What is Fall Prevention?
Identifying places and behaviors that can easily result in a loss of balance is called fall prevention. The more you take control of this process, the more confident you feel about returning to your-pre amputation lifestyle. If you haven’t been taught and warned about the potential harm that ignoring risks creates, you will be surprised when you quickly try to grab something to steady yourself. The more you have a good sense of
balance, the more you can recover quickly. Like a ballerina, you will walk out of your prosthesis maker’s office without a cane.
Unless you insist on inpatient recovery for as long as you can, you will be released to home as soon as your amputation is medically stable. Your wound is stitched close. The slightest fall will rip it open. Just as when you have sliced across the grain in carving a cooked roast, all those strands of leg muscle separate in a fall, leaving tunnels between the muscle fibers that are easily open to infection. At that point, only a nurse can push a q-tip down those tunnels with enough antibiotics to stop the further infection and reduce the need for another amputation. The q-tip process is intensely painful.
Post-operative care nurses want to get you medically stable. In the best of worlds, you need additional help getting stronger. After that, you need help to identify places and activities that represent these high-risk triggers for falls in your home. Your chances of falling are highest when you are in a familiar place like home when you are struggling with a limb loss.
You will find physical therapy very helpful while you are recuperating in the hospital. They are great at helping you maintain balance. They will work on the interior components of not falling. You have the option of continuing to work with them when you return to your home to help with your muscular renovation. They are not allowed to deal with psychological problems like a panic attack. That is outside the scope of their practice.
Fear generalizes quickly especially when you realize that there are places in your home where the potential of losing your balance is high and you don’t know how to reduce it. By securing one will give you problem like getting to the bathroom and deciding how to take care of being able to use a high-rise toilet and wall bars. That sense of figuring out a small problem will give you the courage to figure out a larger one. That is the essence of fall prevention. Fall prevention means taking control of the situation.
What Can Cause Falls?
The essence of falls results from not dealing with this transition. Simplistic views are things like in the early stages following amputation your brain is still adjusting to the fact that you don’t have a limb to put down on the ground. As you learn to move and regain your balance, falls can happen. I never found this to be the case even in my dreams. If anything, you are acutely aware that your dismembered foot is really not there. More realistically falls are due to assumptions like being able to lift yourself up with your hands and good leg when you are not strong enough. What results is you slowly sinking as your muscles are not strong enough to hold you up. Other factors that make you prone to a fall can include:
- The feeling or sensation that your amputated limb is still there also known as a phantom sensation.
- Easily losing your balance when you are reaching forward or leaning down to put on your shoe.
- If you get up too quickly after sitting or lying down.
- Forgetting to put the brakes on your wheelchair, and your chair moves out from underneath you trying to get from the chair to your bed or a walker
- Loss of concentration getting into or out of the shower or more specifically, from the shower stall chair to the walker or from the walker to your wheelchair.
- After you have a prosthesis using a walking stick on a slippery or wet surface.
Who Can Help You Prevent Falls?
Your Vascular surgeon is in charge of your amputation until you are medically stable. During his care, you are strongly recommended to insist that he write orders for two weeks of inpatient rehabilitation with a visiting nurse and a physical therapist coming to your house till you can be fitted with a prosthesis. Once you are signed off by your vascular surgeon, it is your general physician that is in charge of your care. Do not be disappointed when you find you must educate your physician on what post-operative care you need. This is not something many GP”s have had experience with. Should any wounds appear in your stump or other leg ask him to refer you to a wound clinic for the best in healing that skin problem. Check with your insurance carrier because outpatient physical therapy helps you use your prosthesis safely and will encourage you to do the right exercises to be able to walk again without pain. Your general physician will then write the orders for this treatment. It will shorten your recovery time and encourage you to not sit in a wheelchair or bed all day.
Physical therapists and occupational therapists require certain criteria to be utilized. You must have specific issues in transferring from a wheelchair to a bed or shower seat. This transition involves specific behaviors you need to learn to go from a wheelchair to a walker and a walker to anything. One major area of falls is transferring to and from the bed. Physical therapists do not help with taking clothes on or off, showering, and dressing your self. These are the specializations of the occupational therapist. They will make a valiant attempt at developing skills needed to keep your job but if that doesn’t work, you need the assistance of vocational rehab, which is a completely different entity dealt with in another article.
If you don’t bring up any specific problems to your prosthesis maker, they will do what they do best which is making sure your prosthesis fits properly. Nursing and other post-operative team members can help you practice safe ways to transfer and reach items only if you insist on working on those items. With shrinking budgets, such in-home visits and identification of potential falling situations, never take place unless you insist on it. These skills can include:
- Transferring from the bed to a wheelchair
- Transferring from your wheelchair to a shower chair•
- Transferring from your wheelchair to different chairs or the car
- Using a pickup stick to reach items from the floor or items which are above your head
If you are unsure if you can reach an item, not feeling well or confident with your balance, seek help from the pre-discharge nurse at the hospital where you had your amputation. Once you miss that opportunity, there is nowhere you can have a physician order more help for you short of convincing your GP to write those orders. Most GP’s have little ad experience treating amputees, so you must be proactive. You must be organized and able to advocate for the care you need. It is easy at this point to give in to your resentment that no one is out there to help you so you might as well give up. Take a good look at all the people using walkers and wonder why they got there.
What Happens If You Do Have A Fall?
Like anyone that falls over, you will want to get back up again. Doing this as an amputee can sometimes be more challenging. You may need to learn some new skills and techniques which will help you to have the courage to get back up. Falls are very common until you get used to your limitations. If you have a fall, speak to your Physical therapist about floor recovery techniques. If no one made an appointment for a physical therapist for you, insist on getting one. You should ask the order to read home visits at least twice a week. While your stump heals, they will encourage you to exercise.
Even a week in a wheelchair will degenerate your back muscles enough that learning to walk is so painful that a substantial number of people at this point never walk again. They can provide you with instructions about how to get up safely, without hurting or damaging other parts of your body. They will show you the correct way to recover from a fall.
A key feature here is the psychological effects of falling. You want answers on the internet. Your physical therapist cannot talk to you about it because it is out of their area of expertise. Nurses are usually too busy to deal with the fear of falling and resulting panic attacks that you feel. Fear of falling is inversely proportionate to your self-confidence. The fear of falling will generalize if you don’t improve your sense of balance. There are other articles I have written addressing this specifically. Concentrating on what you are doing and remaining centered is an aspect of meditation that is also important in reducing your fear of falling. Specific exercises also help immensely, and there are articles on this website that address that. Using support groups like the amputee coalition will keep your attitude positive and reduce your resentment and feeling sorry for yourself.
Lastly, there are amputee life coaches out there that specialize in helping you through this transition. They help you with your fears, discouragement, and self-pity. Utilize them and you will grow from this life-transforming event.