Studying falls among schoolchildren has taken on considerable social importance, as it is a subject with close ties to public health, safety and child protection; for this reason, it has become a worldwide intervention priority in developed countries. The subject’s salience is also visible in numerous publications in high impact journals on education and public health [1
The World Health Organization (WHO) has expressed concern about falls, as they are the second most common cause of children’s deaths resulting from unintentional injuries [6
]. In Spain, different studies [7
] have shown falls to be the third cause of child deaths from unintentional injuries. In Andalusia 4.3% of deaths caused from unintentional injuries derive from falls [8
]. According to the Andalusian regional government, 26% of these deadly falls occur in the school setting [11
]. In turn, in 2014, the Spanish Association of Pediatrics [13
] pointed to falls as the leading cause of unintentional injuries in children under fourteen years of age. These statistics are similar at the international level, where the results obtained in Spain coincide with those of the European Alliance for Child Safety [14
]. Regarding the type and frequency, several research projects have been carried out with the objective of determining what type of falls are the most common and how often they occur. These studies highlighted the frequency, severity, and the types of injuries that occur in the head, the upper and lower limbs, and the hip [7
]. However, it can be observed that backwards falls, without being the most frequent, are responsible for the most serious types of injuries [9
]. In support of the above statistics, the United States estimates the healthcare expenses arising from injuries from falls in children from 0 to 14 years to be $
58 billion USD a year [16
As awareness of this issue has grown, Spanish [8
] and international [4
] researchers have responded with prevention programs and research, with attempts to approach the issue from multiple sectors. However, prevention is not enough, as the risk of children falling while they practice sports or games is still present [5
]. To provide a response to the problem associated to child falls beyond prevention programs, the current study proposes a proactive training program that serves as a new tool in the field of fall prevention. This program, Safe Fall [21
], teaches children how to protect themselves when they fall. The program forms part of WHO proposals internationally, and in Spain, the Health Ministry [22
] is contemplating multi-disciplinary programs aimed at minimizing the risk of injuries from falls. A recent study [23
] showed that there is great demand for training in falls among future health and education professionals, owing to the current lack of training in this specific field.
Safe Fall has been designed to mitigate the risks posed by unintentional falls in school-age children. In turn, from a teaching viewpoint, it aims to improve the competences regarding this phenomenon of specialists in health, physical education, and sports. Safe Fall aims to contribute to existing fall prevention programs, giving education professionals an innovative and practical tool to proactively teach falling in a safe way.
The objective of this study is to analyze the motor response of primary schoolchildren when a backwards fall occurs before and after the implementation of the Safe Fall proactive program for the teaching of safe and protected ways of falling.
The proposal to teach children safer falling techniques in Physical Education classes provides a new orientation for falls prevention and active protection aimed at the improvement of children safety and health [8
]. It corresponds to the recommendations of the WHO [6
], and the Spanish Ministry of Health [22
], for the design of effective preventive programs. As these organizations point out, for these programs to be effective, they must be extensive and multi-disciplinary if the expected result is to eliminate the factors that cause the severity of the injuries when the fall does occur. In this sense, it is possible to teach school-age children protective motor responses to the most frequent responses that can lead to injuries during a fall [21
The Safe Fall program is aimed at safeguarding minors when they fall by training motor responses associated with the protection of those areas of the body most at risk of injury in falls: head, upper limbs, hip or lower limbs [6
]. Our results suggest that through repetition of the exercises performed in the Safe Fall program, students develop automaticity of the correct motor response, as has been shown in the elderly [26
]. This would reduce the risk of injuries, as shown by the teaching of falls in judo [27
The risk of falling increases in children between the ages of 6 and 12 because their development leads to participation in more complex games and activities that require greater dynamism [2
]. Furthermore, in more developed societies, children in this age group are initiated into sporting activities, which in many cases entail a high risk of injury [8
]. The improvement of basic motor skills proposed in the program, through the work of dynamic coordination, balance, and turns prepares minors to produce an adequate response to a fall, thus reducing risk of injury [21
]. Essentially, the program aims to teach minors so that their motor response in the event of a fall is in accordance with parameters of greater protection and safety, and may contribute to a reduction in the risk of suffering injuries. After students have completed the Safe Fall program, repetition of the program’s exercises should be executed throughout all the academic years (ages 6–16) so that the response to a fall can be replicated. On this approach, it would be necessary to monitor the students trained in the program on safe falls and perform a new evaluation in order to obtain new data to establish the permanence or absence of the tested response. Likewise, it would be necessary to know what level of transfer can be expected in the event of a fall that occurs in a situation different from the context of the program. Furthermore, it would be important in order to establish a training program on falls, to understand the influence that the load in terms of volume and time of practice, have on the response obtained, so that the program continues to be effective in the event of an unexpected backward fall.
