1. Singh Joy, Subhashni D.
  2. Kayyali, Andrea MSN, RN


According to this study:


* Although early physical therapy can increase mobility and improve walking after a stroke, it may also increase the risk of falls-particularly serious falls in patients with severe impairment.



Article Content

In an attempt to discern the effects of exercise and mobility therapy on fall risk after stroke, researchers enrolled a total of 408 patients in the Locomotor Experience Applied Post-Stroke trial. Two months after their stroke, patients were randomized to receive one of three therapies: a specialized locomotor training program starting immediately; the same locomotor training program beginning six months after the stroke; or a home exercise program consisting of progressive strength and balance training, which also began immediately. The locomotor training program included walking on a treadmill and on the ground. Patients received their assigned therapy in 30 to 36 sessions over 12 to 16 weeks.


At 12 months after their stroke, patients were classified according to their poststroke fall history: 36% had had multiple or injurious falls; 22% had had a single, noninjurious fall; and the remaining 42% hadn't fallen. A majority of falls (55%) occurred during the early postrandomization period (three to five months after stroke), and most (87%) occurred at home. Patients experiencing multiple or injurious falls tended to be older and to have worse upper-body and lower-body motor control than those in the other categories. The factor most predictive of multiple or injurious falls was a Berg Balance Scale score of 42 or lower; the authors write, however, that the scale doesn't account for the multifactorial causes of falls and is helpful but of limited value.


Although the overall fall incidence was similar across the three exercise groups, multiple or injurious falls were more prevalent in those who underwent the early locomotor training program than in those who underwent the late locomotor training program or the home exercise program. On the other hand, those who underwent the late locomotor training program were less mobile than those who received early intervention-taking almost half as many steps per day.


The authors conclude that because increased mobility also is associated with greater fall risk and fall prevalence is greater at home and during the initial months after a stroke, a multi-factorial approach should be taken to assess fall risk, and fall management should include exercise interventions.-SDSJ




Tilson JK, et al. Stroke. 2012;43(2):446-52