Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 107: Reducing Fall risk After Knee Replacement (Using the CDC STEADI Framework)

Transcript

Episode 107: Reducing Fall risk After Knee Replacement (Using the CDC STEADI Framework) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Handrails should be secure. A towel rack is made
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  for towels, while a properly installed grab bar
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  is designed to support your weight. Not the other
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  way around. Are you ready to get back to what
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  you love after knee replacement? The Total Knee
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  Success podcast is your trusted guide with practical
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  tips, evidence -based strategies, and no fluff.
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  It's not personal medical advice, just solid
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  education to help you manage pain, regain mobility,
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  and get back to living the life you love. Let's
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  dive in. Welcome back to the Total Knee Success
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  podcast. I'm Michelle. Ellen was about six months
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  past her knee replacement. She had finished formal
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  physical therapy. She was walking well in most
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  places and her operated leg was getting stronger.
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  Then she had two close calls at home. The first
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  happened while she was carrying a cup of coffee.
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  Her shoe caught the corner of a rug, and she
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  grabbed the counter. A few days later, she stood
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  up during the night, turned toward the bathroom,
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  and reached for a wall that was farther away
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  than she had remembered. She caught the dresser
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  and stayed on her feet. Once felt like a fluke.
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  Twice got her attention. Ellen's not a real person.
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  Her story reflects situations people may experience
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  after knee replacement. You may have had your
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  own version of Ellen's story. Maybe your toe
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  caught a threshold, you wobbled when you turned,
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  or you suddenly reached for the counter. You
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  stayed on your feet and carried on with your
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  day, but the experience left you wondering whether
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  you should do something about it. This is the
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  third episode in our four -part series on fall's
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  balance and everyday independence. Episode 105
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  covered what to do after a fall. Episode 106
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  explained why balance can continue to require
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  more care even as your operated leg gets stronger.
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  Today, I'll show you how the STEDI framework
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  can help you notice possible fall risks and learn
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  about common ways to reduce them. By the end
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  of this episode, you'll know how to use STEDI's
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  three steps to think through a fall or close
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  call. You'll also have five useful questions
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  you can use to check the places where you spend
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  your time. We're going to use a program from
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  the Centers for Disease Control and Prevention,
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  or CDC, called STEADY. STEADY stands for Stopping
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  Elderly Accidents, Deaths, and Injuries. Now,
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  the name sounds kind of scary and formal, but
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  the basic idea is simple. Find out whether someone
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  may be at risk for falling, look at what is contributing
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  to that risk, and do something about the factors
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  that can be changed. The CDC created STEADY to
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  help healthcare professionals prevent falls in
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  adults age 65 and older. It also provides public
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  resources that you and your family can use, including
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  a fall risk questionnaire and a home safety checklist.
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  Steady starts with three questions. Have you
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  fallen in the past year? Do you feel unsteady
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  when standing or walking? Do you worry about
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  falling? You can answer those questions for yourself.
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  A yes to any one of them is a reason to look
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  more closely at your fall risk. Remember, this
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  podcast is general educational information, not
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  a diagnosis or a substitute for advice from a
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  healthcare professional who knows your situation.
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  Ellen answered no to the first question, which
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  was, have you fallen in the past year? She answered
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  no because she had stayed on her feet. She answered
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  yes to feeling unsteady, and she had started
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  thinking about whether she might fall. Those
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  two answers told her that the close calls were
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  worth taking seriously. A close call counts.
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  You do not have to wait until you fall before
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  you take it seriously. In fact, you shouldn't.
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  Catching yourself on a counter, stumbling in
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  the same place, or suddenly reaching for furniture
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  may show that something about your body, the
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  task, or the area around you needs a closer look.
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  If this happens to you, make a quick note after
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  you're safe. Write down where you were, what
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  you were doing, and what you felt. Add anything
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  that stood out, such as if it was in darkness,
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  if there was a wet floor, if you felt dizziness,
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  pain, or fatigue. You're simply trying to remember
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  enough detail to see whether the same situation
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  happens again. Ellen wrote down both close calls.
