Falls After Stroke

After acute stroke, one of the most common medical complications is unexpected falls. Furthermore, the high fall risk remains a considerable health concern throughout the post stroke life span. Unfortunately, most of the stroke patients are aged people and social impact is growing. Stroke survivors are much more likely to sustain a hip fracture due to a fall than people without stroke; they often more easily lose independent mobility or even face more severe consequences. Preventing falls is an important issue for every person involved in stroke care and in any of the post-stroke stages.

Rates

In the general population of elderly people, one out of three falls at least once a year, one out of six falls twice or more. However, this probability is much higher in patients with stroke. This makes falls the most frequent medical complication during hospitalization after stroke. Often falling can become repetitive.

Circumstances

Circumstances vary in inpatient falls and community stroke survivor falls. The observation showed that most falls occurred during the day and in the patient’s room, toilet or bathroom. Transfers are the most common activity leading to a fall, whereas only a few falls involve walking or exercising. Therefore, despite of exploring the patient’s limits of balance and gait abilities, physiotherapy to improve these motor capacities appears to be very safe. In fact, almost 60% of the falls occur when people act against instructions: when he or she is transferred or walked without the recommended supervision or aids during inpatient rehabilitation, especially when the patient has cognitive deficits and can’t be instructed properly. In community stroke survivors, transfers are still a problem, but falls more often occur during walking indoors than outdoors.

Risk factors

For inpatient and community patients, the risk factors are generally similar, however the transfer ability is more pronounced for inpatients.

Doctors and researchers often use a scale called Activities of Daily Living (ADL) in order to assess the dependence of a stroke survivor. Fallers are more dependent than non fallers, especially in gait and balance.

Disease-related mental factors like depression, cognitive deficits and sensory deficits also likely contribute to increase fall risk in patients with stroke, as fallers are more often unable to walk and talk at the same time, or slow down when performing another mental task.

What are the consequences?

Falls should be seriously considered because of their consequences, both physically and psychosocially. As you can imagine, elders fall, but a large proportion of fractures in persons with stroke involve the hip, as the loss of bone mineral density is a common long-term complication post-stroke, and the affected arm cannot be stretched to break the fall.

Patients with stroke have not only an increased risk for hip fractures but also more severe consequences. After a hip fracture, the regain of independent mobility is very rare. Psychosocial consequences can be significant as well. Out of 5 individuals with stroke who have fallen, 4 of them develop a fear of falling. This fear not only leads to reduced physical activity and deconditioning but also makes the person less socially active then before these falls. Furthermore, depression not only is a risk factor for falls, it can also be a consequence of falling.

What should you do?

During inpatient rehabilitation, nurses are suggested to adequately supervising your training of strength, balance, and cognition; to take care of you during the transfer. Afterwards, when you are discharged from inpatient rehabilitation and here comes the chronic post-stroke stage, pay much more attention while walk – falls are most frequently related to loss of balance during walking.

You may consider physiotherapy treatment which is one of the solutions; however it might not be sufficient. A task-specific training program is recommended. It targets various domains of balance and gait abilities like balancing on various support surfaces, weight-shifting, side-stepping and walking over obstacle etc.

Start by asking for doctors if you want to take these task-oriented exercise programs. Don’t be afraid of falling if you have already experienced but try to get over of it. Use an assistive device like walking aids while walking.

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