Physical and psychosocial consequences of falls in ambulatory individuals with cerebral palsy by age and gross motor function.

Abstract

Objective: To quantify physical and psychosocial impacts of falls by age and Gross Motor Classification System (GMFCS) level in ambulatory individuals with cerebral palsy (CP).

Design: Cross-Sectional Survey.

Setting: Tertiary specialty hospital and online CP communities.

Participants: Ambulatory individuals with CP (N=201 adults; 18-76 years old) or the caregivers of minors (N=180; 5-17 years old).

Main outcome measure(s): Participants completed online surveys to report fall frequency, fall characteristics, injuries, concern about falling (Short Falls Efficacy Scale-International), activity avoidance due to concern about falling (Short Falls Efficacy Scale-International Avoidance Behavior), and psychosocial constructs related to perceived consequences of falling (Consequences of Falling-Damage to Identity subscale).

Results: Most participants fell in the past 12 months (86%). Fall frequency in the past 12 months differed by age (P<0.001) and GMFCS level (P=0.021). Individuals 5-12-years-old or GMFCS level II reported the most falls. The percentage of participants who experienced a past serious fall-related injury (e.g., head/face stitches, concussion, fractures) increased with age (P<0.001), affecting 80% of ≥50-year-olds. Falls often occurred in the forward direction, when wearing shoes, and during ambulation. Uneven surfaces and fatigue were notable causes. Concern about falling and associated activity avoidance scores differed by age and GMFCS level (all P<0.01), both which were highest for ≥50-year-olds and GMFCS level III. Although psychosocial consequences of falls (e.g., embarrassment, lost confidence) were elevated across all groups, they did not differ by age or GMFCS level (P=0.130, P=0.083). Nearly everyone (88%) wished they fell less.

Conclusions: Falls are common for ambulatory children and adults with CP. Physical and psychosocial consequences of falls were frequent and impacted behavior. Differences observed by age and GMFCS level should be considered in care delivery. Clinically tracking and discussing falls and their repercussions across the lifespan will aid in addressing this under-researched and under-resourced concern of people with CP.