Abstract TP318: The Circumstances and Consequences of Post-stroke Falls

Abstract

Introduction: Three-quarters of people with stroke sustain a fall. Fall risk and risk for injury persists into the chronics phases of stroke recovery. Currently, the circumstances surrounding post-stroke falls are not well understood; identifying these circumstances is a key step in the development of fall prevention programs. Likewise, the consequences of falls during the chronic phases of stroke are largely unexplored. Objectives: The objectives of the study were to identify the circumstances and consequences of post-stroke fall events. Methods: This is a secondary analysis of data derived from a large trial. To be included in the trial and these analyses, participants had to have survived a stroke and had a diagnosis of hypertension or blood pressure >140/90 mmHg. Demographics and stroke characteristics were recorded. Patients were asked about falls prospectively over the one-year study period. Once a fall event was identified, chart review and interviews were used to obtain information regarding circumstances and consequences of the fall. Fall circumstances were separated into intrinsic/personal and environmental categories including: falls with activity; falls with movement; falls due to trips or slips; falls related to a physical or mental state; location of the fall; and the season when the fall occurred. Consequences of falls were classified according to type of injury (laceration, fracture) and medical care received. Results: A total of 53 of the 225 (33%) participants reported a fall; 70% of falls occurred at home and 40% of falls were associated with impaired physical or mental state (e.g., falling asleep and falling out of a chair or inattention to tying shoes, or forgetting to use a device). Additionally, 21% of falls were associated with activities, 21% with mobility, and 34% with slips or trips. The majority of people who fell sustained an injury (72%); injuries ranged from bruising to fractures and 55% of those with an injury sought medical care (32% to emergency). Conclusion: Post-stroke falls are associated with an alarming rate of injury and healthcare utilization. Targeting mental and physical states may be key to fall prevention programming for people with chronic stroke.

Impairments in the mechanical effectiveness of reactive balance control strategies during walking in people post-stroke

“…These impairments result from a combination of delayed muscle activation to external perturbations (Kirker et al, 2000;Marigold et al, 2004), abnormal muscle activation patterns (Higginson et al, 2006), and weakness (Olney & Richards, 1996). In addition, trips or slips, which commonly occur in the direction of walking, are one of the most prevalent causes of falls among people post-stroke (Schmid et al, 2013). Although prior studies have examined the dynamics of backward losses of balance during stance (Patel & Bhatt, 2017;Salot et al, 2016) and walking post-stroke (Dusane et al, 2021;Kajrolkar et al, 2014;Kajrolkar & Bhatt, 2016), few have investigated the mechanics and recovery strategies following forward losses of balance during walking.…”