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Falls and Fear of Falling after Stroke

By David Wasielewski

 

As we age the consequences of a fall become more serious. For stroke survivors the danger and consequences of a fall increase significantly. Individuals who survive a stroke have a risk of fall two times greater than non-stroke survivors. There is an obvious physical danger associated with a fall. Broken bones and head injuries are common consequences. 20-30% of fall related injuries are moderate to severe and include concussions, traumatic brain injuries and fractured hips and shoulders.

 

But there are other, often unexplored, consequences that will be examined here as well. A fall is defined here as an event in which an individual unexpectedly comes to rest on the ground without losing consciousness. The statistics gathered on falls indicate that they are a fairly common occurrence. In 2010 2.3 million individuals 65 and older were treated in emergency rooms for nonfatal injuries resulting from falls.

 

The estimated cost to treat those injuries was $30 billion with total costs estimated are over $50 billion. Stroke is considered one of the greatest risk factors for falls in older adults. The balance function in the brain can be directly affected by a stroke. Paralysis or numbness of a limb resulting from stroke also decreases the body’s ability to sense the environment and maintain proper balance. Stroke survivors should be aware of the intrinsic and extrinsic or environmental factors that increase the probability of a fall.

 

The intrinsic factors include arm or leg weakness or numbness, decreased self-awareness or understanding of physical limitations caused by a stroke. Decreased hearing and sight can increase the risk of a fall. Failing to hear or see something approach in one’s path can result in a fall. An in-home survey by a therapist often identifies one or more issues that can increase the risk of a fall. Loose throw rugs and exposed electrical cords can trip an individual.

 

Busy rug patterns with multiple colors and shapes can be confusing especially for sight impaired individuals. The same is true of surfaces that are unevenly lit. Crowded floors with many toys, wet floors and pets are also factors that need to be controlled in the home environment. Medications, particularly more than four prescriptions, put individuals at increased risk for a fall.

 

To determine if you are at increased risk of falling you need to ask yourself if you have difficulty climbing steps or curbs. Do you have difficulty putting on pants while standing? Do you have problems stepping into the tub or shower? Do you lose your balance if you turn around quickly or get lightheaded with a position change? All indicate an increased risk. An individual who cannot balance on one foot for five seconds is at increased risk for a fall.

 

One interesting finding is that the fear of falling alone will increase the risk of experiencing a fall. The fear of a fall can be the beginning of an unhealthy cycle. The fear of falling often results in decreased activity. An individual afraid of falling is less likely to take a walk or engage in any physical activity that might result in a fall. The decrease in activity or exercise leads to increasing weakness from muscle atrophy.

 

An individual afraid of falling will limit activity that often includes social interaction. For example this individual might not meet a friend for lunch or go shopping in order to avoid any danger of falling. The physical weakness, lack of exercise and limited social interaction can lead to depression which leads to psychological deterioration and physical weakness. All these factors lead to a further increase in the probability of experiencing a fall.

 

So what can a survivor do to reduce the risk of falling? Education is the first step. Have a checkup with your doctor and an assessment by a physical therapist. Engage in a prescribed exercise program to increase strength and improve balance. Be aware of the side effects of medications and eliminate environmental risks in the home.

 

A physical therapist can help determine the need for assistive devices such as walkers and determine if the survivor is using the proper footwear. Slide on footwear and sandals might be easy to put on and take off but can also be very unstable if the survivor has deceased foot sensation or muscle control. Supportive, well-fitting footwear is essential for good balance.

 

So, stroke survivors are at increased risk of falling. The physical consequences of falling are real and common. The psychological consequences of fear of falling can also contribute to the increased probability of a fall injury. Stroke survivors need to be assessed in order to determine if a stroke has impaired balance and, if so, engage in exercise and balance improvement exercises to reduce to the chances of falling.

 

It might seem to make sense for a stroke survivor to limit activity in order to avoid a fall. This article points out that limiting activity can, in some cases, actually increase the potential for a fall.

 

 

Much of the content of this article comes from a presentation to my stroke support group by Jessica Abraskin, a physical therapist on staff at Berkshire Medical Center in Pittsfield, Mass. Thanks Jessica!

 

 

 

 

Copyright@October 2013

The Stroke Network, Inc.

P.O. Box 492 Abingdon, Maryland 21009

All rights reserved.