Early Stroke Rehab Helps But Raises Fall Risk

But do babies fall when they are learning to walk? Maybe Michelin man suits would help protect the faller.
http://www.medpagetoday.com/Cardiology/Strokes/30748?utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&email=oc1dean@yahoo.com&eun=g424561d0r&userid=424561&mu_id=
Early rehabilitation helps stroke survivors walk sooner and faster, but it also increases the risk for falls, a randomized clinical trial found.

Among 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study, 36% of those who initiated rehabilitation within two months of stroke had multiple and/or injurious falls, and 22% had single, noninjurious falls, Julie K. Tilson, DPT, MS, of the University of Southern California in Los Angeles, and colleagues reported in the January issue of Stroke: Journal of the American Heart Association.

Action Points

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• Note that falls are a common complication after stroke, occuring in 40% to 70% of individuals within 12 months post-stroke and their hip fracture risk is doubled.



• Note that in this study, only 42.4% were nonfallers and most falls occurred at home in the first three months after assessment.

Most of the falls occurred within the first three months, and falls were highest for those with severe walking impairment following stroke. Nonetheless, although those who underwent early balance and exercise training achieved double the improvement in walking and mobility compared with those in the late training group, it came at the cost of an increased risk of falling.
LEAPS enrolled 408 patients within 45 days of a confirmed stroke. The average age of patients was 62, and they had to be able to walk at least 10 feet with no more than one person assisting.
All patients had moderate or severe walking speed, and most had moderate to moderately-severe disability.
Tilson and colleagues randomly assigned patients to one of three groups:

• A specialized locomotor training program (LTP) that included stepping on a treadmill with body weight support, followed by walking practice at two months post-stroke
• The same specialized LTP at six months post-stroke (between two and six months post-stroke, this group received usual care)
• A progressive strength and balance exercise program provided by a physical therapist in the home at two months post-stroke

Those who fell multiple times or had injurious falls had the lowest walking speeds, six-minute walk distance, and balance scores. They were typically older than nonfallers and single, noninjurious fallers, and had the the worst overall disability.
Analysis at six months showed those in the early and home training groups had more multiple and injurious falls than those in the late locomotor training group, which up to this point had received only usual care. However, researchers noted that overall, the late group at six months had less mobility and had taken half as many steps as the other two groups.
The best predictor of multiple or injurious falls was a Berg Balance Scale score of 42 or less at two months post-stroke. Of the 230 patients with a balance score of 42 or less, 47% of them had multiple or injurious falls compared with 21% of the 178 patients with higher balance scores.
But the low sensitivity and specificity (73% and 53%, respectively) of this balance cutoff point reflect the "multifactorial causes of falls and suggests that a measure of balance, although useful, cannot independently account for fall risk."
The authors noted that the findings were limited by the highly selective nature of the population and therefore the results might not be generalizable to the larger stroke population.