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:

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.