Increasing the Fall Risk
Every week I'll perform therapy screens on long-term care patients at the skilled nursing facility where I work. Often, this is a result of a patient's recent falling episode or general decline in transfer safety. Typically the patient, whether modified independent with his walker or wheelchair level, is a fall risk. We just have to assess if therapy services can reduce injury to the patient and staff during functional transfers.
After discussing the patient's current physical condition and transfer status with staff, I'll submit my recommendation for a possible evaluation by a physical therapist if the patient's insurance allows or if a restorative program is more appropriate. Many times, a patient will be picked up on caseload who has just experienced a recent health decline (fracture, pneumonia etc.) and will be seen in therapy a few times a week for increased strength and functional transfer safety.
It's exciting when we see a patient progress from a dependent sling lift transfer to a minimal assist with aide staff within a short few weeks of therapy. Even more rewarding is helping a patient walk the length of the parallel bars after being non-ambulatory for over a year. The one potential drawback we find is that with the increased strength and self-assist the patient is gaining, so is the potential risk of these folks attempting to self-transfer.
Whether the patient has cognitive issues or not, with increased practice and familiarity transferring from a wheelchair to his bed with therapy, the temptation to attempt the transfer himself increases as well. The nursing staff describes this phenomenon as "just strong enough to fall." They're right, of course, but we're also just effectively doing what the therapy department was asked to do -- improve the physical strength of the patient. Along with this increased self-assist, we also educate the patient in safety strategies and waiting for staff to arrive to provide continued assistance when necessary.
Unfortunately, there will always be a few patients who attempt transferring and walking on their own that will result in a fall -- despite all the education provided by their therapist. In my opinion, the prevented falls and injury to patients and staff due to exercise and training in physical therapy far outweigh the risk.