I said something in a comment once about falls and our friend Dean replied that I would make an excellent neuro PT and that I might actually know what I’m talking about.  Now, I had to do a post about this because Dean has a strong, strong dislike of physical therapists, understandably so.  So him saying that is a HUGE HUGE compliment!  What I said that made him say that was this…..All neuro PTs listen up!  Falls are a necessary evil for stroke survivors.  It’s gonna happen.  It just is going to happen.  So instead of therapy focusing so much on preventing a fall, therapy should focus on what to do in certain scenarios.  If someone is falling, teach them to throw out a protective extension, if possible.  Teach them and practice ways to control the fall as best as possible.  Dean said, and I LOVE this, that learning to walk again after a stroke is just a series of controlled falls.  Good God that’s beautiful.  Therapy needs to teach people how to get up after a fall.  I know for a fact this skill is not taught.  Maybe it’s taught to some people, but it’s sure as hell not taught to the majority of patients.  A series of controlled falls, therapy needs to focus on controlling those falls, not preventing them.

Categories: Brain stuff, Health, Recovery, Rehab, Stroke stuff

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45 replies

  1. My PT taught me how to get up from a fall which was very important once I did fall. I’m very grateful to her. It’s too bad she’s the exception not the rule, as you are too Amy.

  2. I think you are right about the falls. I think I made the most progress when I started aquatic therapy and quit worrying about breaking something with a fall. It helped my balance and my motion related nausea. I only wound up under the water and fished out by the therapist sputtering about 3 times. I fell over but was supported by water hundreds of times.

  3. falls were very commonplace after my stroke i’m laying on the ground laughing and ppl around me freakin out! But i taught myself how to get up after months of struggling with it. Now almost 3 years post stroke i very rarely fall

  4. One of the last things my PT did was ask me to stand up from the floor (as if I’d fallen). That was a year after my stroke and I was well versed on doing it myself by then. Seemed kinda ridiculous at the time.
    In my acute rehab, just after my stroke, I stressed the need but was ignored. I kept telling them it wasn’t if I’d fall but when.

  5. What your PT really needs to do as they are walking alongside you is to give you unexpected shoves or pulls in any direction

    • Yes, perturbation training.

      • next post – perturbation training

        • They used to do this with Zack at CNS. Also, the pic you have up of him on the GoFundMe page where he is with the walker and in that harness thingy…that harness runs along the roof so patients can practice walking without a walker or cane (or like in Zack’s case in that photo, he was in BAD shape and couldn’t walk without support from people AND a walker). They can even program it to give more or less support as the patient gets better, or they can program it to help them have controlled type falls to (as you are saying) practice falls. It’s a cool machine.

  6. The first time I fell post-stroke I slid under the car in the snow. I doubt any therapist would have been able to prepare me for that. It was quite a chore to get rolled onto my belly and pull myself out far enough to stand up again.

    • aww snow and ice.. source of extra falls but sometimes the snow is the soft landing. I have found myself under a car too. Usually because the passenger side door is too close to a poorly plowed road side curb.

      • My trouble with ice is when my cane, not my feet, hit an icy patch. If I can’t find a clear spot (snowy is ok) for my cane, I don’t put much weight on it as I step forward. I agree about the snow being an ok place to land. I was once making my way to a neighbor’s house after a blizzard, and Tom was hovering more than usual, trying to control every step. Finally I told him to back off – worst case was that I’d fall in the snow and get snow in my socks.

  7. Ken and I have already been experiencing falls and we have been home for three days. He said that it was alright to go take a shower that he was fine on the couch. I heard a thud and our little dog start barking. I got into the living room to find Ken on the floor laughing with pillows around him from the couch. Between getting him on his back and standing together we got him back on the couch. He couldn’t stop laughing. I was chuckling too after he said that he wasn’t hurt. So… we are falling and I know that his family would freak right out. but we are learning and doing good.

    • How are you guys doing at home? It’s incredibly overwhelming for both of you.

      • I am frustrated. I have had two different aides come to the house and both of them have managed to let Ken fall transferring him from the bed to the wheelchair. So… I have had to rush home from work to pick him up off of the floor. I am an electrician, NOT A NURSE OR CNA OR THERAPIST. How is it that I can get my husband up off the floor but these aides with 20 years experience have no clue?!?!?! I am lucky that my boss is understanding because it is 20 min one way just to get home, so there is an hour+ shot out of my day. Ken told me today to put him in a home and to find someone else so that my life would be easier. We both started crying and I told him that it wasn’t an option EVER! I feel helpless, alone, tired, and almost to my next breaking point and we have only been home for 6 days. Ken and I are great when it is him and I working together. I am having a hard time with the people that are with him while I am at work.

        • Jan, congratulations on being a better PT than the professionals who “help” your husband. It’s no surprise to us that you are in a DIY stroke rehab situation – we all are.

