Evaluation of Recurrent Falls



Core Concept:

Maintaining an upright posture requires the integrated function of multiple systems.

Disruption in any of the following areas can contribute to falls.



1. Oxygenation of the Brain

Category: Cardiopulmonary Disorders

• Examples:

   - Orthostatic hypotension

   - Cardiac arrhythmias (e.g., atrial fibrillation with rapid ventricular response)

   -  Heart failure

   - Syncope (vasovagal, cardiogenic)

   - Pulmonary embolism

   - Severe anemia

• Clues: Syncope or presyncope, exertional symptoms, hypotension



2. Sensory Input

Category A: Visual Disorders

• Examples:

   - Cataracts

   - Macular degeneration

   - Glaucoma

   - Retinopathy

• Clues: Bumping into objects, recent vision changes

Category B: Auditory/Vestibular System

• Examples:

   - Benign paroxysmal positional vertigo (BPPV)

   - Meniere’s disease

   - Vestibular neuritis

• Clues: Vertigo, imbalance when turning head

Category C: Proprioceptive Impairment

• Examples:

   - Peripheral neuropathy (e.g., diabetic, B12 deficiency)

   - Spinal cord disorders

• Clues: Numbness in feet, positive Romberg sign



3. Motor Strength

Category: Neuromuscular Disorders

• Examples:

   - Stroke

   - Parkinson’s disease

   - Myopathies

   - Motor neuron disease (ALS)

• Clues: Focal weakness, muscle wasting, slow movements



4. Joint Movement

Category: Musculoskeletal Disorders

• Examples:

   - Osteoarthritis

   - Rheumatoid arthritis

   - Joint instability (e.g., post-injury)

• Clues: Joint pain, limited range of motion, gait abnormalities



5. Coordination of Movement

Category A: Cerebral Cortex

• Examples:

   - Dementia

   - Stroke

   - Seizure disorders

• Clues: Cognitive decline, neglect, postictal confusion

Category B: Basal Ganglia

• Examples:

   - Parkinson’s disease

   - Huntington’s disease

• Clues: Bradykinesia, rigidity, tremor

Category C: Cerebellum

• Examples:

   - Cerebellar stroke

   - Alcohol-related cerebellar degeneration

   - Multiple sclerosis

• Clues: Ataxia, dysmetria, intention tremor



6. Additional Contributing Factors

• Medications: Sedatives, antihypertensives, polypharmacy

• Environmental Hazards: Poor lighting, slippery surfaces

• Psychiatric: Depression, fear of falling, functional gait disorders



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