One day, as Roberta rolled out of the house to go shopping, her wheelchair slipped off the side of the ramp, tipped over, and Roberta fell on the ground. Her caregiver checked her over, Roberta said that nothing hurt, and she was lifted back into her wheelchair. The next day, her lower legs were swollen and bruised and she was immediately taken to the hospital. X-rays showed that she had broken both her legs, even though she continued to say no when asked if her legs hurt. Casts were applied and fortunately her legs healed without a problem.
Roberta’s situation is a good illustration of some of the unique problems that may occur when someone with intellectual and physical disabilities falls. Roberta has cerebral palsy and uses a wheelchair all the time. Because she does not bear weight on her legs, she has developed osteoporosis which causes her bones to break more easily. Roberta’s ability to recognize and report pain is impaired; while anxiety may prevent her from admitting that she’s in pain. Because some people, like Roberta, cannot express pain, it is so important that you do not move them until it has been determined that there is no serious injury.
If you witness someone fall, call 911 immediately if the person:
- Is crying or calling out when lying still or when they move
- Is unconscious or slow to respond
- Is gray in color, lips blue or very pale
- Has an obvious deformity (bone sticking out, swelling or unusual position of the arm leg or head)
If none of these are applicable, allow the person to move themselves. Ask them to move their arms and legs before you attempt to lift them. Proceed very slowly. If they are unable to move any part of their body (but were able to move it before the fall) do not move the person and call 911. The EMTs can help you to safely move the person and assess the injury.
If you don’t need 911 continue to observe for:
- Scrapes or abrasions like “rug burn”
- Cuts or bleeding
- Any signs of pain, where the pain seems to be located and when it hurts. Some people express pain by a behavior change such as hitting their head or biting their hand
Remember that sprains and bruising may not initially show up so keep checking the person every couple of hours and seek medical advice if significant swelling or bruising develops. If the person you care for has had spinal, neck, hip or knee surgery problems consult with their doctor and get guidelines for when the person should be seen if they fall. Roberta has a letter from her doctor to take with her to the emergency room requesting X-rays whenever she falls even if she does not complain of pain. Planning ahead results in better medical care and treatment.
Author: Elizabeth R. Steele RN BSN MS CDDN, VP of Health Services and Supported Home Care
Beth began working at Fidelity House Human Services in 1988 and has worked at Fidelity House in various capacities as the Health Care Coordinator, Associate Executive Director, and Director of Health Services. Her previous experience was in teaching health care paraprofessionals for the Greater Lawrence Department of Training and Development and several other agencies. She enjoys working with people with intellectual, developmental, and physical disabilities and the people who care for them. Her favorite part of the job is empowering caregivers through education and support.