        • Jan, I am so sorry. I remember day six. It goes fast… It really does. Is there anyway that you can take some time off? Do you not have that option in your benefits or insurance? I took an unpaid leave if absence for the last three months of school last year. Also, are there any inpatient rehabs near your home? Has he gone to inpatient rehab yet? That may be the ticket until he can get a little more mobile. Did he have a cerebellar stroke? Sorry for all the questions. I am the wife of a brain injury survivor too. I know how lonely you feel, email me anytime. My husband is coming up on his one year mark. brookeannfuller@gmail.com

          • We just got discharged from an acute rehab facility. We were there for 2 1/2 months. The only other option was to put him in a nursing home for more “rehab” but I know that they would be leaving him in his bed for 23 hours of the day except for the hour that they would do “therapy” with him.
            I was out of work for almost three months during the entire situation. I used all of my sick, vaca and personal time and then had 34 days donated to me. The only way that I could have time donated was if a doctor said I was unable to do my job because of what happened to Ken. I haven’t been in this job a year yet so I am still on probation. Taking unpaid time off isn’t an option because I am the only income. Insurance isn’t going to be hardly paying for squat now that we are home. The only thing I keep hearing is TBI Waiver, but that is Medicaid and we are not quite ready to liquidate his entire future just to apply.
            I am hoping that our aide today was able to work with him enough yesterday so that she can get him out of be. I can’t lose my job with all of this, and my boss is going to get sick of me running home if these people can’t figure it out.

            • I am unfamiliar with a TBI waiver and Medicaid, sorry, so I am not sure what that means. We are in very similar situations. I did the exact same thing-exhausted all leave and then some. Zack was able to go on to an inpatient rehab under our skilled nursing facility benefits, after his acute rehab it was a life saver for us. As he was still pretty much full care after he was discharged from that facility… And yes, I am all too familiar with the in bed for the entire day except for when he had therapy. That was the first place. The second place he went into had six hours of therapy, which is unheard of and exactly what he needed. Where are you guys at in the US? I would bug the heck out of insurance and talk to rehab facilities to find out what all the benefits are that are a solvable to you guys. There are thousands of dollars in insurance monies available that we have no idea about and insurance sure as heck doesn’t want to share that info. Push, push, push, is my advice. I, too, hope it works out with your aide. Also, your husband’s recovery will start to move along and he will become stronger and more able on his own. My life was complete hell when zack came him this last September and it has improved so much since then! It will get better! I am so sorry you are having to traverse this terrain. Peace and grace to you. Email anytime!

              • HE MADE IT TO THE LIVING ROOM!!! Finally a morning where I don’t have to speed home to pick him up for the aide!!!
                He has already been to a place where he was doing 4 hrs a day and the only other option is the nursing facility after that. That is why I brought him home. At least all of the therapies will be coming to the house 2-3 times a wk. I am going to meet the PT today for the first time.
                With medicaid he could only have $14,550 in assets and they would cover pretty much the entire cost of his care and therapy after we pay so much $$ out of pocket. You pretty much have to be poor in order to get it. Our insurance doesn’t cover much as far as rehab facilities.
                We are in upstate NY close to Albany. I work for the state and have tried finding help through them and there is none.
                I can’t thank you enough for chatting with me and giving me your email. You can be sure that you will be hearing from me.

                • Wow, wow, wow! I’m so glad (I think) that you got to put in a full day of work. The change of scene for him must be pleasant too. Nice progress. That’s how it goes – small increments.

                  Sent from my iPhone

                • yeah!!! Thank Heavens. Small victories will, before you know it, all add up to bigger ones. Hoping for momentum to continue for you guys!

            • And yes, Jan, I wholeheartedly agree-no busing homes for us either. Hell to the no!

  8. Good morning Amy, would you be able to become a pt consultant? Could you speak at colleges teaching pt, stroke centers, etc? Sorry I don’t remember what your challenges are, but I always thoroughly enjoy reading your blog!

  9. Yes, I’m terrified of falling, mostly because I had a bad fall pre-stroke and I never want to feel that again: helpless and knowing it will end badly. Post-stroke, I have been lucky enough to have soft landings, and have been caused by turning at my waist quickly, which is easy enough to not do.

    I WAS taught how to stand after a fall as soon as my PT knew I was going to start being alone in my house (once my last full-time keeper left), but it involved crawling to a stable object to help pull myself up, which was useless when I fell in my garden.

  10. Tonight coming home from someone elses’ presentation, I purposely walked on the sheet ice that dripped from the carports. I need more challenges and if I injure myself I’ll have more stories to tell in retirement.

  11. Amy, too true, I had a really bad fall in my 2nd year post stroke off the third sterp on my concrete patio – trying to pull shut the sliding glasss door which was much too heavy for me. I fell about 4 feet and broke my shoulder as a result, which put my recovery back at least a year, but I haven’t fallen since, and I am at home by myself quite a lot. I think falls are a part of learning to walk again. marta

  12. I still cant believe he purposely walked on ice! I avoid ice at all costs!
    Sorry, I was originally going to say my PT in the inpatient rehab hospital showed me to properly get off the ground in case I fall, in case I’m just down there, what-have-you. Then I got up in front of my brother once and he was like “what the hell are you doing?!?” “I’m getting up! This is how I was taught to get up. This is how stroke-people have to do it, Johnny!”

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