Stroke and Falls
Entering physical therapy school, I was determined that I was following the path to become a sports physical therapist. However, after clinical time and coursework, I felt myself being inexplicably drawn to neuromuscular physical therapy. After my acute care and inpatient rehabilitation rotations, this feeling was solidified. Since then, I have taken a special interest in patients with stroke, as they each present uniquely, with a wide spectrum of impairments. Furthermore, during my neuromuscular rotations, I became aware that falls reduction is a constant goal in treating individuals with stroke. Therapists work to use the most effective treatments in improving balance and gait to reduce the risk of falls and increase functional capacity. Unfortunately, at the same time, patients who are treated know little about the etiologies of falls or the impact they impose.
First, I conducted a literature review to determine a composite of causes leading to falls in individuals with stroke. My findings align with many of the impairments that exist after stroke including weakness, loss of sensation, perceptual and cognitive difficulties, anxiety, and incontinence. These causes are important for patients and therapists to understand, so they have a better awareness of the barriers that make individuals susceptible to falls.
<Multifactorial Factors for Falls in Stroke>
Next I conducted an extended literature review upon my evidence-based practice course review regarding dynamic balance training. I found that many different types of interventions offer promising results including body-weight symmetry training, biofeedback training, vitamin supplementation, upper extremity training, body-weight supported treadmill training, and functional electrical stimulation.
<Interventions for Reducing Falls in Stroke>
After conducting both literature reviews I began to put together patient education materials, primarily starting with a frequently asked questions section for patient’s to receive during therapy. I wanted to keep this portion brief, as patients are often overwhelmed with information as they are admitted to the hospital. The patient education handout also consists of a few home exercises for the patient to practice to encourage adherence and continued strengthening.
My main goal in conducting this literature review was to create an in-service presentation for my final clinical rotation in inpatient rehabilitation at Care Partners Health Services. At this point I was able to collaborate with my clinical instructor, Debbie Johnson, PT, to cater a presentation to the needs of that particular clinic. The in-service will be presented via PowerPoint and will give information on the evidence gathered regarding etiology of falls, and three intervention topics relevant to Care Partners. The selected interventions included static and dynamic balance training, AFO use, and upper extremity training. Additionally I will present copies of my patient education materials to be evaluated by physical therapists in the hospital.
My references can be found on the last slide of the PowerPoint presentation posted above. Thanks for visiting my site! Bring on any questions!
Acknowledgements
A special thanks goes to my advisor Kmac for your feedback and guidance. Another special thanks goes to past and future clinical instructors Marcie Brown and Debbie Johnson. Your input was so valuable in incorporating the needs of therapists and patients alike! Thank you as well to Christopher Chapin for being my home exercise plan model!
4 Responses to “Reducing the Risk of Falls in Older Adults After Stroke”
nclawler
Hi Kim! The exercises I used for the handout were a combination of those mentioned in evidence I found, and those I have used in clinic with patients with stroke. I think the main focus in any inpatient rehabilitation is functional exercise. The sit-to-stands represented a task-specific exercise that translates functionally into a patient’s daily life, so I found this to be an important one! Safety and personal preference were definitely taken into account as well.
I actually did not come across any split-belt studies. All the ones I looked at were on standard treadmills. Since I was focusing less on gait training and more on balance, I think perhaps the split belt would be examined more from a gait perspective, looking at step length, symmetry, and speed. Good question though!
Kim
Natalie,
Like you, I thought I would always end up in sports PT, and yet here we are both most interested in the neuro-world! I found your Capstone VERY helpful as I prepare for my last clinical rotation in an inpatient neuro setting. You make a great point that often times, patients do not know the causes of falls and just how harmful they can be. Through your first evidence table, I think you found some great studies that can be used to increase a therapist’s knowledge and improve patient education so that our patients can truly understand WHY we are are asking them to do something things that we do! Your patient falls handout solidifies this fact and gives patients something tangible to aid them through what can often be an overwhelming phase. I was just curious as to how you selected the exercises you did for the handout. Were these based on what evidence deems is most effective? Was this what you found to be most accepted and safe in the clinic or patient/personal preference?
In your second evidence table, I saw that body-weight supported treadmill-training can improve balance and balance confidence. With the innovation and sudden craze surrounding split belt treadmill therapy for individuals with stroke, I was curious to know if you came across this at all in your research and how it may relate to balance in this population. Does this mode of therapy have an effect on balance? Do you know how it compares to other methods?
You did a great job! I think that your upcoming clinical rotation and their patients are really going to benefit from your hard work and presentation of your project! Bravo! Bravo!
nclawler
Hey Lauren!
Thanks so much for reading! And YES please use it for your patients, that’s what it’s there for!
lbsuggs
Natalie,
You did such a GREAT job on this project! We have similar clinical interests and our capstone projects also had a similar focus, so I really enjoyed looking through all of the materials you created. The patient education handout is very simple to understand, yet very informative. It also provides patients with a great starting point for basic exercise to improve balance and LE strength. I’ve saved a copy and with your permission, I’d love to be able to give it to patients in the future!
Overall, I think your capstone project integrates and elaborates upon concepts that we’ve learned in our classes this year. One is that the cause of falls after stroke is multifactorial. Your first evidence table does a great job of making this point. The second is that in order for our interventions to be effective, they have to be implemented at a high enough intensity. Your second evidence table seems to show that this is also true for balance retraining and gait training after stroke. Our interventions need to include task-specific training with a high number of repetitions to truly drive neural plasticity. Thanks for reminding us of that!
Lastly, your PP presentation looks great! I enjoyed reading through your slides and learning about the use of AFOs to enhance balance, mobility, and gait. I appreciated your point that AFOs are merely a way to compensate for weakness and tone and that they do not facilitate strengthening. This further illustrates the point that an AFO alone is not going to establish lasting change.
Again, wonderful job 🙂 I learned a lot from your page!