Falls prevention is nice in theory but....

Hi Ade,

Great conversation to start and all valid points that you mention! Have you discussed this with your physio? I'm interested to hear from other health professionals and stroke survivors on this topic too. I spoke with Katherine (physiotherapist at the Stroke Foundation) a few weeks back about falls. You are correct in that the majority of intervention and research in this area is around prevention: strengthening weaker limbs, sensory retraining, improving coordination and balance, reviewing footwear, use of hip protectors, the environment, etc. Looking at potential causes of falls is essential to determine where to focus falls prevention strategies on and aiming to prevent the fall in the first place. Is it vision, slowed reflexes, poor footwear, lighting, medication, all of those things or something else contributing to falls? Looking at potential causes give us a glimpse of where to focus our efforts.

How to get up from a fall is often taught in falls prevention clinics and rehabilitation but I haven’t personally observed practising ‘falling well’ to the same degree. Maybe one case comes to mind in over a decade of working as an OT. I imagine this is due to lack of evidence, it not being a goal and also one’s fear of falling. Not everyone may feel confident or have the desire to practice ‘falling well’ even onto a mattress or soft surface as this may bring up more anxiety for some. I would also be curious if hospital policy would come into it. Falling is unpredictable and it is difficult to know how or when one might fall hence prevention seems an obvious focus.

If ‘falling well’ is a goal for you then I would definitely discuss ways to work on this with your rehab team. Chat to your physio about ways you can increase your chances of ‘falling well’ or modified/simulated situations that challenge your reflexes. Practising the act of falling (onto a soft mattress) like in the video you’ve shared may be an option depending on recommendations by your physio. I found other videos on falling well, although I haven’t found much evidence or studies specifically on this.

A great general resource is Don’t Fall For It. While it is aimed at older people it is still relevant for any age and raises some good points of consideration.

I hope this helps Ade, happy to chat over the phone as always. Look forward to other contributions to the topics, partiuclarly health professionals working in falls prevention clinics.

Yours in falls prevention and client centred goal setting ;-)

Simone (Occupational Therapist for StrokeLine)

Hi Ade,  I think you're are right we do need to learn to fall well.  My first few falls my propriaception was so bad that I didn't even register I was falling until I was actually on the ground.  Crazy as it sounds I liked that with my later falls I realised what was happening before it was over and with that I also got better at saving myself the full indignity. However the reality is that I do still fall now and again.  I seem to be pretty good at it, so far I haven't damaged myself other than a few bruises and scratches.  I think part of it is that I did some martial arts training as a young adult so that training takes over in a crisis and I roll rather than splat.  I also do a regular training session that takes the form of games and silly stuff designed to test and improve my coordination and reflexes. During these sesions we deliberately do stuff that 3 year olds do instinctively to learn this stuff like walking on a curb or plank, throwing and catching while walking etc. By doing this in a controlled environment I'm much more confident in the real world.

I fall too much, every few weeks.  All I can put it to is my balance just goes on the blink or left knee just goes nope and down I go.  Living in a house with tile floors is a challenge i can say.

Im 6 months post and just today my doc suggested betting a dull night light for when nature calls at night.  She said its something about spacial awareness and at night it is much harder to balance.  So Ill give it a go.  I still fall in daytime and it gives me anxiety going out and doing stuff because I may Fall.  Even having a walking stick doesn't work when my knee goes.

im yet to figure that one out!

Hi Simone,

Had a conversation with two O.T's, one of whom I've worked with on and off for 8 years, and a Physio. They could understand my motivation for wanting to fall well and thought it was a great idea but...

There's always a but it seems.

They thought no one would touch it because it is too risky. This seems counter intuitive to me. You can do all the falls prevention stuff, stay active, wear sensible shoes (and I always wear sensible shoes Darling!), improve balance and coordination etc etc etc and yet gravity sucks. I will trip over a tiny crack in a foot path and down I go. The damage incurred in not learning to fall well is increased. Take a risk with someone who accepts there is inherent risk in learning to fall  to lessen the damage on impact was/is my point.

If all the talk these days is about patient focused care and client centred goals I'd love someone to pick up the baton and take a risk with me.

Another point to consider, and Gaz mentions this, is that a fall works between the ears as well. When you fall you confidence takes a jolt as well. As Gaz says, "I still fall in daytime and it gives me anxiety going out and doing stuff because I may Fall." So lets normalize falling so your confidence doesn't take a jolt. I fall over, I dust myself off and I carry on but I accept that this is not the case for everyone and I accept that this may not always be the case for me too. I don't want falls to get the better of me.

Hi Heather,

I think the Martial art training you did is perhaps the way to go and thank you for your insight. I want to become a black belt in falling down. I think a place where people get thrown around on nice padded floors is where I will seek my Falls Sensei. I think they will also be less risk averse than the health system.

Yours in gravity sucks but falls don't have to,

Ade

Hi Ade, Heather and Gaz,

Completely see where you're coming from and this was why I believe I only experienced this being offered in one case in over a decade - due to the red tape and potential risk involved. Getting up from falls was far more commonly practised or taught but still not frequent. It would be wonderful to get other health professionals thoughts on this and see if they know of anywhere it is being offered. Are your OTs and physio saying no then? I'm not sure if a private rehab provider would be more inclined to offer this compared to the public system.

Have you contacted any Falls and Balance clinics locally to see if they would offer it? Otherwise sounds like working with martial arts clubs may be another option. 

I like Heather's comment and experience -

"I also do a regular training session that takes the form of games and silly stuff designed to test and improve my coordination and reflexes. During these sesions we deliberately do stuff that 3 year olds do instinctively to learn this stuff like walking on a curb or plank, throwing and catching while walking etc. By doing this in a controlled environment I'm much more confident in the real world."

Do you do similar activities to Heather in physio Ade and Gaz? If not this is definitely a good option to introduce more simulated situations in a controlled environment. It may not be practised falling entirely but it comes closer and can lead to increased confidence. Tai Chi also gets a mention in falls prevention literature. 

Confidence is definitely impacted on after falling and if at increased risk of falls. You might be like to read some of the statistics on fear of falling here and the Prevention of Falls Network Earth page is also interesting. 

Gaz - I would chat to your therapy team to work on this as a specific goal and like Heather has done above work on improving the coordination, perception and reflexes. Lighting will definitely help at night and sitting on the bed for a few minutes to get your bearings and ensure you're fully awake, pumping the ankles to wake the muscles up before you get moving. 

Look forward to ongoing conversation on this topic. 

Simone (StrokeLine)