To correctly determine the methodology and progressions that allow effective responses to be established to facilitate the learning and automation of protective motor responses in backward falls, it is necessary to have prior knowledge of the circumstances and factors that take place during the fall [14
]. The data obtained in this study is directly related to the possibility of reducing the injuries that occur most frequently in backward falls [10
], such as, for example, decreasing the intensity of the impact of the head against the ground, and even avoiding the blow, providing protection against the most serious type of injury produced by this type of fall [9
]. Although it has not been possible to compare this proposal with other programs designed to teach children to fall, the results obtained by other authors about a group of judokas between 16 and 30 years old, who train the falls in their sport, shows that in the event of an impending fall they suffer less injuries and less severe, compared to a group of people who did not practice professional sports [27
This program directly influences one of the main causes of injuries among children [12
]. Regarding this problem, a study carried out by the Andalusian government has determined that 26% of children’s falls occur in schools, which highlights the need to train primary school teachers in the specific area of falls and justifies that the program is a practical tool for teachers and those responsible for the education of school-age children [23
]. Despite that, in the reviewed literature, no programs were found that teach school-age children to fall in a safe manner.
In the comparison of the results obtained after this program between boys and girls, no significant differences have emerged in the data obtained, and it can be said that therefore, the program it is suitable for both genders despite the fact that boys are more likely to suffer falls [9
Within the limitations of the study we must mention the scarce existing literature on programs to teach children to fall at school age, which prevents the comparison of data obtained with other studies. Another limiting aspect is the impossibility of correlating the motor response of the students, after receiving the training, in contexts different from those used in the laboratory conditions; although it should be noted that this limitation is determined by the predominant principle of protecting the physical integrity of the child. In successive research interventions it would be necessary to broaden the study of other forms of falling, such as sideways and forward. Finally, we want to point out in this paragraph the limitation of not establishing a control group to be able to contrast the consistency of our results. In future interventions, a control group will be established that, once the intervention has been carried out, will receive the same training that is carried out with the experimental group.
According to the results obtained, the study should be extended with the development of ways to fall forward and sideways, which contribute to the reduction of the risk of suffering injuries. This entails the need to develop new observation scales to evaluate the learning of protective gestures on falls occurring in those directions. Similarly, the sample could be extended to cover all state schools in Andalusia, Spain. Finally, the program could also be implemented in secondary schools, extending the age range from 12 to 16. In order to establish the possible positive correlation between the participation of the students in the program and the decrease of the number and severity of the injuries suffered as a consequence of a fall in everyday life, joint longitudinal studies and research in the area of Public Health would be needed, in which it could be established whether or not a decrease of the quantity or severity of injuries suffered as a consequence of a fall, as described by the WHO, is taking place in a target population that has received education regarding protected and safe falling techniques through the Safe Fall program. Likewise, new longitudinal studies must be carried out to determine the length of time required to implement the Safe Fall program, so that the motor responses considered adequate for safety in the event of a fall are automated by the students.