By Jackie Harry, Physical Therapist
SS: Why should stroke survivors be concerned about falling?
Studies have shown that stroke survivors are twice as likely to fall following a stroke and more than three times as likely as the general population to fall multiple times. Falls are a major cause of death in the elderly, and are listed as a major reason for 40% of nursing home admissions. Also, injuries such as fractures are common with falls. And if the stroke survivor has brittle, thin bones due to osteoporosis, a fall can result in serious injury and even more problems with movement and getting around.
SS: Why do so many stroke survivors fall?
Stroke survivors have a higher likelihood of problems that make them more likely to fall. These problems range from dizziness to problems with balance, loss of vision, overall poor health and more. Also, people who have fallen in the past year are more likely to fall again. This is due in part to changes in their habits and activity level as a result of the first fall.
SS: It sounds like the deck is stacked against the stroke survivor. Is there anything a survivor can do to prevent falls?
There’s quite a lot that can be done to prevent falls! But it depends on what’s causing the falls to begin with. So, let’s look at each of the main reasons for falls, one by one.
1. Dizziness — There are many causes of dizziness, including a side effect of medicine, dehydration and other dietary problems, blood pressure problems, or visual problems caused by your stroke. It is very important that your doctor review all your medicines with you, to avoid undesired interactions.
A healthy diet is also important. You may want to meet with a dietician or nutritionist to discuss your eating habits and make sure your diet is not causing any dizziness. If you haven’t had your eyes checked since your stroke, your prescription may need to be adjusted. If your eyes don’t focus as they used to before your stroke, there are exercises that a physical or occupational therapist can teach you to help retrain your vision.
2. Mobility/balance/strength deficits — Leg muscle weakness is one of the biggest risk factors for falls. Just because you find it harder to get around, doesn’t mean you can’t get stronger and improve coordination with an appropriate exercise program provided for you through physical and occupational therapy. Also, don’t assume that the brace you were fitted with after your stroke is still the right brace for you two years later. If your leg is more or less swollen than when you were first casted for it, the brace may need to be repaired or otherwise modified. Your physical therapist can work with the orthotist to reassess your walking ability and a new or adjusted brace can improve your stability.
3. Beware of the bathroom! — The bathroom is one of the most common places for falls in the home. Many potential hazards such as slick, wet floors or throw rugs make it that way. A home safety assessment from a rehab therapist and a well-placed grab bar can make a huge difference. If you have incontinence/urgency issues you should discuss treatment with your doctor or urologist. Also, if you find that you often need to use the restroom in the middle of the night, you will be safer if your path is lighted or if you have an alternative such as a bedside commode or urinal.
4. Postural hypotension — The problem of your blood pressure dropping dangerously when you go from lying down to sitting up or from sitting to standing can rob your brain of blood flow and cause you to feel dizzy or faint. Medicine management with your doctor is again very important. Also, a simple trick of counting to five before you go from one position to the next can help because it lets your heart respond to pumping blood against gravity.
5. Cognitive/judgment impairment — Memory problems increase the risk of falls. Medicine side effects, poor diet and inactivity can cause a decline in your thinking abilities. This is another area to discuss with your doctor. There are many home care agencies with staff whose main job is to help you stay safe in your home. This can include helping with setting up your medicines so you take the right ones or making sure you are eating well enough. Exercise also helps a person stay mentally sharp, as do hobbies such as playing cards, which help you stretch your memory and give you a social outlet.
6. Visual/perceptual problems — The first thing to do is have your vision checked by an eye doctor. You also may want to have a home assessment to make sure your home is free of obstructions and safety hazards and is adequately lighted; this can usually be done by an occupational therapist. Finally, your eyes can be trained to work better with appropriately designed exercises.
7. Overall health status — If your other health problems such as diabetes, depression or arthritis aren’t treated properly, you are more likely to fall. Inactivity alone can put you at risk of falls, so make sure you find ways to become active and stay involved.
SS: That’s a lot of information. How would you sum it all up?
The take-home message from all of this is that preventing falls involves many things. Taking charge of these risk factors will definitely help keep you on your feet!
