http://nnr.sagepub.com/content/early/2013/03/15/1545968313478486.abstract
Abstract
Background. Individuals with
stroke fall more often than age-matched controls. Although many focus on
the multifactorial nature of falls,
the fundamental problem is likely the ability for
an individual to generate reactions to recover from a loss of balance.
Stepping
reactions to recover balance are particularly
important to balance recovery, and individuals with stroke have
difficulty executing
these responses to prevent a fall following a loss
of balance. Objective. The purpose of this study is to determine if characteristics of balance recovery steps are related to falls during inpatient
stroke rehabilitation. Methods. We
conducted a retrospective review of individuals with stroke attending
inpatient rehabilitation (n = 136). Details of
falls experienced during inpatient rehabilitation
were obtained from incident reports, nursing notes, and patient
interviews.
Stepping reactions were evoked using a
“release-from-lean” postural perturbation. Poisson regression was used
to determine
characteristics of stepping reactions that were
related to increased fall frequency relative to length of stay. Results.
In all, 20 individuals experienced 29 falls during inpatient
rehabilitation. The characteristics of stepping reactions significantly
related to increased fall rates were increased
frequency of external assistance to prevent a fall to the floor,
increased
frequency of no-step responses, increased frequency
of step responses with inadequate foot clearance, and delayed time to
initiate stepping responses. Conclusions.
Impaired control of balance recovery steps is related to increased fall
rates during inpatient stroke rehabilitation. This
study informs the specific features of stepping
reactions that can be targeted with physiotherapy intervention during
inpatient
rehabilitation to improve dynamic stability control
and potentially prevent falls.
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