Introduction
Falls are very common among amputees like yourself. Especially in the early stages of rehabilitation before you receive a prosthetic limb. Some research suggests that in the first year after amputation over half of amputees fall. This can have devastating effects on the residual limb (stump), your mobility and confidence.
Reasons for falling
The reasons why you may fall are many and varied. Some of the common causes are described below:
⦁ Phantom sensations
Many amputees experience Phantom sensations, that is, they feel they still have a limb where there is not one. You are particularly at risk of this at night, when drowsy, as you may wake up and attempt to stand and fall, forgetting you have had an amputation.
⦁ Balance
It is likely that your balance will be affected by the loss of a limb, whether you wear a prosthesis or not. When not wearing a prosthesis you will not be able to correct your balance by putting your foot down.
When wearing a prosthesis you lose the normal sensation of your foot on the ground, therefore your balance is poor when standing or walking.
If you are on a drug called gabapentin, this may affect your balance. If you think this may be happening, please be extra careful when moving about, and speak to your doctor.
⦁ Diabetes
Many amputees have diabetes, which can have a huge effect on eyesight and sensation (feeling) in legs. This can lead to falls, as hazards may not be seen and uneven surfaces may not be felt underfoot.
⦁ Muscle Weakness
If you have been unwell for a long time, your muscles may have weakened. This can also affect your balance.
Exercises from your Physiotherapist will help. If you are unsure about which exercises to do, then ask your Physiotherapist for some advice.
⦁ Vascular Disease
As with diabetes, people with vascular disease may have problems with sensation in their limbs, as the blood flow may be poor. This may lead to less awareness of surfaces underfoot and therefore increase the chances of falling.
⦁ Taking risks
Sometimes, when people are ‘transferring’ from one place to another they may take risks, such as leaving too big a gap, or not putting the brakes on their wheelchair. Although at times there may be no problems from taking risks, it can lead to falls.
⦁ Environmental Factors
Many amputees fall due to tripping or slipping in the home. Hazards such as rugs, cables, door thresholds, and magazines left lying on the floor, can get ni the way. Also, poor arrangement of furniture can make transferring difficult and dangerous.
Effects of Falling
Wound problems
Especially in the early stages, a wound or partially healed residual limb (stump) can be very seriously damaged by a fall. This can have consequences such as delayed rehabilitation or even the need for a higher level of amputation.
Mobility
Even if the residual limb (stump) is well healed, it may not be possible to wear your prosthesis for a period of time, due to pain and swelling. This may mean you need to use your wheelchair to get around.
Confidence
It is quite normal that a fall can lead to anxiety about having another fall. However, anxiety can lead to avoidance of activities associated with the fall, such as walking. You may need the confidence boost of another person walking with you initially, to get your confidence back.
How to Prevent Falls
Most falls are preventable. Use common sense:
⦁ Always apply brakes on a wheelchair before transferring
⦁ Make sure you are close as possible to the surface you are transferring to
⦁ Always remove footplates
⦁ If advised to, by your therapist, take the side off your wheelchair. This will help you to transfer safely
Initially you may need somebody to help or supervise your transfer. Your Physiotherapist or Occupational Therapist will advise you when you are safe to do this on your own.
Before discharge from hospital, an Occupational Therapist will look at your house. They may give advise on lifting rugs, lowering door entrances or how best to arrange furniture for safe transfers.
It is common for amputees to fall at night. Often they wake up drowsy and need the toilet, they forget they are missing a limb. When they attempt to stand they may lose balance and fall over. There is no weal way to prevent this, but be aware that this does happen.
Don’t take unnecessary risks. This is when many people fall, and it can delay rehabilitation by many months if the stump is damaged.
What to do if you Fall
⦁ Don’t panic! Take a few moments to regain your composure and calm down
⦁ If you are injured and feel you can’t get up off the floor, then try to remember 3 things:
⦁ If you wear a pendant alarm or have a pull cord, use these to call for assistance. Keep telephones on low surfaces. If you realise you are injured, do not hesitate to call for an ambulance
⦁ Have blankets tucked in the corner of each room. Pull these around yourself to keep warm
⦁ Pull any cushions you have off sofas and chairs. Put them underneath you, so you are not sitting on a hard floor
⦁ If you feel you are well enough to try to get up, then do so as shown by your Physiotherapist. See the guide below.
After you fall you should always check your residual limb (stump) for damage. If seriously injured, you may need to go to Accident and Emergency, or your GP. You should monitor your residual limb (stump) for a few days – it may take this long for problems to arise after the fall.
Many people feel embarrassed if they fall. Make sure you let your therapist or GP know, especially if you were dizzy before you fell, as there may be a medical reason for it.
If you have any questions or concerns about falling please speak to your therapist.
Advice on how to get up off the floor – Method one
If you are wearing a below-knee prosthesis, you are advised to get up from the floor in the following way:
1 Stay calm. Get your breath back first.
2 When you are ready, roll to one side.
3 Using your arms push yourself up into side sitting.
4 Using your arms push yourself up onto your knees.
5 Crawl to the nearest piece of sturdy furniture (something which is unlikely to move if you put your weight onto it).
6 Push through your arms and strong leg to a standing position.
7 Rest and alert your doctor if you have any serious injuries.
Alternative – Method two
If you find the first method of getting up from the floor too difficult, have painful knees or you are not wearing a prosthesis, you may find it easier to get up from the floor in the following way:
1 Sit on the floor and rest. Shuffle your bottom to a footstool, pile of cushions or a step. Put your hands up onto the step and lift your body up onto the step. Be careful not to scrape your back.
2 From the step put your hands back onto a sofa or chair (make sure the chair is stable), push up onto the chair or sofa.
3 Rest and inform your doctor if you have any injuries.
General advice following a fall
⦁ Contact your prosthetist so your artificial limb can be checked if necessary
⦁ If you notice any problems such as damage to your skin, or pain in a joint, make an appointment to see your GP
⦁ If your fall has affected your walking please contact your physiotherapist or consultant.
Walking aids
⦁ Keep a check on wear and tear of rubber ferrules on sticks, crutches or frames. They should have grooves and NOT be smooth in appearance.
⦁ Be careful where you leave your walking aid. It could be tripped over.
⦁ Do not use another person’s walking aid. It may not be suitable for you.
⦁ Please only use walking aids that are advised by your therapist.
Wheelchair use
⦁ Make sure that, if you need it, your wheelchair is easily accessible at night.
⦁ Make sure you put your wheelchair brakes on when getting in and out of your wheelchair.
⦁ Ensure your wheelchair is in good condition. Check the brakes are working correctly and the tyres well inflated.
Footwear
⦁ Wear shoes/slippers which are comfortable, fit properly and have non-slip soles.
⦁ Avoid using your prosthesis bare foot.
⦁ Speak to your prosthetist or physiotherapist if changing your shoes to a different heel height.
Outside
⦁ Take extra care when walking on sloping, uneven, wet or icy ground.
⦁ It may be helpful to use a walking aid outside, even if you do not need one indoors. Talk to your physiotherapist about this.
Other
⦁ Make sure your artificial limb is checked at your local prosthetic centre annually.
⦁ We advise to keep a phone or pendant alarm with you at all times.
Thanks to Westmarc and www.sfh-tr.nhs.uk for the above info.
Further information about falling can be found here.