Is impaired control of reactive stepping related to falls during inpatient stroke rehabilitation?

Background: Individuals with stroke fall more often than age-matched controls. While many focus on the multi-factorial nature of falls the fundamental problem is likely the ability for an individual to generate reactions to recover from a loss of balance. Stepping reactions to recover balance are particularly important to balance recovery, and individuals with stroke have difficulty executing these responses to prevent a fall following a loss of balance. Objective: The purpose of this study is to determine if characteristics of balance-recovery steps are related to falls during in-patient stroke rehabilitation. Methods: We conducted a retrospective review of individuals with stroke attending in-patient rehabilitation (n=136). Details of falls experienced during in-patient rehabilitation were obtained from incident reports, nursing notes, and patient interviews. Stepping reactions were evoked using a ‘release-from-lean’ postural perturbation. Poisson regression was used to determine characteristics of stepping reactions that were related to increased fall frequency relative to length of stay. Results: Twenty individuals experienced 29 falls during in-patient rehabilitation. The characteristics of stepping reactions significantly related to increased fall rates were: increased frequency of external assistance to prevent a fall to the floor, increased frequency of no-step responses, increased frequency of step responses with inadequate foot clearance, and delayed time to initiate stepping responses. Conclusions: Impaired control of balance-recovery steps is related to increased fall rates during in-patient stroke rehabilitation. This study informs the specific features of stepping reactions that can be targeted with physiotherapy intervention during in-patient rehabilitation to improve dynamic stability control and potentially prevent falls.This study was supported by the Heart and Stroke Foundation Centre for Stroke Recovery and the Ministry of Health and Long-Term Care – Ontario Stroke System. We also acknowledge support of the Toronto Rehabilitation Institute, which receives funding under the Provincial Rehabilitation Research Program from the Ontario Ministry of Health and Long-Term Care