Although the clinical significance of falls in individuals with stroke is widely appreciated and has been underscored in many publications, attempts to prevent falls in this population are still very scarce. This finding makes falls and their prevention an important issue for every person involved in stroke care (neurologists, physiatrists, physiotherapists, nurses, and also caregivers at home) and in any of the poststroke stages. For instance, individuals with stroke are much more likely to sustain a hip fracture due to a fall than people without stroke and more often lose independent mobility or even die after a hip fracture. The impact is primarily related to the physical and psychosocial consequences of falls, which can be devastating. Because the incidence and prevalence of stroke increase as a result of ageing of the population and the prevalence also increases as a result of continued improvement of poststroke life expectancy, the societal impact of falls in stroke is rapidly growing. Furthermore, the high fall risk for individuals with stroke is not only present in the acute phase, but it remains a considerable health concern throughout the poststroke life span. Key words: accidental falls, balance, cerebrovascular accident, fall circumstances, fall injuries, gait, postural control, prevention of falls, rehabilitation, stroke.įalls are the number one medical complication after acute stroke. More research is needed, however, to provide conclusive evidence of the efficacy of these interventions regarding the prevention of falls in individuals with stroke. Technological advances in assistive devices are another promising area. Preliminary evidence shows that task-specific exercise programs targeting balance and gait deficits can indeed reduce the number of falls in individuals with stroke. Interventions addressing these deficits can be expected to prevent falls more successfully. Gait deficits include reduced propulsion at push-off, decreased hip and knee flexion during the swing phase, and reduced stability during the stance phase. Stroke-related balance deficits comprise reduced postural stability during quiet standing and delayed and less coordinated responses to both self-induced and external balance perturbations. Important risk factors for falls are balance and gait deficits. In addition, fear of falling is a common consequence of falls, which may lead to decreased physical activity, social deprivation and, eventually, loss of independence. Individuals with stroke have an increased risk for hip fractures, and after such a fracture, they less often regain independent mobility. Falls may have severe consequences, both physically and psychosocially. 1Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 2Sint Maartenskliniek Research, Development and Education, Nijmegen, the NetherlandsĪbstract - Stroke survivors are at high risk for falls in all poststroke stages.
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