations of many countries throws up many challenges around falls which are important and independent of the weather. We learn very early to keep our balance when walking or running and take it for granted ever since, forgetting that this skill relies on functional abilities which typically reduce as we age. Within elderly populations the issue of falls is increasing in importance as falls take up many medical and surgical resources and are risky in terms of individual independence. The clinical work and costs which result from large numbers of falls is an issue in many medical systems in the world.

We need a variety of both physical and mental skills to manage to maintain our physical state of equilibrium when conditions become challenging. As we age our limb muscles gradually lose their strength and we use less and less of our potential joint movements as we walk. Older people gradually adopt a more restricted gait as they increase the number of shorter steps and decrease the amount of joint movement they employ in each gait cycle. If keeping balance suddenly needs a much bigger joint movement this may not be possible any longer or they may not be able to perform the movement in time to complete the required task.

One of our vital abilities is that which tells our brains continually where the segments of our limbs and trunk are located and whether they are moving in a certain direction. This is joint position sense or proprioception and is essential for normal movement and posture. Losing this sense or more widespread sensation loss from part of or a whole leg stops critical information getting to the brain, meaning it is unable to plan the next movement as it is unsure where the limb is to start with. Function can be more severely affected by loss of position sense than by weakness as people cope with weakness if they have good position sense.

Several of our sensory organs and mental processing systems make important contributions to our ability to move whilst maintaining our balance including our awareness of the environment and our ability to think clearly, vision and balance organs. If we can see properly we can identify changes in the surfaces and so plan how we wish to deal with this and then follow our resulting movements to check they fit in with what we are trying to achieve. Closure of the eyes impairs our balance so if vision is not good and we have reduced position sense then we can be more at risk from falling.

To achieve the correct reactions to balance challenges demands various brain systems to be working effectively as the balance organs and the eyes provide the required input. Loss of accurate input from the balance organs of the ears can cause problems or make a person dizzy on movement of the head and so make falling more likely from loss of balance. As we age our neural abilities reduce in efficiency and the cerebellar part of the brain which deals with coordination can also suffer from this process.

Awareness of what is around us in our environment is vital in permitting us to make the quick and correct decisions to keep our balance. Being alert to what is going on means we can make early plans for managing the presenting circumstances such as other people''s actions, sudden obstacles and wet or slippery surfaces. Maintaining our minds in a mentally active and alert state allows integration of complex information and the formulation of plans to keep our balance.

Author: Jonathan Blood-Smyth


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