Article

Harris JE, Eng JJ, Marigold DS, Tokuno CD, Louis CL: Relationship of balance and mobility to fall incidence in people with chronic stroke

School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5.
Physical Therapy (Impact Factor: 3.25). 03/2005; 85(2):150-8.
Source: PubMed

ABSTRACT People with stroke are at risk for falls. The purpose of this study was to estimate the strength of the relationship of balance and mobility to falls.
The participants were 99 community-dwelling people with chronic stroke.
An interview was used to record fall history, and physical performance assessments were used to measure balance (Berg Balance Scale [BBS]) and mobility (gait speed).
No differences were found between subjects who fell once and subjects who did not fall or between subjects who fell more than once and subjects who did not fall. Neither balance nor mobility was able to explain falls in people with chronic stroke.
Clinicians should be cautious when using the BBS or gait speed to determine fall risk in this population. Falls occurred frequently during walking; it may be necessary to focus on reactive balance and environmental interaction when assessing individuals for risk of falls and devising fall prevention programs for individuals with chronic stroke. The authors' observations suggest that the prescription of 4-wheel walkers for individuals with a low BBS score (</=45) may be a mobility aid that could reduce the risk of falls.

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Available from: Jocelyn E Harris, Aug 22, 2015
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    • "Stroke Research and Treatment to be high, ranging between 23–34%, 40–73%, and 43–70% during a 3-4 month [7] [16], 6-month [17] [18], and 1-year follow-up [19] [20], respectively. Most falls are reported to result from a trip, a slip, or a misplaced step while walking [17, 21–24] and walking is also the most frequently reported activity (39%–90%) at the time of a fall in stroke survivors [7] [17] [25] [26], suggesting the reduced ability of individuals with stroke to adjust walking to task and environmental demands. Despite the relevance of walking adaptability to everyday mobility and the reduced ability of individuals with stroke to adjust walking to task and environmental demands, assessment of walking adaptability has received relatively little attention. "
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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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    • "Inability to maintain balance reduces functional performance and increases the fall frequency [2]. The dysfunction leads to various musculoskeletal complications multiplying the rehabilitation challenges [3] [4] [5] [6] [7]. "
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    ABSTRACT: Background. Poststroke impairment may lead to fall and unsafe functional performance. The underlying mechanism for the balance dysfunction is unclear. Objective. To analyze the relation between the motor level of the affected limbs and balance in poststroke subjects. Method. A prospective, cross-sectional, and nonexperimental design was conducted in a rehabilitation institute. A convenience sample of 44 patients was assessed for motor level using Brunnstrom recovery stage (BRS) and Fugl-Meyer Assessment: upper (FMA-UE) and lower extremities (FMA-LE). The balance was measured by Berg Balance Scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT). Results. BRS showed moderate correlation with BBS (ρ = 0.54 to 0.60; P < 0.001), PASS (r = 0.48 to 0.64; P < 0.001) and FRT (ρ = 0.48 to 0.59; P < 0.001). FMA-UE also exhibited moderate correlation with BBS (ρ = 0.59; P < 0.001) and PASS (ρ = 0.60; P < 0.001). FMA-LE showed fair correlation with BBS (ρ = 0.50; P = 0.001) and PASS (ρ = 0.50; P = 0.001). Conclusion. Motor control of the affected limbs plays an important role in balance. There is a moderate relation between the motor level of the upper and lower extremities and balance. The findings of the present study may be applied in poststroke rehabilitation.
    05/2014; 2014:767859. DOI:10.1155/2014/767859
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    • "The consequences of hip fractures are more severe in hemiplegics than in the general population [11]. Stroke victim falls are often related to postural and gait problems [6] [7] [21] [48]. Numerous studies demonstrated an improvement in postural and gait capacity following retraining programs given long after strokes, but retraining programs that use fall reduction as an endpoint are few and far between. "
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    ABSTRACT: Objectives Focus on the different therapeutic patient education (TPE) programs for stroke survivors found in the literature. Verify their content and efficacy. Method A literature review was conducted by searching for entries from 1966 to 2011 in the Medline and Cochrane Library databases. The references for the accepted articles were taken into consideration and the articles corresponding to the criteria inclusion but not present within the initial search were selected. The keywords used were “self care”, “self management”, “patient education” and “stroke”. Given the multiplicity of symptoms that may be addressed in TPE programs, and following expert advice, the symptoms were grouped after expanding the bibliographic search using the following, additional keywords: “dysphagia”; “swallowing disorder”; “urinary incontinence”; “caregiver”; “fall prevention”; “falling”; “injury”; “shoulder pain”; “physical activity”; “exercise”; “aphasia” and “cognitive impairment”. Results We found 30 article abstracts. In the end, we only accepted seven articles on general TPE programs that were well structured and detailed enough. The TPE programs found in the literature were often of questionable methodological quality. The multiplicity of symptoms led to very general TPE programs that covered all possible stroke after-effects. The purpose of these programs was to reduce stress and anxiety, to improve quality of life and to alleviate psychosocial after-effects. A change in caregiver and patient behavior was observed at times. We expanded the bibliographic search to include scientific arguments that could help implement TPE programs for more specific targets. Conclusion TPE programs for stroke survivors could be improved by standardizing and assessing programs that focus on a specific problem caused by the various possible after-effects of strokes. In order to promote education for stroke survivors, specific training for health care professionals and appropriate funding are necessary.
    Annals of physical and rehabilitation medicine 12/2012; 55(s 9–10):641–656. DOI:10.1016/j.rehab.2012.08.011
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