Post Fall Syndrome

Post Fall Syndrome

 

Post Fall Syndrome or Psychomotor Regression Syndrome (PRS) is defined as:

“Decompensation of the systems and mechanisms implicated in postural and walking automatisms (Mourey, 2009)”

It appears either insidiously due to an increase of frailty or either brutally after a trauma (fall) or an operation. This syndrome is composed of a combination of neurological signs, motor symptoms and psychological disorder.

 

Motor symptoms

  • Standing
    • “Retropulsion” (gravity center kept backward)
    • Posterior instability (tendency to fall backward)
    • Both leading to postural compensation (Knees/hips kept flexed and bend forward) and to this traditional posture:
Geriatric: elderly patient with a post fall syndrom and typical posture

Typical anterior/flexed posture

  • Sitting
    • Impairment of sitting posture is less visible but as problematic
    • Patients with PRS keep their buttocks forward, shoulders backward and feet far from the seat (image B)
    • However, to stand up we need to transfer our gravity center forward (image A)
    • Therefore, standing up is difficult/impossible without exterior help for patients with PRS (image B)
Geriatric: impact of post fall syndrom on ability to stand up

A: normal way of standing up B: wrong way of standing up

  • Walking
    • It is difficult for them to
      • Initiate the walk (they look like freeze)
      • Difficulty to avoid obstacle and to turn
      • Gait
        • ↓ length of the step
        • ↓ knees and hips flexion (↑ trip risk)
        • ↓ heel strike
        • ↑ time spend in bipodal stance (↑ posterior instability)

 

Neurological signs

  • Alteration or absence of postural adaptation (the person is not able to balance herself and to stand up without falling)
  • Protective reaction (put her arms in front when falling to slow the fall)

 

Psychological disorder

  • Patient with PRS present with
    • Anxiety/phobia of verticality (afraid to stand up)
    • Loss of self-confidence/self-esteem
    • Loss of motivation associate with a reduction of their activity and social interaction
  • Therefore, they end up in a vicious circle
    • They are afraid to move
    • They move less
    • They become even less able to move and even more afraid

 

Treatment for patient suffering from Post fall syndrome is composed of:

  • Exercise to promote movement and strength
  • Postural work to correct the compensation
  • Work on the change of position to teach the easy and safe way to stand up, sit down, and lie down.
  • Work on the walk and to correct their gait

For more details please have a look at the Walking Rehabilitation section.