Risk Factors for Falling in Home-Dwelling Older Women With Stroke The Women’s Health and Aging Study
ABSTRACT Much of our knowledge of risk factors for falls comes from studies of the general population. The aim of this study was to estimate the risk of falling associated with commonly accepted and stroke-specific factors in a home-dwelling stroke population.
This study included an analysis of prospective fall reports in 124 women with confirmed stroke over 1 year. Variables relating to physical and mental health, history of falls, stroke symptoms, self-reported difficulties in activities of daily living, and physical performance tests were collected during home assessments.
Risk factors for falling commonly reported in the general population, including performance tests of balance, incontinence, previous falls, and sedative/hypnotic medications, did not predict falls in multivariate analyses. Frequent balance problems while dressing were the strongest risk factor for falls (odds ratio, 7.0). Residual balance, dizziness, or spinning stroke symptoms were also a strong risk factor for falling (odds ratio, 5.2). Residual motor symptoms were not associated with an increased risk of falling.
Interventions to reduce the frequency of balance problems during complex tasks may play a significant role in reducing falls in stroke. Clinicians should be aware of the increased risk of falling in women with residual balance, dizziness, or spinning stroke symptoms and recognize that risk assessments developed for use in the general population may not be appropriate for stroke patients.
Full-textDOI: · Available from: Linda P Fried, Mar 08, 2015
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ABSTRACT: Control of walking has been described by a tripartite model consisting of stepping, equilibrium, and adaptability. This review focuses on walking adaptability, which is defined as the ability to modify walking to meet task goals and environmental demands. Walking adaptability is crucial to safe ambulation in the home and community environments and is often severely compromised after a stroke. Yet quantification of walking adaptability after stroke has received relatively little attention in the clinical setting. The objectives of this review were to examine the conceptual challenges for clinical measurement of walking adaptability and summarize the current state of clinical assessment for walking adaptability. We created nine domains of walking adaptability from dimensions of community mobility to address the conceptual challenges in measurement and reviewed performance-based clinical assessments of walking to determine if the assessments measure walking adaptability in these domains. Our literature review suggests the lack of a comprehensive well-tested clinical assessment tool for measuring walking adaptability. Accordingly, recommendations for the development of a comprehensive clinical assessment of walking adaptability after stroke have been presented. Such a clinical assessment will be essential for gauging recovery of walking adaptability with rehabilitation and for motivating novel strategies to enhance recovery of walking adaptability after stroke.08/2014; 2014. DOI:10.1155/2014/591013
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ABSTRACT: Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult.01/2012; 2012:136525. DOI:10.1155/2012/136525
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ABSTRACT: The purpose of this study was to find correlation between the Berg Balance Scale which is most commonly used and the equilibrium scores from Smart Balance Master System which is used for the test of the balance ability for the patients with chronic hemiparetic stroke to predict their falling risk though examining the postural control. Twenty-two subjects who had first stroke participated in this study. Participants were measured the Berg Balance Scale and the Smart Balance Master System. The study found that there was a significant correlation between the Berg Balance Scale and the equilibrium scores from Smart Balance Master System. And there was no significant correlation at all "eye-closed and sway of surfaces" in the 6 conditions of Smart Balance Master System and there was a significant correlation with over median in the other 5 conditions. The study was uncovered that there was no meaningful correlation between the Berg Balance Scale and "eye-closed and sway of surfaces" because chronic hemiparetic stroke patients heavily relied on their vision to maintain their balance ability and the Berg Balance Scale did not properly exam it. Thus to predict their falling risk in clinical practice for the patients with chronic hemiparetic stroke, it would be more efficient ways for us to consider all the effects of sensory organs with more than one clinical evaluation method.12/2011; 12(12). DOI:10.5762/KAIS.2011.12.12.5741