Falls -- They Come in Threes
Just over a week ago, I had my first experience with an incident report. All in all, it wasn't a big deal. A patient of mine with T11 paraplegia was attempting to stand from his wheelchair to complete a 10-meter walk test. As it turns out, his brakes (even when engaged) barely work. He went to push up from the chair, it started to slide backward, and he basically dipped himself down onto the floor. Minor incident report. No harm, except to my ego.
Six days later. Much bigger deal. Another patient of mine s/p TKA with an extensively complicated orthopedic history has been in PT for 12 weeks now. She has been dealing with the chronic effects of brain injury since she was 17, the same incident that caused her to have bilaterally fused ankles. Surely not a good prognostic factor for TKA recovery. We've been addressing any and every aspect of balance, strength, flexibility and mobility in the attempt to avoid another knee surgery, but it's been a rocky road.
I put together an obstacle course of familiar activities to encourage functional knee flexion. I wasn't really on high guard at the start (big mistake) as she was ambulating over quad canes, which she has never had trouble with before. I didn't even have time to react when she caught her foot on the cane, was unable to catch her balance with her bad leg, and fell to the ground faster than I've ever seen. On the way down, she hit her head on a step. All in the middle of the gym.
I was completely mortified, as was she. Thankfully she's fine. I kind of wanted to walk out of the clinic, turn in my ID, and call it quits on this whole "PT career." Now, I'm waiting to see if falls really do happen in threes. I'll keep my fingers crossed and gait belts on until I know I'm in the clear.