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  One happened late in the day while she was carrying
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  coffee, and her shoe caught the rug. The other
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  happened at night after she stood from bed and
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  turned toward the bathroom. She felt unsteady
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  during the turn and remembered that the hallway
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  was dark. She did not remember feeling dizzy
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  or lightheaded. Now she had more than, I almost
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  fell twice. She knew when each close call happened,
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  what she was doing, and what she noticed. The
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  next part of steady is figuring out what may
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  be increasing the risk. The CDC calls this assessment.
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  Steady looks at several areas because falls rarely
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  have one single cause. A healthcare professional
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  may ask about previous falls, walking, balance,
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  leg strength, medications, blood pressure when
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  you stand, vision, feet and footwear, health
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  conditions, and hazards in your home. That's
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  a lot. But each part answers a useful question.
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  Did something change in your health? Did a medication
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  make you sleepy or lightheaded? Did your foot
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  catch an object? Was the room dark? Did you lose
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  your balance when you churned? The goal is to
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  understand what was happening at the time. Ellen
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  made an appointment with her physician to discuss
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  the two close calls. At the visit, her physician
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  asked about dizziness, faintness, vision changes,
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  weakness, and other symptoms. Her physician also
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  reviewed her medications and supplements for
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  anything that might contribute to sleepiness,
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  dizziness, blurred vision, or slower reactions.
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  Ellen continued taking her medications as prescribed.
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  Because Ellen had finished physical therapy and
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  was now having trouble with balance and turning,
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  her physician referred her back for an evaluation.
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  Her physical therapist watched her walk, change
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  direction, step over an obstacle, and complete
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  dynamic standing balance activities, among other
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  things. Ellen's operated leg had continued to
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  get stronger after therapy ended. Her balance
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  challenge showed up when she had to change direction
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  quickly or manage more than one thing at a time.
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  When she carried the coffee, part of her attention
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  was on the cup. During the nighttime walk, she
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  stood, turned, and started walking before her
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  eyes had adjusted to the darker hallway. Her
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  physical therapist could now see which activities
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  challenged her and decided whether more gait
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  training with turns, dynamic upright balance
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  practice, or another type of exercise would be
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  useful. If you want a deeper explanation of why
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  turning and uneven surfaces can still challenge
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  your balance after knee replacement, Episode
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  106 covers that in detail. You can check that
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  out after you're finished with this episode.
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  Ellen also looked closely at the two places where
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  the close calls occurred. The rug had a curled
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  edge. A charging cable sat near the walking space.
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  The hallway between her bed and bathroom stayed
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  dark until she reached the bathroom switch. Her
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  cane was leaning against the opposite wall, so
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  she could not reach it before standing. This
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  gave Ellen a much better picture. Her close calls
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  involved a mixture of timing, attention, turning,
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  lighting, and things in her home. Her plan needed
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  to address the combination that showed up in
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  her life. The third part of study is taking action.
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  The CDC calls it intervention. In everyday language,
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  you do something about the risks you found. Ellen
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  moved her cane beside the bed so she could reach
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  it before standing. Her husband plugged in a
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  motion -activated nightlight that came on when
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  she stepped in the hallway. She could now see
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  the floor before she reached the bathroom switch.
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  Ellen liked the rug and did not want to remove
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  it. Her home still had to feel like her home.
