Near fall

During my placement for neuro, I was treating a lot of patients who had suffered strokes, both L and R hemi's. This particular patient was a L hemi and as it was a outpatient facility they had progressed quite well in their rehab and was sent home and was coming to us for continuation of their gait re-training. I was not the therapist for this particular patient, a fellow student was, but i had seen the patient in the gym in the previous weeks and had thought they looked good in their walking.

The student treating the patient had decided to trial walking on various surfaces, so i went along to give extra safety as it was their first time walking up a slope and on grass. The patient ambulates with a walking stick and was very chatty and walked well up and down the slope without any incidences of loss of balance. They also managed the grass quite well, but had a slight trip due to their decreased activation in their dorsiflexors and their toes caught the grass, however they recovered without assitance.

During the entire walk we were both close to the patient and as we made our way back into the door we were not expecting anything to happen as he was now back in the room and they had managed so well outside. As we walked through the door they looked over to the corner and this caused both myself and the other student to look in that direction also. In the split second that we looked away from the patient they began to fall to their L. My fellow student was still in a very close position and had to catch the patient and then helped straighten them up. It was a very near fall and if the other student not been so close the patient would have fallen for sure, also if the fellow student had not been as strong as this particular student then the patient may have still fallen and taken the student with them.

I suppose what I am getting at here is this importance of close supervision and not becoming distracted as i believe if we had not looked where the patient was looking we would have noticed earlier that they were losing their balance and much less effort would have been required to help the patient maintain their balance. I have also noticed the importance of this on my current prac with the elderly. When doing balance work with them in some of the more difficult positions even in the time it takes to look down at my stopwatch the patient can start to fall let alone if you become distracted and look away for a few seconds!!

To deal with this I now make sure i focus when i have a patient who is a falls risk, not letting anything distract me and if i need to look away for a few seconds, for whatever reason, i make sure the patient stops the exercise and is in a safe position, either sitting down or holding onto parallel bars before i turn away or leave them. Near falls are quite frightening for the patient and for the therapist and i hope that occasion was my last.