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“Our greatest glory is not in never falling but in rising every time we fall.”

Confucius (551–479 B.C.E.)

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Objectives

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On completion of this chapter, the student/practitioner will be able to:

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  • List possible fall etiologies.

  • Identify fall risks.

  • Discuss the fall risk impact of medications.

  • Develop a comprehensive fall prevention program.

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Key Terms

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  • Fall prevention

  • Fall prevention program

  • Fall risk assessment

  • Somatosensation

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Introduction

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Two of the most important capabilities of an individual, regardless of physical, health, or cognitive status, are the ability to navigate the environment and the ability to perform social roles. Physiological mechanisms supporting these capabilities include postural alignment, balance, and mobility, all of which depend on sensation and strength in the lower extremities. Impairment among these entities resulting from peripheral neuropathy increases the likelihood of an individual experiencing a fall. Unintentional falls in all age groups (excluding ages 15 to 24 years) are the leading cause of nonfatal injuries treated in hospital emergency departments; falls rank as the leading cause of death from injury in adults older than age 65 years. In 2007, greater than 8 million individuals were seen in emergency departments for treatment related to unintentional falls, of which more than 2.6 million were adults 55 years old and older.1 The cost of these unintentional falls can be a financial burden on the health care system and the individual and family and a loss of revenue generation.

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Balance, mobility impairments, and falls are commonly reported in older adults who have peripheral neuropathy associated with diabetes mellitus.25 However, studies found that not all older women who have diabetes mellitus and peripheral neuropathy fall.6,7 Although these impairments are typically not reported, they may be secondary consequences for other types of pathologies resulting in peripheral neuropathy. For the purpose of this chapter, a fall is defined as an unexpected event during which the person comes to rest on the ground, floor, or lower level.8

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The purposes of this chapter are to provide (1) an overview of mechanisms leading to fall risk in individuals with lower extremity peripheral nerve dysfunction; (2) guidelines for assessment of balance and falls; and (3) guidelines for interventions to maintain or regain balance or strategies to compensate for sensory and motor neuron loss, reducing the risk of falls. Detailed descriptions of pathologies leading to peripheral nervous system dysfunction are not included in this chapter but do appear in Chapters 3 through 13. Table 26-1 provides some examples of peripheral nerve dysfunction and potential mechanisms that increase the likelihood of falling. As is evident from the literature, fall risk is not specifically discussed because falling may be considered a secondary consequence of the medical condition. Inferences regarding fall risk can be made by examining the medical condition and mechanisms contributing to a fall.

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