In defence of falling: the onomastics and ethics of “therapeutic” falls in rehabilitation

Abstract

Aim: Despite efforts towards a more just culture, rehabilitation providers still experience shame and trauma when their patients fall. This paper proposes a shift in philosophy in how we classify, communicate and learn from falls, and joins the growing literature in which falls in rehab are not seen as something to be avoided at all costs, but rather as part of the recovery journey for some patients. Methods: Patients who understand and are willing to take on the risks of falling are more likely to collaborate with their care team to practice higher-risk activities, such as walking to the bathroom independently at night, as part of their recovery. If a fall takes place in this context, we argue that it should be considered a “therapeutic” fall. Results: This paper details some of the clinical and ethical approaches to supporting a care environment where values—and potential conflicts—about the benefits and challenges of risk-taking are recognized. An expanded concept of a therapeutic fall may help patients and providers take a more balanced and nuanced approach to promoting safety while maximising independence. Conclusion: The goal of this work is to offer rehabilitation patients greater opportunities to make autonomous decisions about their mobility, and lay the groundwork for a more successful transition home. IMPLICATIONS FOR REHABILITATION Despite best efforts, patients are often less active than they or their rehabilitation team might wish them to be. An expanded concept of a “therapeutic” fall may help patients and providers take a more balanced and nuanced approach to promoting safety while maximising independence. Rehabilitation is the right environment to support shared decision-making about risk that better prepares patients and families for the often challenging transition back to community living. This works represents a shift in philosophy in how we classify, communicate and learn from falls, and joins the growing literature in which falls are not something to be avoided at all costs, but can instead be part of the journey to recovery.