© 2018-2019 by Kupuna Aikido.  All Rights Reserved.

SURVEY

As an experienced martial artist, we would appreciate your feedback.  We plan to use the information to prepare for consideration as an Evidence Based Falls Prevention Program. The information is anonymous and will not be linked to any individual.

The survey has three kinds of survey input:

  • There are YES/NO choices.  These choices are set to "YES" (green).  If you click on it, it will turn to "NO" (red).

  • Pull Down Menu (Age Group): Click on the down arrow and select one of the age groups.

  • Text Box: When more detailed information is asked for, please click on the text box and the box will open for your input.

After you complete the survey, click on "SUBMIT" and a Thank You page should open when you have successfully submitted the survey. If you need to report another fall, a link will lead you back here.

  • What martial arts do you practice?

  • How many years current experience?

  • Did you fall after starting martial arts?

  • If yes, what was your age bracket when the fall occurred?

  • If yes, how many years of martial arts experience at the time of the fall?

  • Circumstances of the fall:

Off balance?​

Tripped on something unseen/unnoticed?

Carrying a lot of items?

Were people with you?

What did you do as you were falling?

What did other people do after you fell?

What did you do after you fell?

What were the nature of your injuries?

What sort of medical treatment was administered after your fall?

  • In your opinion, were injuries less severe as a result of martial arts training?

  • What preventative measures did you employ?

Martial/Situational awareness:

Better sense of balance due to martial arts:

Years of martial arts practice:

Muscle memory from repetitive falls:

Lower body closer to the ground/floor:

Turn and distribute impact across muscle mass:

Protect head, neck and joints:

Relaxed while falling:

Other:

  • Additional Comments:

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