TAILIEUCHUNG - Chapter 024. Gait and Balance Disorders (Part 5)

Falls Falls are a common event, particularly among the elderly. Modest changes in balance function have been described in fit older subjects as a result of normal aging. Subtle deficits in sensory systems, attention, and motor reaction time contribute to the risk, and environmental hazards abound. Epidemiologic studies have identified a number of risk factors for falls, summarized in Table 24-3. A fall is not a neurologic problem, nor reason for referral to a specialist, but there are circumstances in which neurologic evaluation is appropriate. In a classic study, 90% of fall events occurred among 10% of individuals, a group known. | Chapter 024. Gait and Balance Disorders Part 5 Falls Falls are a common event particularly among the elderly. Modest changes in balance function have been described in fit older subjects as a result of normal aging. Subtle deficits in sensory systems attention and motor reaction time contribute to the risk and environmental hazards abound. Epidemiologic studies have identified a number of risk factors for falls summarized in Table 24-3. A fall is not a neurologic problem nor reason for referral to a specialist but there are circumstances in which neurologic evaluation is appropriate. In a classic study 90 of fall events occurred among 10 of individuals a group known as recurrent fallers. Some of these are frail older persons with chronic diseases. Recurrent falls sometimes indicate the presence of serious balance impairment. Syncope seizure or falls related to loss of consciousness require appropriate evaluation and treatment Chaps. 21 and 363 . Table 24-3 Risk Factors for Falls a Meta-Analysis Summary of Sixteen Controlled Studies Risk Factor Mean RR OR Range Weakness Balance deficit Gait disorder Visual deficit Mobility limitation Cognitive impairment Impaired functional status Postural hypotension Note RR relative risks from prospective studies OR odds ratios from retrospective studies. Source Reprinted from Masdeu et al with descriptive classification of falls is as difficult as the classification of gait disorders for many of the same reasons. Postural control systems are widely distributed and a number of disease-related abnormalities occur. Unlike gait problems that are apparent on observation falls are rarely observed in the office. The patient and family may have limited information about what triggered the fall. Injuries can complicate the physical examination. While there is no standard nosology of falls common patterns can be identified. .

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