Untitled

Abstract

Stroke survivors are at high risk for falls in all poststroke stages. Falls may have severe consequences, both physically and psychosocially. Individuals with stroke have an increased risk for hip fractures, and after such a fracture, they less often regain independent mobility. In addition, fear of falling is a common consequence of falls, which may lead to decreased physical activity, social deprivation and, eventually, loss of independence. Important risk factors for falls are balance and gait deficits. Stroke-related balance deficits comprise reduced postural stability during quiet standing and delayed and less coordinated responses to both self-induced and external balance perturbations. Gait deficits include reduced propulsion at push-off, decreased hip and knee flexion during the swing phase, and reduced stability during the stance phase. Interventions addressing these deficits can be expected to prevent falls more successfully. Preliminary evidence shows that task-specific exercise programs targeting balance and gait deficits can indeed reduce the number of falls in individuals with stroke. Technological advances in assistive devices are another promising area. More research is needed, however, to provide conclusive evidence of the efficacy of these interventions regarding the prevention of falls in individuals with stroke.

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

“…In 2008, Weerdesteyn et al reviewed the literature regarding poststroke falls and found a high fall incidence rate after discharge from stroke care: between 1.4 and 5.0 falls each person-year [41].…”

“…That being said, note that in their recent review of the poststroke falls literature, Weerdesteyn et al stated that some falls after stroke may be inevitable and that fall prevention programming, while effective in improving balance and strength, has not negated poststroke fall risk [41]. History of anxiety was an independent predictor of falls in the acute hospital inpatient setting.…”

Incorporating Research Technology into the Clinical Assessment of Balance and Mobility: Perspectives of Physiotherapists and People with Stroke

“…1 Comprehensive balance and gait assessment by a physiotherapist is essential to developing treatments aimed at regaining safe independent mobility. Conventional assessment tools used in rehabilitation may identify impairments in balance and gait performance but do not identify the underlying pathophysiological mechanisms responsible for these deficits, which is essential for targeted fall prevention and rehabilitation strategies.…”

“…Conventional assessment tools used in rehabilitation may identify impairments in balance and gait performance but do not identify the underlying pathophysiological mechanisms responsible for these deficits, which is essential for targeted fall prevention and rehabilitation strategies. 1 Biomechanics technologies, such as force plates and pressure-sensitive mats, have been used in research to provide detailed quantitative information on control of balance and gait but have rarely been incorporated into clinical practice. 2 Understanding the clinician's perceptions and experience of these technologies would be helpful in developing clinical tools and improving the ongoing collaboration between clinicians and researchers required for knowledge translation.…”

Medical utilization and cost outcomes for poststroke veterans who receive assistive technology devices from the Veterans Health Administration

“…This CMS determination conflicts with legislative actions that mandate individuals with disabilities be provided with the necessary supports to live as independently as possible in their communities [1]. Even though increased use of assistive technology devices (ATDs) has been cited as one of the reasons for decreasing disability [3][4] and has positively affected health-related costs by reducing falls and, subsequently, hospital admissions and institutional care [4][5][6][7][8][9][10][11], fewer than 50 percent of older adults with chronic disability and fewer than 25 percent of individuals with recent disabilities received ATDs [12]. Further, only 6 percent of community-dwelling Medicare beneficiaries received any ATDs from Medicare [13].…”