Characterizing and Identifying Risk for Falls in the LEAPS Study

Abstract

Background and Purpose Better understanding of fall risk post-stroke is required for developing screening and prevention programs. This study characterizes falls in the Locomotor Experience Applied Post Stroke (LEAPS) randomized clinical trial, describes the impact of two walking recovery interventions on falls, and examines the value of clinical assessments for predicting falls. Methods Community-dwelling ambulatory stroke survivors enrolled in LEAPS were assessed 2-months post-stroke. Falls were monitored until 12-months post-stroke and participants were characterized as multiple or injurious (M/I); single, non-injurious (S/NI); or non-fallers. Incidence and time to M/I falls was compared across interventions [home exercise (HEP) and locomotor training initiated 2-months (early-LTP) or 6-months (late-LTP) post-stroke]. Predictive value of 2-month clinical assessments for falls outcome was assessed. Results Among the 408 participants, 36.0% were M/I, 21.6% S/NI, and 42.4% non-fallers. Most falls occurred at home in the first three months after assessment. Falls incidence was highest for those with severe walking impairment who received early-LTP.(p=0.025). Berg Balance Scale (BBS) score ≤42/56 was the single best predictor of M/I falls. Conclusions As individuals with stroke improve walking capacity, risk for M/I falls remains high. Individuals walking <0.4 m/s are at higher risk for M/I falls if they receive early-LTP training. BBS, at 2-months post-stroke, is useful for informing falls risk but cannot account for the multifactorial nature of the problem. Falls prevention in stroke will require multifactorial risk assessment and management provided concomitantly with exercise interventions to improve mobility.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…174 Individuals with stroke are also at risk to be repeat fallers and to experience an injury associated with a fall. 175 A larger portion of fractures occurring in individuals with stroke (27%) involve the hip or pelvis compared with <10% of the general population of older adults who fall. 176 The loss of bone mineral density (BMD) associated with stroke may contribute to the higher hip fracture rate for individuals with stroke.…”

“…587 If left undetected or untreated, balance impairments can result in a cascade of serious, undesirable, and expensive events. 175,245 Evaluation of balance abilities is considered part of routine clinical practice in individuals with stroke. 308,588,589 Standardized tests of balance challenge different aspects of postural control such as anticipatory postural reactions during a variety of functional behaviors.…”

Foot placement control and gait instability among people with stroke

“…The Berg Balance Scale (BBS) is likely the most common clinical measure used to assess poststroke balance performance [8]. While this tool does not evaluate stability during walking, it has been used to predict fall risk among people with stroke with mixed success [4,9–10]. The Dynamic Gait Index (DGI) was developed explicitly to test stability in various gait tasks [11] and has been validated in people with stroke [12].…”

Association between dual-task performance and balance during gait in community-dwelling elderly people after stroke

“…Results to date do not support the applicability of these interventions in stroke survivors who are living in the community [28,29]. While it is likely that some of the approaches proven to reduce falls in the elderly may, in general, also be effective in individuals who have suffered stroke, there are [30].…”