Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 7;16(1):3.
doi: 10.1186/s12984-018-0478-4.

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

Kelly Bower  1 , Shamala Thilarajah  2   3 , Yong-Hao Pua  3 , Gavin Williams  4   5 , Dawn Tan  3 , Benjamin Mentiplay  6   7 , Linda Denehy  4 , Ross Clark  2
Affiliations

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

Kelly Bower et al. J Neuroeng Rehabil. .

Abstract

Background: Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge.

Methods: A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars.

Results: Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001-0.018; IQR-OR = 5.28-10.29).

Conclusions: Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.

Keywords: Accidental falls; Gait; Outcome assessment; Postural balance; Stroke.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional ethics committee at each site (Epworth HealthCare 643–14; Singapore General Hospital 2015/2010) and all participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Mackintosh SF, Hill KD, Dodd KJ, Goldie PA, Culham EG. Balance score and a history of falls in hospital predict recurrent falls in the 6 months following stroke rehabilitation. Arch Phys Med Rehabil. 2006;87:1583–1589. doi: 10.1016/j.apmr.2006.09.004. - DOI - PubMed
    1. Kerse N, Parag V, Feigin VL, McNaughton H, Hackett ML, Bennett DA, Anderson CS. Falls after stroke: results from the Auckland regional community stroke (ARCOS) study, 2002 to 2003. Stroke. 2008;39:1890–1893. doi: 10.1161/STROKEAHA.107.509885. - DOI - PubMed
    1. Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. BMJ. 1995;311:83. doi: 10.1136/bmj.311.6997.83. - DOI - PMC - PubMed
    1. Jørgensen L, Engstad T, Jacobsen BK. Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke. 2002;33:542–547. doi: 10.1161/hs0202.102375. - DOI - PubMed
    1. Mackintosh SFH, Goldie P, Hill K. Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (>1 year after stroke) and matched controls. Aging Clin Exp Res. 2005;17:74–81. doi: 10.1007/BF03324577. - DOI - PubMed

Publication types