Falls are a common and serious, but potentially preventable, problem after stroke. Avoiding falls requires balance, which is a fl uid and dynamic physical skill. There are a number of perceptual, neurological, and mechanical mechanisms underlying our ability to balance, and they are complex and heterogeneous. Depending on where strokes occur in the brain, balance may be affected in different ways. It is important to identify stroke patients who are at risk of falls in order to optimize prevention, and a number of stroke-specifi c risk factors have been identifi ed, but the available assessment scales have only limited sensitivity and specifi city. If management of falls risk in stroke is to be effective, assessments have to identify the precise and individual mechanisms underlying balance problems, and then specifi c management has to be targeted at these defi cits. The consequences of falls after stroke can be severe and include loss of confi dence and loss of independence, as well as serious injury including fractures. Stroke patients are at greater risk of osteoporosis, particularly on the hemiplegic side, which occurs rapidly following paresis. Management of falls risk post-stroke should also include timely assessment of bone health and the associated fracture risk.
Keywords
Key Messages• Following a stroke, falls risk is increased over and above the falls risk associated with ageing. • The assessment of stroke patients who are at risk of falls should be multidisciplinary, so too should the delivery of interventions designed to prevent them. • Bone density is lost rapidly in the hemiparetic limb following a stroke, with resultant increased fracture risk.• Along with osteoporosis drug treatment, exercise, nutrition, and addressing falls risk are important strategies to reduce fracture risk.