Factors associated with falls among wheelchair users living with spinal cord injury

Abou, Libak

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https://hdl.handle.net/2142/115532 Copy

Description

Title

Factors associated with falls among wheelchair users living with spinal cord injury

Author(s)

Abou, Libak

Issue Date

2022-04-11

Director of Research (if dissertation) or Advisor (if thesis)

Rice, Laura A

Doctoral Committee Chair(s)

Rice, Laura A

Committee Member(s)

• Sosnoff, Jacob J
• Jan, Yih-Kuen
• Hernandez, Manuel E
• Shen, Sa

Department of Study

Kinesiology & Community Health

Discipline

Kinesiology

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Accidental falls
• Risk factors
• Wheelchair
• Spinal cord injury, Postural control, Sitting balance

Abstract

Spinal Cord Injury (SCI) results in damage to the spinal cord that affects approximately 296,000 persons in the United States. As a result of damage to the spinal cord, more than half of those individuals affected by SCI are not able to ambulate and will use a wheelchair to support performance of their daily living activities. Falls are highly prevalent among non-ambulatory individuals with SCI and can result in detrimental consequences including physical injuries such as bone fractures and head concussions, fear of falling (FOF), functional limitations, and low quality of life. In worst cases, falls can lead to death. The first step essential to prevent falls and fall-related injuries is to assess risk factors, then identify individuals at risk of falls, before intervening with targeted fall prevention programs. Despite the evident importance of fall prevention in this population, few studies have specifically investigated the characteristics and predictors of falls and fall-related injuries. Consequently, there is a lack of clinical guidelines and evidenced-based fall prevention programs for non-ambulatory individuals with SCI. The overreaching purpose of this dissertation is to investigate factors associated with falls and fall- related injuries among non-ambulatory individuals with SCI. The project was divided in three studies. Study 1 (Chapter 3) focused on investigating the feasibility and preliminary validity and reliability of remote sitting balance assessments among non-ambulatory individuals. This study was deemed necessary due to the restrictions placed on human research because of the COVID-19 pandemic. Study 2 (Chapter 4) investigated the characteristics of falls, fall-related injuries, and FOF among non-ambulatory individuals with SCI. Study 3 (Chapter 5) explored factors associated with falls and fall-related injuries among non-ambulatory individuals with SCI. The potential factors associated with falls and fall-related injuries were evaluated according to the International Classification of Functioning, Disability and Health model. The potential risk factors investigated included variables of demographics information, sitting balance performance, psychological measures, environmental barriers, functional independence, wheelchair skills, quality of life, and community participation. Results from study 1 indicate that remote assessment of sitting balance is feasible, valid, and reliable using the Function in Sitting Test, the Trunk Control Test, the modified Functional Reach Test, and the T-Shirt Test. The results from study 2 confirm that falls, fall-related injuries, and FOF are frequent among non-ambulatory individuals with SCI. Participants reported that falls occur mostly inside of the house, during transfer activities, and associated with environmental barriers or surface conditions. Injuries resulted from falls varied from minor injuries, such as cuts or bruising, to severe injuries, including fractures and head concussions. The study also reveals that FOF is highly related to reduced overall function. The results from study 3 indicate that clinicians should consider time since injury and level of mobility function in a wheelchair when identifying individuals at risk of falls and components of physical health when identifying individuals at risk of fall-related injuries. This project provides evidence that remote monitoring of sitting balance critical for daily living activities of non-ambulatory individuals is feasible, valid, and reliable. These findings are important to provide targeted care and can guide home-based interventions through remote assessment. The results of this project also provide more information on characteristics of falls and fall-related injuries. This information can guide the development of targeted fall prevention programs specific for non-ambulatory individuals with SCI. Finally, the findings demonstrate that clinicians can identify non-ambulatory individuals with SCI at risk of falls and fall-related injuries. The identification of individuals at risk of falls is important to refer them to appropriate fall prevention programs. This information is also important to develop effective fall risk screening tools specific for this population. Future research is needed to develop fall risk screening tools and fall prevention programs specific for non-ambulatory individuals with SCI.

Graduation Semester

2022-05

Type of Resource

Thesis

Copyright and License Information

Copyright 2022 Libak Abou

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