Post Fall Syndrome and recovery for elderly people

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:

• 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)

• 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.