Predicting people with stroke at risk of falls

School of Health Professions and Rehabilitation Science, University of Southampton, UK.
Age and Ageing (Impact Factor: 3.64). 06/2008; 37(3):270-6. DOI: 10.1093/ageing/afn066
Source: PubMed


falls are common following a stroke, but knowledge about predicting future fallers is lacking.
to identify, at discharge from hospital, those who are most at risk of repeated falls.
consecutively hospitalised people with stroke (independently mobile prior to stroke and with intact gross cognitive function) were recruited. Subjects completed a battery of tests (balance, function, mood and attention) within 2 weeks of leaving hospital and at 12 months post hospital discharge.
122 participants (mean age 70.2 years) were recruited. Fall status at 12 months was available for 115 participants and of those, 63 [55%; 95% confidence interval (CI) 46-64] experienced one or more falls, 48 (42%; 95% CI 33-51) experienced repeated falls, and 62 (54%) experienced near-falls. All variables available at discharge were screened as potential predictors of falling. Six variables emerged [near-falling in hospital, Rivermead leg and trunk score, Rivermead upper limb score, Berg Balance score, mean functional reach, and the Nottingham extended activities of daily living (NEADL) score]. A score of near-falls in hospital and upper limb function was the best predictor with 70% specificity and 60% sensitivity.
participants who were unstable (near-falls) in hospital with poor upper limb function (unable to save themselves) were most at risk of falls.

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    • "Greater than 50% of stroke survivors experience falls within one year post-stroke (e.g., Ashburn et al., 2008; Sackley et al., 2008). Studies have shown that whole-body angular momentum is highly regulated during normal walking to maintain dynamic balance (e.g., Herr and Popovic, 2008; Pijnappels et al., 2005). "
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    ABSTRACT: Background In post-stroke hemiparetic subjects, solid polypropylene ankle-foot-orthoses are commonly prescribed to assist in foot clearance during swing while bracing the ankle during stance. Mobility demands, such as changing walking speed and direction, are accomplished by accelerating or decelerating the body and maintaining dynamic balance. Previous studies have shown that the ankle plantarflexors are primary contributors to these essential biomechanical functions. Thus, with ankle-foot-orthoses limiting ankle motion and plantarflexor output during stance, execution of these walking subtasks may be compromised. This study examined the influence of a solid polypropylene ankle-foot-orthosis on forward propulsion and dynamic balance in healthy adults. Methods Kinematic and kinetic data were recorded from 10 healthy adults walking with and without a unilateral ankle-foot-orthosis at steady-state slow (0.6 m/s) and moderate (1.2 m/s) speeds, and during accelerated (0-1.8 m/s at 0.06 m/s2) and decelerated (1.8-0 m/s at -0.06 m/s2) walking. Propulsion was quantified by propulsive and braking impulses (i.e., time integral of the anterior-posterior ground reaction force) while dynamic balance was quantified by the peak-to-peak range of whole-body angular momentum. Findings The propulsive impulses decreased in the leg with ankle-foot-orthosis compared to the contralateral leg and no ankle-foot-orthosis condition. Further, the ankle-foot-orthosis resulted in a greater range of angular momentum in both the frontal and sagittal planes, which were correlated with the reduced peak hip abduction and reduced ankle plantarflexor moments, respectively. Interpretation Solid ankle-foot-orthoses limit the successful execution of important mobility subtasks in healthy adults and that the prescription of ankle-foot-orthosis should be carefully considered.
    No preview · Article · May 2014 · Clinical biomechanics (Bristol, Avon)
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    • "Missteps, also referred to as near falls, have been defined as a loss of balance that would result in a fall if sufficient recovery mechanisms are not activated [12]. The amount of self-reported missteps has been related to fall risk in PD and other populations [1,13-16]. Missteps are usually more frequent than falls and may occur before a person begins to fall, enhancing the potential predictive value of missteps. Unfortunately, self-report is, to a large degree, the gold-standard method for characterizing and quantifying missteps [17-19]. "
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    ABSTRACT: Falls are a leading cause of morbidity and mortality among older adults and patients with neurological disease like Parkinson's disease (PD). Self-report of missteps, also referred to as near falls, has been related to fall risk in patients with PD. We developed an objective tool for detecting missteps under real-world, daily life conditions to enhance the evaluation of fall risk and applied this new method to 3 day continuous recordings. 40 patients with PD (mean age +/- SD: 62.2 +/- 10.0 yrs, disease duration: 5.3 +/- 3.5 yrs) wore a small device that contained accelerometers and gyroscopes on the lower back while participating in a protocol designed to provoke missteps in the laboratory. Afterwards, the subjects wore the sensor for 3 days as they carried out their routine activities of daily living. An algorithm designed to automatically identify missteps was developed based on the laboratory data and was validated on the 3 days recordings. In the laboratory, we recorded 29 missteps and more than 60 hours of data. When applied to this dataset, the algorithm achieved a 93.1% hit ratio and 98.6% specificity. When we applied this algorithm to the 3 days recordings, patients who reported two falls or more in the 6 months prior to the study (i.e., fallers) were significantly more likely to have a detected misstep during the 3 day recordings (p = 0.010) compared to the non-fallers. These findings suggest that this novel approach can be applied to detect missteps during daily life among patients with PD and will likely help in the longitudinal assessment of disease progression and fall risk.
    Full-text · Article · Apr 2014 · Journal of NeuroEngineering and Rehabilitation
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    • "Osteoporosis and low-impact trauma are the main determinants of HF in the elderly. Stroke increases the risk of falls [1–5] as a result of impaired locomotor function and muscle weakness [6, 7], accelerates bone loss (especially in the hemiplegic leg) [8–26], and subsequently leads to fractures [4, 27–29]. Although accumulating evidence suggests bidirectional links between vascular diseases, including stroke, and osteoporotic fractures [9–11, 30–35], there is still considerable uncertainty regarding the contribution of stroke to osteoporotic HF. "
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    ABSTRACT: Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF). Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3 ± 8.8 years; 75% females) with osteoporotic HF. Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF. Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.
    Full-text · Article · Sep 2013 · Stroke Research and Treatment
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