How do individuals with subacute stroke nearly fall during forward walking?

Abstract

Background

Clarifying how falls have occurred in individuals with stroke is difficult because most falls are unwitnessed. We regularly measured gait using a 3D motion analysis system; thus, falling motion was recorded kinematically, allowing analysis of the relationship between near-fall timing and direction.

Research question

When and in what direction an individual with stroke nearly falls?

Methods

Sixty-seven individuals with stroke who experienced near falls (67 trials) were selected from 2,494 participants (40,602 trials). Near-fall timing was classified into the loading response phase (LR), single stance phase (SS), pre-swing phase (PS), and swing phase (SW) groups of the paretic limb. Near-fall direction was classified into forward, backward, paretic, and nonparetic side. Differences in frequencies of near-fall timing and direction were examined using Fisher’s exact test.

Results

Regarding the relationship between near-fall timing and direction analyzed using adjusted residuals, two participants of the LR group (2 participants) fell in the paretic side direction, 12 participants of the SS group (22 participants) fell backward, and 9 participants of the SW group (13 participants) fell forward (p < 0.01). PS group (30 participants) showed no specific near-fall direction.

Conclusions

We clarified the specific near-fall timing and direction in individuals with stroke; finding they tended to fall during the backwards in the single stance phase and forwards during the swing phase. Providing caregivers with information and instructions regarding when and in what direction participants are likely to fall may contribute to fall prevention in patients with subacute stroke.