Falls Information for Amputees

Introduction

Falls are very common among amputees. 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 may be 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 your 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 may 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 reduced 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 in 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 from wheelchair before transferring
• If advised to, by your therapist, take the side off your wheelchair. This will help you to transfer safely

As an amputee you may wake up drowsy and need the toilet, and possibly forget you are missing a limb. You may then attempt to stand, lose balance and fall over. There is no real 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 o Have blankets tucked in the corner of each room. Pull these around yourself to keep warm o 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 ‘How to Get Up Off the Floor’ Guide.

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.