Article

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.

Langue : ANGLAIS