Incidence and risk factors of falls and fall-related injuries at the medical and surgical wards of the Philippine General Hospital

OBJECTIVE: There is no published local data available on falls and fall-related injuries among hospitalized patients. This study aims to determine the incidence of falls, fall-related injuries and related risk factors at the surgical and medical wards of a tertiary government hospital in the Philippines. METHODS: This is a cross-sectional study using consecutive sampling of patients admitted to the medical and surgical wards of a tertiary government hospital from May 2014 to April 2015. Data collection included the patients' demographic data, diagnosis, medications, details on the fall, consequence of the fall, and risk factors for the fall. RESULTS: During the one-year period, 25,849 patients were admitted to the medical and surgical wards and only six patients, representing 0.02%, were reported to have sustained a fall. No major injury occurred. The patients had varied neurologic and/or musculoskeletal disorders. Two patients fell from a wheelchair, while one fell from a bedside chair. One patient fell from the bed and one slipped on the floor. All patients had watchers/witnesses at the time of the fall. CONCLUSION: The incidence of falls and fall-related injuries is low in a local tertiary government hospital. No serious injury resulted from the falls. Prevailing practices, local cultural expectations and under reporting may have affected the relatively low incidence rates of patient falls reported in this study.

Strümpell-lorrain syndrome in three brothers

Three brothers, aged 5, 19 and 24 years, from Tuguegarao, consulted because of walking difficulty due to stiffening of lower extremities which started at varying ages. Common findings were mild spasticity and weakness in both lower extremities, consistent with Strumpell-Lorrain Syndrome. Individualized rehabilitation medicine interventions were provided to address different functional deficits, leading to improved outcomes. This case series aims to illustrate the importance of initiating early, comprehensive rehabilitation to maximize function and minimize complications.

Stroke rehabilitation during pregnancy

A 34-year-old, G5P4, non-hypertensive patient presented with headache, left hemiplegia, and dysarthria on her third trimester. Cranial computed tomography scan revealed a right capsuloganglionic bleed. The biophysical report was essentially normal. Non-surgical management was instituted. The patient was referred for rehabilitation consisting of physical and occupational therapy with fetal monitoring to facilitate optimal functioning. This case report highlights the importance of early multidisciplinary management of a patient with stroke during pregnancy.

Fascioscapulohumeral dystrophy

Two Filipino sisters from Capiz presented with facial muscle weakness followed by weakness of both shoulders and arms, and scapular winging. Both presented with difficulty in performing activities of daily living. The younger sister also had bilateral lower extremity weakness with difficulty in ambulation. The results of electrodiagnostic testing in both sisters were compatible with myopathic disease. Comprehensive individualized rehabilitation addressing different functional limitations, focusing on maintaining mobility and functional capacity, and resulting improvements are presented.