How a Functional Home Layout Can Decrease your Risk of Falls

By Dr. Emily Reilly, MSOTR/L, ECHM, Founder of Purposefully Home, LLC

The environment around us can have a great impact on how we manage our daily routines, either enhancing or inhibiting our function. Balance is a crucial component of how we interact with the world around us; whether we are sitting or standing, our body provides information to help our posture to be centered. In some circumstances, balance becomes impaired after suffering a neurological event, causing short-term or long-term deficits. Not only are individuals at a heightened risk for falls, but there are increased challenges in performing day to day tasks independently, such as taking a shower, getting dressed, preparing a meal, enjoying hobbies, and so forth. Often, self-imposed limitations due to symptoms associated with a brain injury can have a negative impact on an individual’s quality of life, cause social isolation, increased levels of anxiety, and restricted engagement in leisure activities.

There are often common safety recommendations to minimize risks of slips, trips, and falls. In some cases, these “common sense” approaches can be quite helpful for the Neuro-typical individuals, but for those who have sustained a brain injury, there is a multitude of complicating factors that cause imbalance and simple fall prevention solutions are inadequate. First and foremost, it is important to understand the reason for your imbalance. Once the primary cause is identified, non-pharmacological interventions can be explored, including an emphasis on functional home design.

Creating an environment within your home space that inhibits undesirable symptoms associated with a brain injury can ultimately increase safety and independence for improved participation in everyday activities. Despite the countless reasons for brain injury-related imbalance, some common causes may be related to medication, vertigo, visual impairments, or ataxia. Although individuals may have the basic tools to improve safety such as grab bars, a shower seat, and/or mobility devices, there are several design solutions within the home that can be completed to enhance function and minimize stress and strain.

Medications: Consider the following tips. By maintaining a clean, organized place within the home for managing medications, you limit errors, improve carryover for those that have someone overseeing medication management, and minimize the effort of navigating room to room as you retrieve all the pertinent items.

• Avoid keeping medications out on countertops
• Consult with your physician about altering the dosage and time of day in which you take them in order to combat negative side effects
• Set up space within the home where medications can be stored in a locked cabinet or drawer
• Dedicated supplies such as a calendar, pen, pill organizer, cup for water, and snack food items can help minimize risk for errors and improve carryover of prescribed information.

Vestibular impairments: Dizziness, nausea, and a sense of spinning are symptoms associated with vertigo. The instability that affects a person’s ability to get out of bed, stand, or walk can be debilitating. There is also an increased risk of falls and injury during mobility, bathing, and object retrieval. By minimizing clutter, there is a limited risk of injury from bumping into furniture or misjudging the distance of an object. In addition, it is important to place frequently used items within reach that minimizes having to bend, stoop, or reach overhead, which may exacerbate symptoms associated with vertigo. Although symptoms may be temporary, it is beneficial to create a living space conducive to your day to day routines to minimize symptoms.

Be mindful of your position.

• Place items within reach from seated and standing to avoid bending/stooping and overhead reach
• If possible, utilize raised pet dishes
• Rollout or drop-down shelving
• Laundry station to include washer/dryer risers and elevated space for sorting and folding clothing items
• Avoid placing items that require frequent or repetitive head turns

Visual Impairments: There may be visual impairments as a result of brain injury that may cause blurry vision, double vision, peripheral deficits, or other visual disturbances that cause light sensitivity, headaches, and ultimately, imbalance as a result. The visual system is often a compensatory strategy when other sensory systems aren’t working. If the body is unable to rely on vision to help correct midline orientation, the risk of falls is elevated.

• Incorporate layered lighting throughout the home to minimize shadows and glare
• Emphasize contrast to improve perception (avoid white sink, white tile, white walls, etc.)
• Consider smart technology, especially for CO2/Smoke Detectors
• Minimize patterns throughout the home

Impaired Coordination (Ataxia): Coordination impairments can greatly impact balance and the ability to grasp objects without dropping them. This can be quite dangerous throughout the home because it can limit one’s ability to navigate from room to room, complete tasks like cooking, as well as entering/exiting easily. If there is fear of falling or embarrassment, the quality of life can drastically be diminished. There may even be an increased dependency on a caregiver, which also has a negative impact on one’s feelings of self-worth. There are numerous ways to improve function throughout the home despite the struggles of ataxia.

•  Spring-loaded hinges to adjust the resistance needed to open/close cabinets. Increased resistance can accommodate proprioceptive deficits attributed to ataxia
• Consider soft and non-slip flooring options; they are resilient and can minimize impact from a possible fall. Options may include rubber, vinyl, linoleum, and carpet
• Lever-style knobs for doors and faucets
• Scald-proof faucets (set hot water heater to <120*)

Whole home design can take a great deal of time and investment. It is important to hire a team that understands your personal needs beyond the aesthetics in order to optimize function. Consider open concept design, minimize clutter, ensure adequate lighting, use contrast colors and limit use of patterns. Be sure to implement slip-proof flooring and incorporate design that promotes safety, independence, and energy conservation.

ABOUT BRAIN INJURY ALLIANCE OF ARIZONA

The Brain Injury Alliance of Arizona (BIAAZ) is the only statewide nonprofit organization dedicated to improving the lives of adults and children with all types of brain injuries through prevention, advocacy, awareness, and education. BIAAZ also houses the Arizona Brain Health Resource Center, a collection of educational information and neuro-specific resources for brain injury survivors, caregivers, family members, and professionals.

What began in 1983 as a grassroots effort has grown into a strong statewide presence, providing valuable life-long resources and community support for individuals with all types of brain trauma at no charge.

The Brain Injury Alliance of Arizona:

• Works with the Congressional Brain Injury Task Force
• Houses Arizona Brain Health Resource Center
• Hosts the Statewide Opioid Use Disorder & Cognitive Impairment Workgroup
• Deploys a  Statewide Opioid Use Disorder & Cognitive Impairment Response Team with peer support, training and family wraparound services
• Facilitates the Brain Health Advisory Council
• Manages a Statewide Neuro Info-Line 888-500-9165