Falls in the Amputee Population

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt, Kim Jackson, Lauren Lopez, Simisola Ajeyalemi and Jorge Rodríguez Palomino

Falls in amputees could be devastating, even more so in the elderly and frail population. 7

In-patient falls[edit | edit source]

Study conducted in the UK showed a 32% fall incidence amongst adult amputee in-patients and in Canada one study found a fall incidence of 20.5% and another 31%. 3 The majority of falls were in the following conditions: a patient seated in a wheelchair attempted an unassisted transfer and fell because of balance loss, improper use of the wheelchair, decreased movement, or because the patient did not follow instructions, or reached for something while seated in the wheelchair. 3 A patient who fell once has a 1 out of 3 change to fall again.

18% of in-hospital amputee patients sustain an injury after a fall. 5 In a retrospective study at a tertiary rehabilitation center in the United States following 1472 patients over 18 months the researchers found the following: 4

  • 9.5% of patients fell
  • patients fell mostly during the day (85%)
  • falls occurred in the patient’s own room (90%) when unobserved (74%)
  • 50% of falls happened in week 1 of rehabilitation

Out-patient falls[edit | edit source]

52% of out-patients fall 4

In general patients at a higher risk for falls: 5

  • patients between 41 and 50 years of age 5
  • diagnosis of stroke and amputation 5
  • patients with a large number of comorbidities (equal or more than 9) 5

Risk factors for falling amongst patients with limb loss: 4

  • Above knee amputation
  • Back or joint pain
  • Multiple prosthesis or stump problems
  • Patient has cognitive impairment
  • more than 70 years old
  • deaf
  • amputation was done less than 4 years ago
  • Increase postural sway during walking compared to non-amputees, esp in patients with amputations due to vascular dysfunction
  • Score low on the balance confidence scale

Fear of falling increases: 6

  • when the patient has to focus on each step taken
  • fall incident in the last 12 months
  • with poor health

==Reasons for falling== 4

  • Related to patient
  • Related to prosthesis
  • Related to environment
  • Combination of all 3

==Consequences of falls== 4

  • Fractures to the femur
  • Trauma to the stump
  • Increase in fear of falling
  • Lengthy hospital stay and patient is discharged to a long-term facility
  • Mobility and social activity restriction

==Goals: ==1

  1. Prevent falling
  2. Know how to minimize injury during a fall
  3. Know what to do immediately after falling
  4. If applicable, report fall to health care professional or get assistance

==In-patient fall prevention==4

==Out-patient fall prevention==1

  • Get rid of potential trip hazards like difficult to see objects, clutter on the floor, loose rug, rugs with a height difference that might catch your foot.
  • Make sure you have enough room between to furniture to move around a wheelchair or with crutches 2
  • Pets running around might lead to a fall and the patient should consider ways to prevent that
  • Immediately clean up any spills, wet floors, or pet urine??
  • Change or avoid areas of low lighting, slopes, or slippery floors
  • Change inaccessible or difficult to access areas
  • Get home assessed by a Physiotherapist or Occupational Therapist
  • Strengthen weak muscles
  • Optimal prosthetics and adjustments, maintain your prosthesis and follow the instructions from your prosthetist 1 2
  • Use of assistive devices, like cane or crutches
  • Be careful to change into shoes you are not used to as a heel height change will influence the alignment of the prosthesis and the change in hardness of the sole could influence your walking.

==Know how to minimize injury during a fall==1

  • People tend to fall forward, blocking their fall with their hands (reflexively) 1
  • Allow the body to be flexible
  • Practice falling with your therapist

==Know what to do immediately after falling==1

  • People will tend to help you and pull you up. This is not advised especially if you have an injury like a fracture or a dislocation. If you feel disorientated or confused then you might fall again.
  • Instruct the patient to stay seated on the floor after a fall and first get over the shock and then re-orient themselves and do a self-assessment to where they are and to feel for any new pain or injury. If the patient wears a prosthesis they should feel if the suspension is still intact and the prosthesis in working order. Gather the walking aids, if any. 1 7
  • If someone rushed over to help they should ask the person to wait for a moment while they come to their senses.
  • The patient could ask for assistance from the bystander. It is the easiest to go on to their stomach, then go on all fours (if possible), and then arise with assistance.
  • If the patient is alone he/she could crawl over to the nearest sturdy seating furniture and transfer into sitting
  • Practice recovery from a fall with your patient so that they are comfortable to stand up on their own, with assistive device, or transfer into sitting on a chair before standing up
  • If any injury is noted the patient should immediately phone/call for assistance
  • Persons living alone should try to always carry their mobile phone or an alert button/alarm (medical alert pendant) to alert emergency services


Resources[edit | edit source]

References[edit | edit source]

  1. 1Highsmith, J. Amputees & Falling. 360 Orthotics & Prosthetics. Available from: http://www.360oandp.com/Health--Wellness-Amputees--Falling.aspx [Accessed 25 Nov 2017]
  2. 2Ensuring Fall Safety. Kimball, C. Amputee Coalition. Dec 2014 https://www.amputee-coalition.org/ensuring-fall-safety/
  3. 3Dyer D, Bouman B, Davey M, Ismond KP. An intervention program to reduce falls for adult in-patients following major lower limb amputation. Healthcare quarterly. 2008 Mar 15;11(Sp). Available from: https://www.researchgate.net/profile/Kathleen_Ismond/publication/5470876_An_Intervention_Program_to_Reduce_Falls_for_Adult_In-Patients_Following_Major_Lower_Limb_Amputation/links/57acee5a08ae0932c974cd91.pdf [Accessed 25 Nov 2017]
  4. 4Falls in the Amputee Population: a literature review Presentation. Angela Stark NSW PAR 5th November 2004. Available from https://www.physio-pedia.com/images/4/44/Falls_in_Amputees.pdf [Accessed 25 Nov 2017]
  5. 5Lee JE, Stokic DS. Risk factors for falls during inpatient rehabilitation. American journal of physical medicine & rehabilitation. 2008 May 1;87(5):341-53. Available from: https://scholar.google.com/scholar_url?url=https://pdfs.semanticscholar.org/4109/1170671ef4eb6bd6ce38437346524bcf139a.pdf&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=ZNMZWsngBKTAjgTu16bYDg&scisig=AAGBfm1wrbr52FIX89tjWz_CJwX5xddOxQ [Accessed 25 Nov 2017]
  6. 6Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Archives of physical medicine and rehabilitation. 2001 Aug 31;82(8):1031-7. Available from: http://www.archives-pmr.org/article/S0003-9993(01)27659-X/fulltext [Accessed 25 Nov 2017]
  7. 7Engstrom B, Van de Ven C, editors. Therapy for amputees. Elsevier Health Sciences; 1999.


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