Emily Tumber
Falls are a common complication of stroke patients, with a reported incidence ranging from 7% in the first week after stroke to 73% in the first year after being discharged from the hospital.
The occurrence of falls in the stationary healthcare may lead to numerous negative outcomes such as injuries and extended rehabilitation periods, increased length of hospital stay, and increased healthcare expenditures along with legal consequences.
Most commonly, hematoma, laceration, and soft tissue damages are caused by other less serious injuries resulting from falls, whereas more severe outcomes are related to open and closed bone fractures, luxations, intracranial hematomas, extensive bleeding, including lethal outcomes as well.
If the fall does not lead to any physical consequences, it can affect the emotional health of patients and it can also lead to fear of falling.
All of the abovementioned facts lead to the impairment of quality of life of patients and their family members, that is, caregivers.
| Characteristics | Values |
|---|---|
| Risk Factors | Poor balance, muscle weakness, sensory changes, perceptual changes, cognitive effects, psychological changes, hemiplegia or hemiparesis, foot drop, hemineglect, executive dysfunction, vertigo, depression, medication, cardiovascular risk factors, hypotensive conditions |
| Safety Measures | Remove tripping hazards, add non-slip mats and grab rails, ensure adequate lighting, add a transfer bench and/or shower chair, clear walkways, raise toilet seats, remove cords and rugs, use a cane, walker, or hemi walker, ask for help |
| Rehabilitation | Physical and/or occupational therapy, improve motor skills, address vision concerns, manage secondary conditions, improve balance confidence, improve gait, improve executive function, improve mood |
What You'll Learn
Motor deficits
- Muscle weakness and poor coordination
- Inability to catch one's balance due to decreased upper extremity functions
- Impaired dynamic balance ability
- Paresis or paralysis on one side of the body
- Foot drop
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Sensory changes
Vestibular system changes can cause a loss of balance, which is a major cause of falling.
Tactile system changes can cause a loss of sensation, which can lead to overbalancing, impaired postural stability, and altered movement dynamics.
Visual system changes can cause a loss of vision, which can make it difficult to navigate one's environment and avoid falls.
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Perceptual changes
- Hemineglect: the inability to pay attention to one side of the body
- Anosognosia: a lack of insight into one's deficits
- Visual field cuts: part of the visual field is lost
- Eye movement disorders: result from difficulties controlling the eye muscles
- Visual neglect: inattention to one side of the visual field
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Cognitive effects
Additionally, survivors may experience psychological changes, such as depression, which can also increase the likelihood of falling.
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Psychological changes
A stroke can cause a wide range of psychological changes, including emotional and behavioural changes. These changes can be temporary or long-lasting and can be caused by both physical and psychological reasons.
Emotional Changes
Stroke survivors often experience a range of emotions, such as irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, anger, grief, sadness, anxiety and depression. These emotions can be intense and unpredictable, with survivors crying or laughing for no reason. This is known as "emotional lability" and can be a symptom of pseudobulbar affect (PBA), a condition caused by a specific pattern of brain damage.
Depression is a very common emotional change following a stroke, with up to 33% of survivors experiencing post-stroke depression. This can be caused by physical limitations, health worries, brain changes, and delays in treatment. Anxiety is also common, with around one in four people experiencing it within the first five years after a stroke. This can lead to sleeping problems, tiredness, muscle tension, irritability and avoidance of social activities.
Behavioural Changes
Behavioural changes can be surprising for both the survivor and their loved ones, as the person may seem like a completely different person. They may experience changes in personality, such as becoming more aggressive, lacking empathy, or losing their sense of humour and social inhibitions. They may also struggle with cognitive tasks, such as language, problem-solving, reading, and mathematical calculations.
Treatment
Treatment options are available to help manage these psychological changes. Cognitive behavioural therapy (CBT) can help individuals identify and change negative thought patterns. Medications such as antidepressants can also be prescribed, although these may have uncomfortable side effects. It is important to seek help from a healthcare professional to find the most appropriate treatment.
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Frequently asked questions
The risk of falling after a stroke is high. Approximately 7% of individuals fall within the first week of their stroke, and 73% experience a fall within the first year.
The following are risk factors for falling after a stroke:
- Motor deficits, such as muscle weakness, poor coordination, and an inability to catch one's balance.
- Sensory changes, such as changes to the vestibular, tactile, or visual systems.
- Perceptual changes, such as hemineglect or anosognosia.
- Cognitive effects, such as impaired judgment, trouble with multitasking, and difficulties with sequencing and problem-solving.
- Psychological changes, such as depression.
- Secondary conditions, such as hemiplegia or hemiparesis, foot drop, hemineglect, and executive dysfunction.
- Adverse effects of medications and cardiovascular risk factors, such as hypotensive conditions like syncope.
Safety measures to prevent falling after a stroke include:
- Modifying the home environment by adding non-slip mats and grab rails, ensuring adequate lighting, and removing tripping hazards.
- Using appropriate medical equipment, such as a cane, walker, or hemi walker.
- Practicing being mindful of one's body and environment when moving.
- Asking for help when necessary.
Rehabilitation can help prevent falls after a stroke by addressing the secondary effects of stroke that increase the risk of falling, such as motor deficits, sensory changes, perceptual changes, cognitive effects, and psychological changes. Rehabilitation can also help improve balance, strength, and mobility.
The prognosis for stroke survivors who fall is poor. Falling is a strong indicator of the likelihood of further falls, and it can lead to a loss of confidence, psychological distress, and serious injuries, such as fractures.
