Following a brain injury some patients display a lack of confidence in attempting to re-establish walking. This can limit the level of walking ability that a patient may eventually achieve. Some patients are reluctant to walk unaided, to walk in more demanding situations (e.g. outdoors), or even to walk at all. In many cases, the lack of confidence is based on a fear of falling. In a case the case report titled "Tackling a Fear of Falling Using Graded Exposure" by Gerald Riley and Donna Holding published in Physiotherapy, March 2000, 86, 3, pp. 143 - 145, a 33 year old male patient status post severe traumatic brain injury 6 years ago was unable to walk outdoors. He still had a moderate amount of left sided weakness with loss of sensation and vision on the left. This did not prevent him from walking without difficulty in his home. He never walked unaccompanied outdoors and since he lived alone, his lifestyle was significantly restricted.

To begin treatment the patient was encouraged to confront his anxieties by tackling the situations that provoked the least amount of fear first. When his confidence was increased and fear reduced, the next situation was introduced. This process was continued until the patient was ready to face his most difficult situations. By the end of treatment the patient was able to walk unaccompanied from his door to the roadside and was able to walk in the community without holding on to his companions arm.

For more information, you can refer to the website at the following address: www.cphysio.org.UK.

"Tackling a Fear of Falling Using Graded Exposure" by Gerald Riley and Donna Holding published in Physiotherapy, March 2000, 86, 3, pp. 143 - 145

Stephen Bergsohn, MSPT