Most people fall after stroke, usually at home: Study

Almost 60 per cent of people who have a stroke experience one or more falls afterwards - most often in their own homes - and some are left with serious injuries, according to a study released today at the Canadian Stroke Congress.

Better identification of people at risk of falling and proactive measures, such as assessments to create fall-proof homes, are required to keep people safe and injury-free, says Prof. Julie Tilson of the University of Southern California.

Ironically, the greatest risk comes when people are resuming their daily routines and regaining self-confidence, according to the study, which involved 408 people from two-to-12 months post-stroke. "As patients start to recover and gain mobility, the risk for falls may actually increase," Prof. Tilson says. "As they become more active, they are more likely to fall."

Over 70 per cent of falls were in the home and three-quarters of those who fell were unable to get up afterward. Of those who fell, 10 per cent experienced serious injury - from loss of consciousness to broken bones. The U.S. researcher said it is crucial that people receive post-stroke rehabilitation to test their balance and to learn exercises and techniques to prevent falls.

The study was part of the Locomotor Experience Applied Post Stroke (LEAPS) study, funded by the National Institute of Neurological Disorders and Stroke, which investigated the impact of different physical therapy treatments for improving people's ability to walk after a stroke.

According to the Canadian Stroke Network's 2011 report on the Quality of Stroke Care in Canada, 90 per cent of individuals with mild stroke are discharged directly home from acute care. Only 37 per cent of all moderate to severe stroke cases are discharged to a rehabilitation facility. The report indicates there are huge gaps in the delivery of rehabilitation services in all parts of Canada and services are not well documented.

"Research tells us that balance can be tested safely and new techniques for fall prevention are being developed by researchers in Canada that should be adopted as soon as possible," says Dr. Mark Bayley of the Toronto Rehabilitation Institute.

"Specialized rehabilitation can substantially improve how well a patient recovers after a stroke," says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. "Given the potential impact that appropriate rehabilitation can have, gaps in care need to be addressed to ensure all patients have access to appropriate rehabilitation.''

Dr. Michael Hill from the Heart and Stroke Foundation encourages people who have strokes and their families to be actively involved with the stroke team in assessing needs and planning their rehab programs. "Rehabilitation after hospital is an important part of the road to recovery and should be individualized for each case," he says. "Building up physical activity levels, when ready, can also enhance balance and help prevent falls."

He recommends that patients and caregivers also speak to their stroke team about what changes could be made to make their homes more safe and accessible.