Rehabilitation settings are unique in that certain – and perhaps uncomfortable – risks are an inherent part of care. One significant risk is that of falls, particularly as patients re-learn how to move again after complex injury or illness. For some rehab providers there is a tension between two primary goals of rehab: To maximize function and independence and keep patients safe.
This work responds to some of these tensions. It joins the growing literature in which falls are not seen as something to avoid at all costs, but rather are part of recovery for some patients. Instead of restricting mobility, we collaborate with patients to make informed decisions about higher-risk activities they may wish to take, even if there exists an increased potential of a fall.
We define a ‘therapeutic fall’ as “a fall that occurs during a higher-risk activity that a patient has chosen to participate in as part of their recovery”. It has three components: the person (1) chooses to pursue the activity as part of their rehabilitation in collaboration with their therapy team, (2) knows that falling and its associated consequences are possible risks, and (3) receives education on preventing falls and reducing harm.
An example is a patient who understands and appreciates the risks of walking to the bathroom without supervision, provides consent after being educated about the risks, alternatives and strategies to reduce harm, and then falls while participating in this activity.
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