What is Falls Prevention Awareness Day?
The first day of fall, September 22, is Falls Prevention Awareness Day. This is a day to raise awareness about preventing fall-related injuries to older adults and at-risk populations. Falls are a leading cause of injury related emergency room visits, fatal head injuries, and a major contributor of hip fractures in older populations .
Who is at Risk?
At-risk populations include, but are not limited to, those with co-morbidities, a previous history of falls, chronic illnesses, and amputations.Individuals with amputations are at greater risk for falls when compared to other at-risk populations . Fall prevention is vital in the early stages of amputation rehabilitation. One’s residual limb is delicate and may only be partially healed at this point. Falls during this stage only serve to delay the rehabilitation process and in some extreme cases can lead to higher levels of amputation .
Even if a limb has fully healed, it is still at risk for injury. A fall during a later period of the healing process can still lead to difficulty wearing a prosthesis due to the pain and subsequent inflammation from a fall injury. This may require one you use an assistive device for mobility like, for example, crutches or a wheelchair.
Falls do not only cause physical damage, but they can take a toll mentally. Falls can often lead to an increase in anxiety and reduce one’s confidence while walking .
What Causes Falls?
There are a number of variables that can increase the likelihood of a fall occurring. For example, phantom limb syndrome, balance, taking risks, diabetes mellitus, muscular weakness, and vascular disease are just some of the culprits.
Phantom Limb Syndrome
Phantom limb syndrome (PLS) is the perception of the limb being intact despite its amputation. PLS contributes to falls in a number of ways but it is common for falls related to PLS to occur at night. When one wakes in the night they tend to be a drowsy dream-like state. It is easy to forget the absent limb and attempt to stand on the amputated side .
Balance is likely to be affected after an amputation, regardless of whether you wear a prosthesis. The forces and mechanisms the body uses to keep itself upright are compromised after an amputation, which can lead to a loss of balance or over compensation to correct one’s self during walking or standing .
There are times when one must transfer between places, for example, from a bed to a wheelchair. A fall in this situation may occur due to the individual forgetting to lock their wheelchair or overestimate their ability to transfer a given distance.
The environment itself can also affect the possibility of a fall taking place. There are numerous variables to consider, however, some environmental factors may include icy or wet surfaces, uneven ground, or ramps. These factors are not limited to the outside, they can also be found within one’s home, for example, stairs, narrow hallways, and poor lighting are just a small sample of some of the possible contributors to falls.
Diabetes Mellitus (DM)
DM can have a profound effect on one’s sensation (ability to feel) as well as their eyesight. DM elevates one’s blood glucose (sugars) and subsequently causes a variable degree of nerve damage or neuropathy. This combination can lead to falls due to an inability to see or feel the surfaces or hazards felt beneath them .
Muscular weakness can occur due to the withering of one’s muscle mass or what is known as muscular atrophy. As a consequence of aging, the amount of muscle mass an individual has will inevitably decrease. Chronic illnesses may result in a decrease in muscle mass due to either the illness itself or by causing an inability to engage the muscles physically. The result is difficulty supporting one’s self during standing or walking because of one’s inability to generate enough force to keep the body balanced or to create the movements necessary for walking .
Those with vascular disease are likely to have poor sensation in their limbs. Similar to diabetes mellitus, when one’s sensation is impaired, the likelihood of falls increases due to an incapability of sensing the surfaces underneath them.
Falls can happen at any time to anyone. It is important to take certain precautions to prevent your chances of a fall from occurring. The NIH Osteoporosis and Related Bone Disease National Resource Center  recommends the following:
- Use a cane or walker outdoors
- Be sure rugs have skid-proof backs or are tacked to the floor
- Make sure stairs are well lit and have rails on both sides
- Put grab bars on bathroom walls near the tub, shower, and toilet.
- More tips from the NIH can be found in the resources section of this post.
The Prosthetist/Orthotist and You
It is vital that you report any falls you have had in the past or concerns about falls with your prosthetist or orthotist. Your prosthetic or orthotic treatment is a collaborative effort; by discussing your concerns and informing your practitioner about your fall history, you can work together to identify the source of previous falls as well as any precautions to prevent future falls from occurring.
Below you will find links to websites with more information about Falls Prevention Awareness Day as well as information on what you can do to decrease the likelihood of a fall from occurring to you or someone you know.
An overview of Falls Prevention Awareness Day by the National Council on Aging
This website has a list of precautions you can take to prevent falls
An article published by the NIH about the causes of falls and fall prevention strategies
The CDC’s guide to creating a community based fall prevention program
An article published by the Amputee Coalition on tips to prevent falls for people with amputations
 “National Falls Prevention Awareness Day,” The American Occupational Therapy Association, Inc., [Online]. Available: https://www.aota.org/fallsday. [Accessed 8 August 2018].
 “RISK OF FALL-RELATED INJURY IN PEOPLE WITH LOWER LIMB,” J Rehabil Med, pp. 1-5, 2016.
 T. v. d. Stockt, “Falls in the amputee population,” Physiopedia, [Online]. Available: https://www.physio-pedia.com/Falls_in_the_amputee_population. [Accessed 10 August 2018].
 Limbs4Life, “Managing Pain,” Limbs 4 Life, [Online]. Available: https://www.limbs4life.org.au/steps-to-recovery/managing-pain. [Accessed 10 August 2018].
 “Gait Deveiations After Limb Loss,” in Fundamentals of Amputation Care and Prosthetics, New York, Demos Medical Publishing, 2014, pp. 202-203.
 U. B. S. o. P. Health, “Why Diabetes Raises Your Risk of Falling,” UC Berkeley School of Public Health, 3 November 2017. [Online]. Available: https://www.healthandwellnessalerts.berkeley.edu/alerts/diabetes/Why-Diabetes-Raises-Your-Risk-of-Falling_7805-1.html. [Accessed 7 8 2018].
 C. Horlings, B. van Engelen, J. Allum and B. Bloem, “A weak balance: the contribution of muscle weakness to postural instability and falls,” Nat Clin Pract Neurol, 2008.
 N. O. a. R. B. D. ~. N. R. Center, “What Are Ways to Prevent Falls and Related Fractures? Fast Facts: An Easy-to-Read Series of Publications for the Public,” NIH Osteoporosis and Related Bone Diseases ~ National Resource Center, [Online]. Available: https://www.bones.nih.gov/health-info/bone/osteoporosis/fracture/prevent-falls-ff. [Accessed 18 August 2018].