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  She decided to secure it with a non -slip backing
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  and move the charging cable away from the walking
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  space. If that setup failed to keep the rug flat,
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  she was willing to move it to another room. Her
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  physical therapist addressed the turning and
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  balance findings from the evaluation. Under her
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  physical therapist's direction, Ellen practiced
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  walking while changing directions, stepping around
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  obstacles, and completing dynamic balance activities
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  in the clinic. Her therapist guarded her as needed
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  and made the activities more challenging as her
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  control improved. The plan fit Ellen because
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  every part connected to something that had actually
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  happened. She wasn't trying to complete every
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  fall prevention recommendation at once. She was
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  working on the risks that appeared during her
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  close calls. The CDC home safety checklist covers
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  a lot of ground. I've pulled its main ideas into
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  five questions you can use as you walk through
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  your own home. First, what's under your feet
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  and what's on them? Think about your shoes or
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  slippers as well as the floor. The CDC recommends
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  shoes that fit well and provide support inside
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  and outside the house. Then look for curled rugs,
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  cords, clutter. pet toys, wet floors, and changes
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  between carpet, tile, and thresholds. Pay special
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  attention to anything you routinely step over
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  or walk around. Second, can you see where you're
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  going before you start walking? Check the path
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  from your bed to the bathroom, the top and bottom
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  of the stairs, entrances, and any hallway that
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  becomes dark at night. A nightlight, brighter
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  bulb, or reachable switch may help. Third, Is
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  the support you need available where you need
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  it? Your cane or walker should be within reach
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  before you first step. Handrails should be secure.
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  A towel rack is made for towels, while a properly
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  installed grab bar is designed to support your
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  weight, not the other way around. Fourth, do
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  you have enough room to move and turn? Notice
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  where furniture narrows a walkway or forces you
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  to squeeze through with a cane or walker. Moving
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  one table a few inches may give you enough room
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  to change direction without twisting around an
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  obstacle. Fifth, can you reach the things you
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  use without stretching, climbing, or carrying
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  too much at once? Keep frequently used kitchen
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  items within comfortable reach. Place your phone,
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  glasses, and walking device near the bed. Think
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  about whether a laundry basket or grocery bags
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  block your view or occupy the hand you need for
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  a rail. You may find several things you could
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  change. Choose the one or two that connect most
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  closely to what has happened in your home. People
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  are more likely to use a plan that fits their
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  routines, priorities, and living space. Different
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  findings call for different actions. A medication
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  concern needs a conversation with the clinician
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  managing the medication. A vision change may
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  call for an eye care appointment. Lightheadedness
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  when standing needs medical evaluation. A walking
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  or balance problem may lead to the need for physical
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  therapy or an evidence -based fall prevention
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  exercise program. Recurrent lightheadedness,
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  faintness, or new change in balance deserves
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  medical attention. Sudden fainting, chest pain,
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  shortness of breath, one -sided weakness, trouble
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  speaking, sudden trouble seeing, or a rapid loss
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  of coordination calls for emergency care. Don't
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  mess around with that. Ellen used steady in a
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  way that made sense for her. The questions helped
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  her recognize that the close calls deserved attention.
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  The assessment showed her what was contributing.
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  The final plan gave her useful changes she could
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  make at home and specific activities she could
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  work on with her physical therapist. If you've
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  had a fall or close call, start with the three
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  questions, then write down what happened and
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  look at the area around you using those five
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  home safety questions. That information can help
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  you decide what you can address yourself. and
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  when you want help from a healthcare professional.
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  And when in doubt, always check with a healthcare
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  professional. The CDC study materials including
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  the fall risk questionnaire and the check for
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  safety home checklist will be linked in the show
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  notes to the blog post for this podcast episode.
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  If walking still feels uneven or less automatic
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  than you expected, my book Walking Like Yourself
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  Again After Knee Replacement explains more about
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  the factors that can affect the way you walk.
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  You can also join the free Total Knee Success
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  Insider Newsletter for new episodes, articles,
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  and knee replacement education delivered by email.
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  The sign -up link is in the show notes and at
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  TotalKneeSuccess .com. In episode 108, we'll
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  complete this series by looking at carrying groceries,
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  laundry, trash, water, and other everyday items.
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  We'll look at what changes when one hand is occupied,
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  when your view of the floor is blocked, and when
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  the load pulls you toward one side. Thanks for
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  joining me. I'm Michelle and this has been the
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  Total Knee Success Podcast. This podcast is for
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  educational purposes only. Discover more at TotalKneeSuccess
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  .com and be sure to subscribe and share because
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  every step forward takes you closer to living
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  the life you love.